Human Fertilisation and Embryology Authority/Human Tissue Authority

Lord Alderdice Excerpts

Tuesday 1st February 2011 Grand Committee

[Lord Alderdice]

My Lords, we are all grateful to the noble Baroness for achieving this short debate—and it is short; one has only a few minutes. For that reason, my noble friend Lord Willis of Knaresborough will address the HFEA, my noble friend Lady Williams of Crosby will have an overall look at the issue and I will focus my attention on the Human Tissue Authority. I declare an interest, because my wife is a consultant histopathologist in the NHS in Northern Ireland. She does not do any forensic or coroner’s work, but I declare the interest in any case.

The assumption in the noble Baroness’s Question is that these bodies—I will refer now only to the Human Tissue Authority—have increased public confidence and patient safety. I am not at all sure that that is in fact the case with the HTA. When I was much younger in medicine, I remember that one government requirement was that 10 per cent of deaths that did not require a coroner’s case PM would be post-mortemed. Why? Because the final judgment about whether or not clinical judgment was correct comes in the court of the full and rigorous autopsy of the pathologist. There is no other way of being certain. Even then, one may not get a final answer.

What has happened over the last few years is that we have achieved not the 10 per cent figure but the almost complete disappearance of such post-mortems. Many histopathologists, especially those who are newly qualified, will no longer carry out post-mortems. The Royal College of Pathologists is looking at whether it should allow pathologists to qualify without having proper experience in post-mortems, because so few of them are being done. One cannot talk about increased public confidence in post-mortems if the outcome has been that almost nobody wants permission for them to be done. That expresses a lack of confidence in post-mortems, not increasing confidence.

I will be more specific. In February of last year, the president of the Royal College of Pathologists wrote to the then Secretary of State, the right honourable Andy Burnham MP, with an eight-page letter—for obvious reasons, I cannot quote it in any detail—expressing the Royal College of Pathologists’ deep lack of confidence in the work of the HTA. He began the letter by saying that the fall-out of the HTA’s actions risked destabilising the provision of post-mortem examination services in England and Wales. He wrote about the concerns not only of the royal college but of the coroners’ service. He talked about the lack of efficiency, citing the work of the CPA, which undertakes external quality assessments for full laboratory services—in other words, histopathology, haematology, microbiology and clinical chemistry. The fee that the CPA requires for inspecting the entire laboratory service is half that which the HTA requires for inspecting just the mortuary. Even in terms of efficiency, therefore, there are serious questions. When the HTA was established, it had a lot of experienced people who had conducted post-mortems, but that is no longer the case.

If the new Government understand that this is the relationship that has developed between the professional bodies—to the point where pathologists are no longer eager to carry out post-mortems—they would not be responsible if they did not take this issue seriously. Should the Government not ask whether the HTA is the best vehicle to carry out what are undoubted requirements for proper procedures to scrutinise this professional work?