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Baroness Ashton of Upholland: My Lords, I am very interested in what the noble Baroness says. She will know from meeting those involved in counternarcotics that 13 provinces are poppy-free—an increase from six in 2006, so some progress is being made. The noble Baroness’s points about corruption in Afghanistan are well made. There are serious difficulties. One piece of work within the EU, initially led by the Italians, looked at how one can deal with corruption. As my right honourable friend the Prime Minister said in his Statement, we need to look carefully at the role of the courts and seek to bring to justice high-profile drug dealers. We need to send the kind of messages that we have spurred on our colleagues in other parts of the world to send, not only to make the point but to ensure that people can see that those who deserve it are brought to justice. The noble Baroness is right to say that this area of work will take some time and we are working closely with European Union colleagues and the United States to ensure that we can achieve our aims. We are also giving support in this area to the police forces and the courts system.
Baroness Falkner of Margravine: My Lords, the Leader of the House has repeated an important Statement on Afghanistan which provides a,
Can the noble Baroness tell us whether, in light of the scope of the Statement, the Government will publish a paper setting out in greater detail the strategy that they envisage under the four headings, or, at least, provide a debate in the House on some of those issues? Many people have said that some of those are optimistic, while some are certainly controversial and relatively untested. My concern is with the increase in support for community defence initiatives. Will the noble Baroness reassure the House that, while community initiatives are very much to be welcomed, community defence initiatives are what in a feudal, male-dominated, authoritarian society led to the rise of the Taliban in the first place? I am sure the noble Baroness is aware that the Taliban first arose as students, pupils and teachers of the “righteous path” to civic organisation. This kind of initiative would just give that back in the absence of the entrenchment of the rule of law.
Baroness Ashton of Upholland: My Lords, the noble Baroness is quite right. On community defence initiatives, it is, indeed, important to remember from whence the Taliban came and to be aware of the kind of justice that they offer—albeit quick and not always appropriate. It is also important, in thinking through how we work with the Afghan people, to bear in mind the cultural and religious framework in which the society of Afghanistan operates, to make sure that we mesh with that very appropriately and to be aware of what people are seeking and how they look for it. As for publishing a paper, it is beyond my pay grade to answer that properly, but I will seek an answer. As for a debate, it is more than my life is worth with my Chief Whip to offer anything, but the noble Baroness makes her point and I am sure that the usual channels will be willing to consider that.
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Baroness Symons of Vernham Dean: My Lords, I very much welcome the announcement of increased provision of equipment and armoured vehicles for our Armed Forces and, indeed, helicopters, which, as my noble friend will know, has been an issue of some concern. I want to ask my noble friend about a quite different issue—women in Afghanistan. Under the Taliban women particularly suffered from a lack of education and from being denied access to jobs. I was pleased to hear in the Statement about the opportunities for microfinancing for women and other parts of the community. Can my noble friend tell us any more about what is being done to help women to re-enter the workforce in Afghanistan and to help them become doctors and teachers? Women were denied access and suffered under the Taliban in those spheres. What provision is being made for widows or those who live without the protection of a male member of the family, who have also had an extraordinarily rough time under the Taliban?
Baroness Ashton of Upholland: My Lords, I am grateful to my noble friend for raising the very important issue of the role of women in the development of civic society within Afghanistan. A number of initiatives are taking place. I described the microfinance one, but we are also providing interpreters where possible to support women in the local communities. In addition, are seeking to involve women in their communities through the NGO framework and to provide support with education and training. I do not have to hand the specific information on doctors but I shall ensure that my noble friend gets an answer and that it is placed in the Library of the House, together with information on teachers. I understand that initiatives are taking place but I do not have the details with me. In relation to widows, one important factor in supporting women is recognising the circumstances that apply, particularly in the rural communities in Afghanistan. I am happy to report to the House the details of the work that is going on in that regard.
The Earl of Sandwich: My Lords, I welcome the Statement very warmly. It is a comfort to see on the Front Bench noble Lords from all three of the departments concerned. It shows that there is true commitment in this House. A metaphor comes to mind: if Tony Blair had Iraq on his back as an albatross, perhaps we should hope that the new Prime Minister is being guided by a swan into the calmer waters of Afghanistan. I shall not give him all the credit because our new ambassador has shown a remarkable enthusiasm for hearts and minds, as the noble Lord, Lord McNally, said. This is a new direction. Given that the Statement was 15 minutes long, I hope that we will have the opportunity of a full debate. This is an exceptionally important subject for the whole country and we want to explore all the aspects beyond defence.
Perhaps I may take up one point by way of a question and by way of a warning. There is a new enthusiasm for administrative reform in strengthening institutions in Afghanistan, but we should beware of a new level of bureaucracy. There are many effective channels of development at the moment, in which, naturally, because of my own background, I include
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Baroness Ashton of Upholland: My Lords, I am grateful to the noble Earl. My colleagues on the Front Bench are here specifically to demonstrate to the House that the Government are working across the different departments to ensure that we deliver appropriately in the way that I described. There is a need to build military capacity and to support the Afghan army, civil society, economic development and growth, and democracy. All those things need to fit together and that requires the Government to think strategically with regard to themselves as well as in their approach to the country. I agree with what the noble Earl said about bureaucracy. It is important to get this right. In our aid programmes, we work directly through the Afghan Government, who work directly with local communities. One facet of that is to ensure that the NGO civic society on the ground is able to hold its own Government to account. That is a very important check and balance on the way that governments operate. I make no apologies for the Statement lasting for 15 minutes because, as the noble Earl said, this is an important matter.
Lord Mackie of Benshie: My Lords, perhaps I may bring up the question of co-operation with Pakistan. The town that was mentioned was freed some months ago. The Taliban ran back across the border to their hideout in Pakistan and then they came back, and they will do the same again. It appears to me that, until we get military co-operation with Pakistan’s forces, any battles that are won will be negative as long as the Taliban have a safe place to go and come back from.
Baroness Ashton of Upholland: My Lords, the noble Lord makes an important point about trying to get Pakistan’s co-operation. There have been recent meetings between Pakistan and Afghanistan to discuss a number of issues. The border between the countries is huge and one must bear in mind the difficulties that that in itself creates. It is a question of trying to build confidence on both sides so as to deal effectively with the broader issues. My right honourable friend the Foreign Secretary would be the first to say that we continue to make efforts to ensure that Pakistan is able to support the work going on in Afghanistan. When thinking of Afghanistan, it is important to think of the neighbourhood and to ensure that we are working with partners in it.
Lord Ramsbotham: My Lords, like many other noble Lords, I welcome this additional contribution to the means to help Afghanistan obtain the end that we want and, like the noble Baroness, Lady Symons, I welcome in particular the military commitment and the additional equipment and helicopters, which are as welcome to the Afghan army as they are to anyone else. However, I shall repeat a question I asked during the debate on defence we had some two weeks ago. Will these additional resources include equipment
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Baroness Ashton of Upholland: My Lords, I am grateful to the noble Lord. We try to strike a balance. We want to get people out to Afghanistan as quickly as possible and where we can we make sure that we provide the training that we think is necessary before they go and, if not, we support them in theatre.
Lord Elystan-Morgan: My Lords, I salute the statesmanship of the Prime Minister in this regard and accept that there will be no talking to or negotiating with the Taliban, but bearing in mind that it is not a unified, integrated, disciplined structure, is it not obvious that there will be some communication at some level with various elements of it? In those circumstances, will Her Majesty’s Government bear in mind the dictum attributed to Metternich that diplomacy is at its best when it is silent?
Baroness Ashton of Upholland: My Lords, the noble Lord recognised that I have already indicated that there are no negotiations with the Taliban. I made clear in the Statement that the Afghan Government and president have made it clear that those who renounce and come across and support democracy, human rights and the constitution of Afghanistan are in a different position. However, it is absolutely clear that there will be no negotiations with the Taliban.
Lord Avebury: My Lords, can the noble Baroness explain where the helicopters are coming from considering that we could not provide any for Darfur? Was it a question of either Darfur or Afghanistan?
Baroness Ashton of Upholland: My Lords, my understanding is that they are European rentals. They are not being moved from a different theatre but are commercial. We are in the process of deploying Sea King helicopters to Afghanistan with new state-of-the-art rotor blades.
Human Fertilisation and Embryology Bill [HL]
4.22 pm
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.
Moved accordingly, and, on Question, Motion agreed to.
House in Committee accordingly.
[The CHAIRMAN OF COMMITTEES in the Chair.]
Clause 25 [Restrictions on disclosure of information]:
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Lord Patel moved Amendment No. 64A:
The noble Lord said: This amendment relates to aspects of the clause which relate to confidentiality. Restrictions on patient confidentiality significantly over and above expected medical confidentiality currently apply to couples seeking infertility treatment through IVF-related procedures even when donated gametes—sperm or eggs—are not required. Not only are those restrictions excessive but the penalties for breaching them are draconian. Under Section 41(5) of the 1990 Act, breach of this confidentiality is a criminal offence punishable by prison, a fine or both.
There is inequity in how the clause treats patients, set out in Sections 33(1) and 33(5) of the 1990 Act, because it does not apply to patients seeking infertility investigations or treatment in their local hospitals but only to HFEA-licensed premises and HFEA clinicians who work or have worked in licensed centres and to IVF-related procedures. It does not apply to treatments that are not licensable by the HFEA, such as drug treatments or surgery on either male or female patients. Confidentiality restrictions may thus change as a patient moves between the treatments offered.
In 1990, IVF treatment may have been viewed as something artificial and novel, with babies created in test tubes. Therefore, Parliament concluded that most patients would not want it known that their child had been born by that process. Clearly, since it did not apply to patients having other forms of fertility treatment such as surgery, it was not the fact of needing such treatment that was of concern, and needed to be kept ring-fenced, but simply the fact that they were using IVF.
Today, every newspaper and women’s magazine seems to have an article about infertility and treatment using IVF technology, with an increasing number of women declaring that that is how they conceived. Why IVF should be seen in law as something to be ashamed of, and hence kept ultra secret to a level punishable by prison, is not clear. The only other branches of medical practice that have such unreasonable restrictions and penalties applied relate to the Gender Recognition Act or, for public safety purposes, in cases of infectious diseases. Indeed, the initial and even more severe restrictions placed in 1990 were all so unreasonable and unworkable that the law had to be modified in 1992 to make it remotely practicable. As it stands, the current law still imposes an unreasonable burden on both patient and practitioner.
It seems to be assumed that patients seeking fertility treatment always go to independent specialist fertility centres where all forms of treatment are offered under the same roof with the same set of notes. Although that may be true of private units, many of the best fertility services are offered as part of routine care being delivered by expert gynaecologists who have sub-specialised in reproductive medicine and are accredited as such by the Royal College of Obstetricians and Gynaecologists. The initial investigations may be undertaken in NHS clinics, using NHS notes which are not covered under this law, and treatment with surgery or drugs offered, completed and recorded as
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Any recording of information between those special notes and the routine notes where the remainder of the patient’s initial assessment was recorded is forbidden without express consent. That is difficult to police effectively without significant additional bureaucracy. In reality, practitioners are in breach of those clauses every day. For example, if a gynaecologist receives a referral letter from a GP or a tertiary referral from a district general hospital clinician about a patient who has had unsuccessful IVF on two or three occasions at some centre in the UK or elsewhere with a request to perform a hysteroscopy to look into the uterus or a laparoscopy to look into the abdomen in order to see whether there is an obvious reason for failure, the gynaecologist would naturally record IVF procedures and any other relevant reproductive issues in the routine hospital notes in preparation for the intended surgery. However, if that gynaecologist works in an HFEA-licensed centre as a clinician, he or she would be in breach of the Act—and liable to criminal prosecution for revealing the IVF information—unless they had specifically requested written permission from a patient to record that information there. Should the gynaecologist not be a licensed individual, no such sanction applies. It cannot be right that the obligations specifically relate to the licensable status of the doctor, and it seems inappropriate that for one there is the usual restriction on confidentiality whereas for the other the threat of criminal sanction unique to this Act.
4.30 pm
Similarly, a male patient could be referred to an assisted conception centre because he has been found to have no sperm in his semen. In the licensed assisted conception unit, a biopsy of his testes is performed and indeed no sperm are found suitable for an IVF procedure. If that individual then went to see another gynaecologist or a urologist to discuss the options available, he and his partner’s story would be recorded in the hospital notes during the consultation. This would be entirely legitimate, provided that that gynaecologist was not regarded as licensed under the Act, for which action he or she would be criminally liable unless they had sought specific permission to do so.
The purpose of the amendment is to bring the HFE legislation more in line with standard rules on medical confidentiality. It will greatly streamline the way clinicians can deal with patients between hospital notes and restricted assisted conception unit notes and substantially reduce the regulatory burden applied by the HFEA. For years in my department my colleagues who are specialists in infertility and look after couples who require IVF had to whisper to me in the corridors, when they were successful in the woman conceiving, the name of the person who would then be attending my antenatal clinic. As I was not allowed to put that information on her notes, when she went into the labour ward no one knew that it was an IVF pregnancy; but we all knew because
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On the effect of the amendments, new Section 33A(2)(i) provides an exception to the restriction on disclosure under the HFEA of information where the individuals to whom the information relates consent. The first amendment extends that exception so that individuals may consent to the disclosure of any information held about them under the HFEA. The second amendment introduces a further exception to the restriction on disclosure under the Act of information relating to individuals, permitting such disclosure for various medical purposes other than medical research, which is addressed by new Section 33C, where this is necessary or expedient in the interests of improving patient care or otherwise in the public interest.
I am not seeking to widen anything; I am merely seeking that the confidentiality rules that apply to other aspects of medical care apply to couples who seek IVF—not beyond that. As I have not mentioned embryo, SCNT or interspecies embryo, even my noble friend Lord Alton may be moved to support the amendment. I beg to move.
Lord Winston: We should be grateful to the noble Lord, Lord Patel, for raising this issue and for moving the amendment, which I fully support in spirit. However, one might wish to look at the wording in due course because it raises an issue of considerable practical clinical importance. I do not intend to speak for long. The current situation is hardly workable and can produce quite dangerous, if not bad, medicine.
The other day, the noble Lord, Lord Alton, raised an important issue about in vitro fertilisation—ovarian hyper-stimulation syndrome, OHSS. When this occurs, women get very large, painful ovaries. If it is left untreated it can result in a quite serious condition and often requires hospital admission. Under the present legislation, if someone has had in vitro fertilisation in one hospital and then goes to another hospital with abdominal pain and ends up in casualty requiring admission, technically we are not allowed to tell that hospital about her treatment unless they have been registered with the HFEA. That, obviously, is a nonsense. At present, as the noble Lord, Lord Patel, said, in my unit at Hammersmith there are two totally separate sets of notes. Clinicians working in the hospital have no knowledge of a patient having in vitro fertilisation, which must be seen now as a routine treatment.
There is one other issue that concerns me as a research worker. There is growing evidence that in the next decade we are going to understand much more about the complications of genetics. There is a growing focus on an area of genetics called epigenetics, which is where the DNA does not change but the way that the DNA function is capable of changing because of its environment. The environment at the beginning of development is extremely important. For example, we now know that very early environmental influences in the first few days of a mammal’s life can radically alter its phenotype—that is, how it becomes later on in life. The classic example was originally the low birth-weight
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