HC Deb 22 May 1989 vol 153 cc767-71

Queen's recommendation, on behalf of the Crown, signified.

9.46 pm
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

I beg to move, That, for the purposes of any Act resulting from the Human Organ Transplants Bill, it is expedient to authorise the payment out of money provided by Parliament of the expenses of any authority exercising functions under that Act. Clause 2(4) of the Bill contains the provision that authorises payment out of moneys provided by Parliament. The financial effects of the Bill will be limited to the expenses of running the authority. The sum involved is very small £20,000 per annum—which is considered the maximum total cost likely to be incurred by members of the authority in carrying out their functions under the Act. Expenses of the authority will cover such items as claims by members for travel, subsistence, overnight accommodation and meeting postage and telephone costs. Also, some minor items of office equipment, including stationery and computer software, may have to be made available to members of the authority.

We envisage that members of the authority will wish to meet frequently, following the Bill's enactment, to familiarise themselves with the handling of referrals and adopt a common approach. In time, we expect members to carry out their functions mainly by post and telephone with occasional meetings to review progress. The final decision about such arrangements, however, will rest with the chairman and members of the authority. We also expect that the authority will wish to maintain a record of cases referred to members. Some dedicated computer equipment will be provided to the authority for this purpose. This is a modest sum for a specifically limited purpose and I commend the resolution to the House.

9.48 pm
Sir Michael McNair-Wilson (Newbury)

It seems that the money resolution, which my hon. Friend assures us is only for a small sum, is remarkably open-ended. It relates to an unspecified authority which is to be set up by as yet unpublished regulations. My hon. Friend talked about members of the authority and that is the first time that I have heard him make reference to a membership of the authority, for there is nothing in the Bill that refers to members of the authority. That membership was not referred to on Second Reading. What sort of authority will we be setting up? What do we want that authority to do? From Second Reading, we know from my hon. Friend that the policing of this Bill is central to its effectiveness, and that therefore how the Bill is to be policed must be spelt out in detail at some stage in the Bill's progress through Standing Committee, through the final stages in this House and in the other place.

We also know from Second Reading that there will be a register. Presumably it will either be held centrally, with copies in all the hospitals that are equipped to carry out transplant operations or, alternatively, a register will be held in each hospital that is capable of carrying out such operations. I am guessing at the details, but operations involving the transplant or removal of organs will be detailed in the register. Presumably it will spell out who performed the operation, who gave the organ and to whom it has been given.

However, that still leaves me wondering whether we shall be any the wiser about whether the organ has been obtained legally or illegally. What mechanism can my hon. Friend suggest to guarantee that organs will be donated legally? I am also left wondering whether a specific duty to maintain the accuracy of the register will be imposed on hospitals that perform transplant operations. If such a duty is to be imposed, what penalty will be incurred by a hospital where the register is found to be neither up to date or accurate?

My hon. Friend the Minister has told the House that he estimates that £20,000 will be required to police the Bill. However, he told the Standing Committee with great honesty that the size of the Bill's task is unknown. The Government do not know how many commercial sales of kidneys have taken place at any stage during the past decade. In those circumstances we do not know whether we are talking about a very small number of such sales or whether they are common practice. To some extent my hon. Friend is guessing both about the Bill's task and about how he will police a system which, at the moment, appears to be outside anybody's control.

I say this with the greatest respect—I have the greatest respect for my hon. Friend—but he is estimating, or at least his advisers are telling him, that for £20,000 he can set up an authority, cover its travelling costs, fund the bureaucracy that such an authority may need and hold a register, whether centrally or in the hospitals. He believes that he can do all that for £20,000, but we all know that 1 he price of a good secretary is at least half that sum. I suggest that he will be hard pressed to introduce a workable scheme for that very small sum.

I began by saying that this money resolution is open-ended and I think it is probably better that way. Perhaps at this stage, before he has brought forward regulations and spelt out the details of the authority, my hon. Friend might be wiser not to state the figure that he thinks will be required. I have an uneasy feeling that he might find that he has considerably under-estimated.

9.53 pm
Miss Ann Widdecombe (Maidstone)

Although I am addressing my remarks strictly to the money resolution, I regret and feel sad that the Second Reading of the Bill was not taken on the Floor of the House. In principle, the Bill has universal support in the House and I cannot believe that any harm would have been done by allowing those of us who have strong feelings on certain aspects of the Bill an opportunity to debate it in full on the Floor of the House. Whatever the arguments—there certainly are some—for curtailing amendments which merely prolong discussion of the Bill, I cannot see any arguments against taking Second Reading on the Floor of the House, and I am sorry that that was not done.

Before you call me to order, Mr. Speaker, I will return to the money resolution. Like my hon. Friend the Member for Newbury (Sir M. McNair-Wilson) I doubt very much, although for different reasons, whether what is proposed could be carried out entirely within the modest sum that my hon. Friend the Minister has suggested. If I were a member of the authority concerned, faced with a rule a s vague as that in clause 5, I should spend a great deal of time and incur a great deal of expenditure simply attending meetings to decide what on earth the rule meant and where the remit of the authority began and ended.

Clause 5 states: In this Act 'organ' means any part of a human body consisting of a structured arrangement of tissues which, if wholly removed, cannot be replicated by the body. At first sight, that seems quite clear, but at what point is it a "structured arrangements of tissues"? Presumably, tissue itself is not included because that can be replicated, at least by a live body. Let us suppose that a brain is removed for the use of part of it. Will that be covered by the Bill or, will it not be covered because the entire organ is not being used? I envisage a great deal of lawyers' time being spent, as well as a great deal more than the £20,000 allocated, in trying to sort out exactly what the Bill means. For instance, when referring to the human body, do we mean both pre-birth and post-birth human bodies, or only one or the other?

My hon. Friend the Minister is well aware of the concern about the use of foetal tissue. Currently, it is only the tissue that is used, and presumably my hon. Friend believes that that does not have to be dealt with at quite the speed that he has had to deal with the sale of organs. However, as there are not even regulations for the definite separation of procurement and use of foetal tissue, what is to prevent the sudden discovery that such tissue is being sold? A year ago we would have said that we could not even contemplate the sale of organs, certainly not in this country, but we have since learnt to the contrary. If we also learn to the contrary that tissue, foetal parts or organs are being sold, will that be covered by the Bill, or will the authority have to discuss at great length whether it is within its remit to act under the Bill? What exactly does the Bill cover?

Mr. Speaker

Order. I hope that the hon. Lady will not delve too deeply into the merits of the Bill, important though it is, because the Bill has had a Second Reading. There will be opportunities on Report to deal with the matters that she is now raising. The money resolution is narrow.

Miss Widdecombe

I have a feeling that the Report stage will be even narrower if it is treated in the same way as Second Reading. I am sure that you, Mr. Speaker, will appreciate that there are perfectly good reasons, which I do not dispute, for hurrying through the Bill. I have related my remarks to the fact that we have been told that the authority is to operate at a total cost of £20,000. The Bill is vague and leaves many questions unanswered. Developments during the past year have clearly shown that there could be further developments, so that the authority could not possibly carry out its activities for the sum of £20,000. I am therefore relating my remarks strictly to the money resolution although I am aware that I might be slightly trying your patience, Mr. Speaker.

If my hon. Friend the Minister will not respond to my remarks under the terms of the money resolution—I suspect that there is not a great deal of will to deal with the problem of foetal tissue—will he say at what future stage of the Bill he expects hon. Members to have the opportunity to discuss these wider issues on the Floor of the House and not in some Committee to which we do not all have access? They are important issues which have been crushed out. It would try your patience, Mr. Speaker, if I recited the history of their being crushed out, so I merely state that they have been.

9.58 pm
Mr. Freeman

With the leave of the House, Mr. Speaker. My hon. Friend the Member for Newbury (Sir M. McNair-Wilson) has, once again, raised the quality of the debate. He asked me four questions relating to the money resolution. It was never contemplated that the authority would have any policing responsibility. There might have been some misunderstanding about that. Its job will be simply to review cases where there is a live donation in the offing and the donor is not closely related genetically to the recipient.

The authority will have no responsibility for the wider policing of the Act relating to donations from those who have died. Such donations account for the vast majority of kidney transplants. Therefore, the authority's role and scope are limited. Membership and procedures will be detailed in regulations, subject to procedures in the House. I can assure the House that, in Standing Committee, I will certainly ensure that there is a proper briefing for members of the Standing Committee and other hon. Members about our thoughts on the authority. We are discussing with the legal profession at this moment how the authority should proceed and operate. I understand my hon. Friend's concerns, and I hope that I have allayed them.

Rev. Martin Smyth

The Minister has said that the authority does not have a policing role and that it will deal with donations. How can donations be verified? Years ago, I asked questions about trade in foetal tissue, and I found a stone wall and ambiguity. Surely there should be a policing role for the authority.

Mr. Freeman

The authority will be charged with reviewing the relatively few cases of proposed donation from non-genetically related individuals. It will certainly wish to investigate the relationship between the donor and the recipient and whether there is evidence of any money having been passed in this country or abroad. It must use its own judgment. When a donation is required, judgments cannot wait for weeks or months, they must be made quickly.

My hon. Friend the Member for Newbury asked about the register and the implications for expense. The register is not covered by the Bill. The register that we are discussing with the medical profession is essential not only for recording donations, particularly live donations and all transplants, but for the recording of clinical information. I am sure that it will be helpful for clinical research purposes. It is not covered by the money resolution. The expenses incurred in setting up a register will be covered to the extent that they fall upon the National Health Service in the normal course of events—that is to say, through district health authorities.

My hon. Friend asked also about the task that the authority will perform in relation to the amount of money provided for in the money resolution. There are about 200 live organ donations each year. Only a small percentage of them are between non-closely genetically related people. Therefore, the balance, which is a small minority, will be those cases that the authority will examine.

Mr. Barry Field (Isle of Wight)

I wrote to my hon. Friend's Department pointing out that there was a historical post within his Department, Her Majesty's inspector of anatomy. The post was created on the basis of tissue and cadaver sales. I wonder whether we should increase the responsibilities of that post to police that very problem.

Mr. Freeman

I will certainly examine that point. I have not yet had the chance to read my hon. Friend's letter. It does not directly affect the money resolution except in so far as it relates to the number of people involved in reviewing proposed donations. We need a collection of wisdom, including clinical judgment. I doubt whether the job could or should be delegated to an authority, which presumably means officials, and perhaps one person in particular. Flexible judgment is required in terms of a collection of individuals who are appointed for their eminence in this medical specialty rather than as a group of officials.

Sir Michael McNair-Wilson

Is my hon. Friend effectively saying that he expects someone in hospital to get in touch with the authority to say that he is concerned that an organ transplant may be taking place that is not within the terms of the law and that therefore he would like the authority to investigate? Is that how my hon. Friend considers the mechanism will work?

Mr. Freeman

I am sure that we shall go into this in greater detail in Standing Committee, but the brief answer is yes, I expect such notification to be made, although I do not envisage a detailed examination of each particular case at the hospital concerned. However, I hope that the procedures can be expedited and a quick response given.

My hon. Friend the Member for Maidstone (Miss Widdecombe) drew my attention to clause 5, and doubtless we shall debate that clause in Committee. My hon. Friend asked about foetal tissue. As to the foetal tissue not convered by clause 5, I explained in the Second Reading Committee that a committee due to report shortly, the Polkinghorne committee, will review entirely the regulations governing the use of foetal tissue for research. I am not, however, aware, of any commercial trade in foetal tissue and therefore, as far as clause 5 is concerned, it does not affect the money resolution, which I commend to the House.

Resolved, That, for the purposes of any Act resulting from the Human Organ Transplants Bill, it is expedient to authorise the payment out of money provided by Parliament of the expenses of any authority exercising functions under that Act.