New Life for the HFEA

In January the Department of Health (DH) published its response to the consultation on proposals to transfer the functions of the Human Fertilisation and Embryology Authority (HFEA) and the Human Tissue Authority (HTA) to the Care Quality Commission (CQC) and the new Health Research Authority (1). There were 479 pages of replies; 75 percent of the respondents did not favour the proposals.

It is heartening to report that the DH listened carefully and has reprieved the HFEA, although it is going to consider afresh the issue of merging the HFEA and the HTA. It is hoped that the two years of uncertainty that have overshadowed the work of the HFEA will now come to an end. It arose from the Government's understandable anxiety to prune the number of quangos in existence.

The arguments against dismembering the HFEA were always strong and convincing. Those who initially favoured the transfer of functions seemed to believe that the Government's plans would actually mean no or less regulation. The primary legislation was however always going to stay in place, but the regulation would be carried out by other bodies with less expertise. It was particularly encouraging to note the number of responses favouring retention of the HFEA and the HTA that were submitted by individuals who had experience of dealing with these organisations and had appreciated the experience. The needs of patients had perhaps not been sufficiently considered.

The arguments that carried weight in the end were the risk of losing the expertise that had been built up over the years by the HFEA and the HTA, together with the trust and respect gained nationally and internationally for the way assisted reproduction and human tissue matters are dealt with in the UK. The need to keep a discrete focus on them, and provide one centre for information, data collection and research proposals triumphed.

The relatively very small savings that might be made by the proposed transfer also played a part; indeed more has probably been spent on consulting and debating reconfiguration over the last few years than might have been saved by doing it. No doubt the morale of the staff has been affected, and it seems that 'back office' savings have already been made by the two organisations in anticipation of change.

The drawbacks of the CQC meant that it was not favoured as a replacement for HFEA inspection. It is just possible that had a more admired organisation been suggested as a repository for HFEA functions, the changes might have won more support. But the consultation coincided with a period when it seemed that every week there was a report of a fresh failure in health services that was attributed in part to the CQC's failure to monitor them. This impression undermined the confidence that the sensitive subject matter of the HFEA and the HTA could be safely transferred. And sensitive it is — the idea that IVF is now routine was not accepted.

IVF might be routine to the practitioners who handle it every day, however, as the public and parliamentary debates of recent years have shown, IVF and embryos are anything but uncontroversial to those not working in the sphere. A few years ago there was a massive public reaction to the holding of tissue, which is now successfully under control.

The range of responses, from individuals, medical organisations and associated organisations, even those opposed to IVF in principle, shows that where there is an important issue and those with an interest to work to explain and defend it, this can persuade and succeed. There was a well organised and heartfelt campaign to keep the two bodies.

There is good regulation, and there is bad regulation. Reproductive technology regulation is in the former category because without it there would be a risk to the public from the activity. In this field, there is asymmetry of information, considerable costs borne by the patients, and without special attention and regulation their welfare, their rights and their future children's health are at stake. It is a tribute to the DH that they recognised this.

It is a pity that in light of the very reasonable opinions expressed in the responses to the consultation, that there should still be a review of the efficiency of the HFEA and the HTA, leading the DH to consider again the possibility of merging the two. This was considered in great detail by the Parliamentary Joint Committee on the Human Tissue and Embryos Bill in 2007 (2) and rejected, for similar reasons. We have a British and international success story here and it should be kept that way.