Tuesday 2 July 2019

Hopes rise for an end to ‘heartless’ rationing of IVF

Health chiefs reinstate UK patients’ access to fertility treatment as minister says postcode lottery is unacceptable

After years of savage rationing of IVF treatment, NHS bodies in England are again making it available to childless women, raising fertility campaigners’ hopes of an end to a “heartless” policy.

The NHS clinical commissioning groups in Herts Valley and South Norfolk reinstated patients’ access to IVF in April and this week Cambridgeshire and Peterborough CCG may follow suit.

Four CCGs in Kent also decided this month to shelve plans to reduce the number of cycles of the treatment they offer to infertile women from two to one as a way of saving money.

All women up to the age of 40 who qualify are meant to get three cycles of IVF free on the NHS, according to National Institute for Health and Care Excellence (Nice) guidelines. But some CCGs offer none at all and many provide only one, despite warnings that they are denying the one in seven couples who are affected by fertility problems the chance to become parents.

The government is ratcheting up the pressure on all England’s 195 CCGs, the local bodies that hold the health service budgets, to stop IVF rationing because it is unfair and damaging.

 Sperm being injected into a human egg during IVF – many CCGs are now offering the treatment after years of rationing. Photograph: Zephyr/SPL/Getty Images/Science Photo Library RF
The Observer can reveal that health minister Jackie Doyle-Price has told CCG bosses that their rationing tactics are unacceptable, have created a postcode lottery in access, and must end.

“For far too long fertility services have become known for the ‘postcode’ variation in their availability to NHS patients. It is unfair to patients with infertility, who have every right to expect NHS services based on clinical need. And it does untold damage to the reputation of the NHS that we all hold so dear,” she said in a letter on 17 June.

Doyle-Price highlighted the “great psychological distress” infertility can cause and told CCGs to review their policies in light of new guidance on the commissioning of fertility services produced by the Human Fertilisation and Embryology Authority (HFEA) regulator. IVF “inequality that has, for too long, been allowed to grow [and] to blight the lives of patients” must stop.

She added: “I cannot emphasise enough that it is not acceptable for CCGs to offer no routine access to fertility services. All CCGs should move towards full implementation of the Nice fertility guidelines recommendations. I urge you to grasp this opportunity to end the lottery of fertility treatment once and for all.”

Campaigners have been encouraged by the minister’s intervention. It follows South Norfolk CCG deciding that it will again fund two cycles of IVF for women aged 23 to 39 and one for those aged 40 to 42 and Herts Valley CCG reinstating one cycle, which it had scrapped in October 2017. The four Kent CCGs voted not to cut provision from two cycles to one after a public consultation revealed that 62% of participants were opposed.

The charity Fertility Network UK says it sees “a glimmer of hope” in these recent decisions. Sarah Norcross, co-chair of the campaign group Fertility Fairness, said: “They are steps in the right direction for NHS fertility services in England after substantial disinvestment over the last two-and-a-half years, with one in five CCGs slashing services.”

In 2017 Cambridgeshire and Peterborough CCG became one of five CCGs to fund no IVF at all when it decided to suspend paying for any treatment. Research for Bourn Hall, a clinic near Cambridge which treats NHS-funded patients from across the east of England, found that it has had a “devastating” effect on people wanting to have a child. Fewer than 150 people in Cambridgeshire a year would be eligible for funding if it was restored, and their treatment would amount to just 0.03% of the CCG’s budget, it is claimed.

The CCG will decide in early July whether or not to reinstate funding. However, its recommendation is that it does not do so because of the “dire” finances of the wider health system it is part of, which includes four hospital trusts and is due to overspend by £192m this year.

“These funding cuts have been devastating for so many people. Infertility severely impacts the quality of life for those affected, and their wider families, straining relationships and causing mental health problems,” said Dr Thanos Papathanasiou, Bourn Hall’s lead clinician.

“We hope to be able to use our experience of fertility care to help C&P CCG streamline the service, reinstate NHS-funded IVF treatment and improve patient outcomes for all.”

(Source: The Guardian)

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