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How not to save money: Unscrambling the HFEA

9 August 2010
By Baroness Ruth Deech
Former chair of the HFEA
Appeared in BioNews 570
Of course we are all against unnecessary regulation: and one of the areas of policy put forward by the new coalition government which has seemed to attract widespread support, even from those who hold no brief for them, is the abolition of superfluous quangos.

But the UK's Human Fertilisation and Embryology Authority (HFEA) is different. It was a world first and it remains a world model and leader. It has enabled the UK to lead the way in issues connected to embryology; its record was a major factor in persuading Parliament to legislate in 2001 to extend the areas of permitted embryo research and again in 2008 in the renewed Human Fertilisation and Embryology Act. The public's excited interest in all matters pertaining to this is in no way diminishing. On the contrary, any story about cloning (for example, the possibility that meat or milk from a cloned animal may have entered the food chain) or any advance in IVF (in vitro fertilisation) attracts maximum publicity, and not always approving. The Department of Health has found the HFEA useful in deflecting the embarrassment or blame that could result if anything went wrong in IVF treatment, and in giving reassurance that, for example, animal-hybrid embryos or the growth of eggs from tissue will be responsibly monitored. For 20 years the device of the HFEA has served to capture the ethical elements of new discoveries and the proper delivery of those treatments in the (largely private) clinics that it monitors. Yes, there have been problems: for example, the granting of licences has been said to take longer than it should; and the pursuit of doctors who may be in breach of the HFEA's Code of Practice may not have been undertaken as irreproachably as it should. These defects however can occur in any organisation and are not peculiar to the HFEA.

Only three years ago the Parliamentary Joint Committee on the Human Tissue and Embryos (Draft) Bill scrutinised the then proposed merger of the HFEA and the Human Tissue Authority (HTA). It recommended as strongly as could be envisaged against merger, on the grounds that the HFEA had a distinct and expert job to fulfil; that no matter where its functions were situated, the same amount of money and the same quantity of expertise were going to be necessary; and that more money would be wasted in physically shifting the functions, creating a merged operation and losing experience. How much stronger are those arguments when it is contemplated submerging the HFEA in much wider health bodies. To quote Sir Ian Kennedy in the 2007 Report, 'in all such amalgamations history tells us that very often you go back to ground zero' and that 'such mergers or amalgamations really lose you two years of expertise and administrative skills as you catch up.'

Would the dismembering of the HFEA be any cheaper, more effective or less bureaucratic? The plan is to distribute its functions to a new research regulator, the Care Quality Commission and the Health and Social Care Information Centre, along with the HTA. Even while spelling it out, one can envisage the costs and delay as a new body is set up, the new offices, the advertisements, the new chief executive, the new logo, the new letterheads and communications to patients and clinics. The 2007 Report estimated transitional costs of merger as around £2m. The current costs of the HFEA are approximately £5 million, most of it recovered from the clinics, with a small grant in aid from the Department of Health. This is minor; but the cost of doing away with it will be enormous.

As the 2007 Report noted, nearly every medical organisation was against merger; there was national interest in the unique moral status of the embryo; embryo research control might become less respectable and watered-down; public confidence could be undermined; a loss of specialist expertise; a new regulatory body would have to divide its remit into subcommittees in any case; and a divergence of practice around the country might emerge. IVF is never 'routine' because people are forever looking at new ways to assess the developing embryos, said Sir Richard Gardner.

Jealousy surrounds the HFEA. The clinicians and MPs feel that they know best and are over-regulated - or alternatively feel slighted because they are not themselves sitting on the Authority. The scientists consider that research should be handled differently from treatment but, as the Report said, the relationship between the two fields is so close and interdependent as to make this impracticable.

Fortunately, a change to the HFEA will require the enactment of primary legislation. One can be sure that it will be opposed in the House of Lords, where sit the gurus in the field - inter alia Lord Patel, Lord Walton, Baroness Warnock, Lord Harries, Lord Mackay, Baron Willis and (modestly) myself. Leave well alone and let us not endanger the satisfactory and rapid progress in embryo research which has been to the advantage of the UK.

SOURCES & REFERENCES
Human Fertilisation and Embryology Authority
|  8 August 2020
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