NHS Fertility Services

Lord Vaizey of Didcot Excerpts

Thursday 19th January 2017 Westminster Hall

[Mr Edward Vaizey (Wantage) (Con)]

I am grateful for the opportunity to speak in this important debate under your chairmanship, Mrs Gillan. I thank the hon. Member for Birmingham, Selly Oak (Steve McCabe) for securing it. I appeared with him in front of the rather intimidating Backbench Business Committee, but thanks to his eloquence and advocacy we now have time to raise this issue in the House. Hon. Members frequently table questions about IVF, but I do not recall when we last had a debate on the subject. It is right that we have the chance to raise the issue, which has frequently crossed my desk since I was lucky enough to be elected to represent the Wantage constituency. Like the hon. Gentleman, I will talk about some of the cases that have come across my desk. They will sound very similar to those that he raised, because couples not being able to have children and not being able to access the treatment that can help them have children has a huge emotional and health impact on them.

As the hon. Gentleman said in his eloquent opening speech, which covered all the issues, it is important to stress that infertility is a disease. Choosing to have children—I hate to put it like this—is not a lifestyle choice; it is a fundamental choice that many people are lucky enough to be able to make. People who are not able to conceive children suffer from a disease, and I think it is therefore incumbent on the national health service to help combat the impact of that disease, as it does for many other diseases. This issue is much more prevalent than people realise: it affects one in seven couples in the UK. I am sure everybody in this House knows people who have been affected directly, and our constituents contact us about it. As the hon. Gentleman pointed out, it is the second most common reason why women visit their GP.

We have also heard how more and more clinical commissioning groups are now disinvesting in NHS fertility services. The signals from NICE, the Government and the CCGs themselves clearly show that fertility services are seen as second-class NHS services that do not rank alongside other, more important services. We in this House know from the many debates we have had, and not least from the huge increase in the profile of and focus on mental health services, that treating something as a second-order issue stores up significant problems. We can reverse that attitude through sustained campaigning. As has been pointed out, in 2016 North East Lincolnshire, Somerset, Wiltshire, Herts Valley, Cambridgeshire and Peterborough, and Bedfordshire CCGs all cut their fertility services and now offer the bare minimum: one funded IVF cycle. Approximately 10% of CCGs are currently considering disinvestment.

The NICE clinical guidance has been around for more than 10 years. It is important to remember that this is not a static issue: the cost of infertility treatment has fallen dramatically and its effectiveness has increased. The second or third cycle tends to be the one that helps a couple to conceive, so I think NICE was visionary and right to say that three full cycles should be offered to women under 40. It is important to remember that CCGs restrict fertility services not only through the front door by making it clear that they will offer only one cycle, but through the back door by restricting the age at which women can access them. In Oxfordshire, for example, the age limit is 35, not 40.

There is also the issue of how a cycle is defined. In Oxfordshire, one fresh cycle is offered to those under 35, and no frozen transfers are allowed. Other definitions of a cycle allow frozen embryos that have been created from the first cycle to be used, so Oxfordshire does not comply with what I understand to be NICE’s definition of a cycle.

Going back to fertility services being seen as second-class services, Oxfordshire CCG’s response to me when I asked it to comply with the NICE guidelines was, “How are you going to fund it? What other services are we going to have to cut to fund fertility treatment?” It was clearly posited as an either/or, and the undercurrent of the message was, “We are funding the important services. Additional fertility services are a luxury. You are asking us to spend £x million on a luxury.”

To defend Oxfordshire CCG, it uses the NICE cost guidelines when it works out what the additional costs would be. It claims that they would be £2.5 million in year 1, four-and-a-bit million pounds in year 2, £5 million in year 3 and just under £5 million in years 4 and 5. What depresses me about that is the fact that it simply took the off-the-shelf guidance from NICE, which gives the game away: it is simply a desktop exercise by a CCG that is not really interested in addressing the issue. It should be possible for it to investigate with a range of different providers how it can potentially reduce the cost. The cost variation in fertility treatment can range from something like £2,000 to up to £8,000 for a cycle, so it is possible to at least engage with providers to investigate how one can provide a cost-effective service.

I also challenged the CCG on how rigorous it is in stopping services that are out of date and past their usefulness. My understanding—I am sure the Minister will confirm this—is that CCGs should be carrying out an ongoing process of reviewing all the services they are currently funding, because there are probably many services that are out of date or falling into misuse but are still being funded.

I pay tribute to Fertility Fairness, which campaigns assiduously on this issue. It made the point that treatment can cost about £2,000 in the north of England, £6,500 in the south and £3,500 across the UK as a whole. One of its asks, which perhaps the Minister can respond to, is this. CCGs can take refuge by charging the highest cost possible, which acts as a barrier to what we want to achieve. If there were a national tariff, more CCGs might be tempted to come to the table and increase what they are doing to support fertility services.

The Minister is not only a fellow Oxfordshire MP but an absolutely brilliant Health Minister. I know that to a certain extent I am knocking at an open door, because she has spoken very strongly about this issue in public. She said:

“Fertility problems can have a serious and lasting impact on those affected. It is important that the NHS provide access to fertility services for those who need clinical help to start a family. I am very disappointed to learn that access to IVF treatment on the NHS has been reduced in some places and it is unacceptable that some Clinical Commissioning Groups have stopped commissioning it completely. I would strongly encourage all CCGs to implement the NICE Fertility guidelines in full, as many CCGs have successfully done. The Department of Health, NHS England and professional and stakeholder groups are working together to develop benchmark pricing to ensure CCGs can get best value for their local investment.”

That is very welcome news indeed.

The hon. Member for Birmingham, Selly Oak pointed out that there are knock-on costs to not providing fertility treatment in the UK. We know, for example, that many couples understandably go abroad to fund and access fertility services, but different regulations apply abroad. Often, many more embryos are implanted in treatment abroad, which can lead to multiple pregnancies. Multiple pregnancies can lead to greater complications, so paradoxically that can lead to increased costs for the NHS. We would all much prefer people living in the UK to be able to access more familiar services, instead of having to go abroad and take those risks.

I mentioned that all of us speaking in the debate will have real stories to tell. We are speaking not in a vacuum about some impersonal procedure, but about a disease that affects the lives of our constituents significantly. The reason why I supported the hon. Member for Birmingham, Selly Oak in securing the debate, and the reason why I am present, is the letters I receive as a Member of Parliament from my constituents.

One 33-year-old constituent wrote to ask how the situation was fair given that in Wales, Scotland and Northern Ireland, people are entitled to three full cycles of IVF—I understand that the Scottish Government are moving to three full cycles early this year. For four and a half years she and her husband have been trying to conceive. They have been through every test, but all the results have come back as normal, so they have what is called unexplained fertility. They pinned all their hopes on a single funded cycle of IVF, although that was difficult to accept. She points out that infertility is not a choice made by women; they have no control over it. Her first cycle, in August, failed and she went on to a frozen egg cycle, but unfortunately miscarried. Her emotional status is now such that she sees her GP regularly, has been referred to TalkingSpace, an NHS service, and awaits counselling. She was quoted £6,000 for a private cycle—her parents helped with the cost of the treatment—although it transpired that the overall cost was about £8,000. That second cycle failed, too, and the couple will now remortgage their property to fund a third cycle.

Those who think of infertility as a second-order issue should consider that some people will mortgage their financial future to treat the disease, as people might do for other diseases. The idea that infertility is something that one can simply put to one side is absolutely ludicrous. Another constituent wrote about having to go to Barcelona for treatment, which cost about £12,000. A third constituent, at the age of 36, was again refused IVF treatment, and she is now funding her treatment privately.

Infertility is clearly a disease, and one that affects many couples throughout the UK, and some of the devolved Administrations are moving forward on it. I respect the difficult choices that clinical commissioning groups have to make, but the NICE guidance is crystal clear and fair. The guidance sanctions not unlimited cycles but only three, recognising that the first cycle often fails. The technology continues to advance, prices continue to fall and there is little evidence from my CCG or, I suspect, many others of active engagement on the issue, such as research on the ground in real time into what it might cost to procure fertility services, as opposed to simply using off-the-shelf NICE cost guidance to rebut my constituents’ concerns.

The lack of infertility treatment has hidden costs, as the hon. Gentleman said, in mental health and emotional issues and the ongoing costs when people go abroad for treatment that might have an impact back home. A great step forward would be if the Minister were to bring forward a national tariff, or if research were commissioned into some of the ongoing costs of not providing infertility treatment. I encourage the Minister to continue to hold CCGs to account for not complying with NICE guidance.