The Human Fertilisation and Embryology Authority (HFEA) was a policy first –the first executive, non-departmental public body in the world. It has sole authority and responsibility for research and routine practice for IVF and stored gametes. Created in 1991, HFEA had a clear role at a time when the dangers of IVF were still not well understood and there were still active debates over whether, for instance, woman should be married in order to receive treatment.
HFEA is one of the most high profile of the 192 bodies that are likely to be axed in the Government’s bonfire of the Quangos, better known as the as the Public Bodies Bill currently making its way through Parliament. Others include the Film Council, the Regional Development Agencies and the General Teaching Council for England.
Unlike many of the threatened Quangos, HFEA’s various governance functions will be entirely transferred to other government bodies. IVF treatment will be overseen by the Care Quality Commission, while research will be overseen by a yet to be specified new Super Regulator. The Academy of Medical Sciences’ recent report examined how this new body might operate.
A public discussion of HFEA a week ago opened with Richard Harries, previously Bishop of Oxford and member of HFEA, arguing for the continuation of HFEA by referring to its “sunk cost”: the time and politicking required to get it up and running. But every government initiative has sunk costs, and so Harries’ argument cannot justify the conservation of HFEA in particular.
But as Harries talked in more detail about the functions of the Authority, he articulated two more specific arguments for retaining HFEA.
An integrated approach: Harries described the process through which new scientific methods and discoveries come first to the attention of the international horizon scanning panel, the most pressing are then passed onto the clinical advisory group, who filter them further before asking the ethics and law group to discuss potential ramifications for the regulation of IVF in the UK. The recommendations of this group are then passed to the Authority for consideration. This integrated approach, he argued, will be lost if HFEA’s function are spread across government bodies. This loss would result in a less responsive, less nimble and perhaps less careful decision-making process for policy around human embryos in the UK.
Intermediate level governance: There are some decisions that are best made by hospital ethics committees, others that must be made by our elected representatives in parliament. Alison Murdoch, opposing Harries, Robin Lovell-Badge and Sheila McLean on the panel, argued that decision made by the Authority would be equally or better made by either of these bodies. Harries, followed by McLean, described “a whole category of decisions” that are appropriate to neither and require an intermediate level of governance that only the HFEA can provide.
HFEA made a recent judgement on saviour siblings, ruling that selection of an embryo without a genetic disorder in order to provide transplant cells for a sibling with a disorder is legal. The Authority also approved in principle the screening of embryos for genes that may lead to certain cancers in middle age. It is these unplanned, emergent issues that find prompt solution through intermediate level bodies such as HFEA.
But the need for integrated, intermediate level governance is not unique to embryology: there are interdependent and emergent problems for policy in all areas from abortion to agriculture. So we come back to the question that follows from argument about sunk costs: why does embryology deserve to be singled out?
Perhaps it shouldn’t. If the need for intermediate level governance is widespread, then there is an argument for keeping HFEA and encouraging the creation of other intermediate level governance bodies where they are needed. But with the current well-stoked bonfire, this line of reasoning is unlikely to go far.
Instead, there might be some worth in extending the argument from sunk costs to future losses. Any reform of complex institutions and arrangements creates costs and inefficiencies in the short-to-medium term: you lose institutional knowledge, you need to train new people, and those interacting with the system have to retrain as well, because no one knows how the new system works. In fast moving areas, this can lead to dangerous lag times between developments and their regulation.
With the exact roles of the Care Quality Commission and Super Regulator still unclear, the short-term costs of changes to HFEA are not well-defined. As the public bodies bill continues through parliament, and the government continues to flesh out the structure of the new regulatory bodies, this debate will no doubt continue to develop over the coming months.