IVF Provision

Maria Caulfield Excerpts

Tuesday 24th October 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Jarrow (Kate Osborne) for tabling this important debate, and all Members across the Chamber for their contributions. It has been a positive debate—a good example of putting politics aside and debating how to do the right thing. While I am not denying the challenges for the LGBT+ community raised by the hon. Member, I want to highlight that the Government have brought in major changes over the years with the introduction of same-sex marriage, and the transformation of the management of HIV with the roll-out of opt-out testing and PrEP treatment.

I am pleased to announce that, following the advice from the Advisory Committee on the Safety of Blood, Tissues and Organs, the Government will be introducing secondary legislation to allow the donation of gametes by people with HIV who have an undetectable viral load; we will be introducing that as soon as we can. We will also be addressing the current discriminatory definitions of partner donation, which result in additional screening costs for female same-sex couples undergoing reciprocal IVF; again, amendments through statutory instruments will be introduced as soon as possible.

Those are some of the measures that we have been working on, but I absolutely understand from what I have heard today that there are many issues still to be dealt with, and I welcome the hon. Member for Jarrow holding my feet to the fire to deliver change. Hopefully some of these updates will provide reassurance. This is a priority area, which is why IVF, fertility, and particularly same-sex access to IVF, were in the first year of the women’s health strategy, and it is why we are not going to wait for the 10 years of the strategy to introduce the changes.

To be clear, the Government are implementing a policy that no form of self-financed or self-arranged insemination is to be required for same-sex couples to access fertility treatment. I acknowledge that is taking a little while to be rolled out across the country. Hon. Members, especially the hon. Member for Pontypridd (Alex Davies-Jones), have spoken about infertility a lot. We absolutely recognise that it has a serious effect on individuals and couples, which is why it is a priority—particularly for the women’s health strategy.

As the hon. Members for Strangford (Jim Shannon) and for Livingston (Hannah Bardell) pointed out, I can only speak on the provision of IVF in England, but I am very happy to work with colleagues in the devolved nations of Scotland, Wales and Northern Ireland to achieve a consistent approach. Although we are dealing with the inconsistencies in England, if we are a United Kingdom, these matters need to be addressed across all four nations and I am not precious about stealing best practice from other parts of the UK.

In our call for evidence for the women’s health strategy, women told us time and again that fertility was a key issue and that they felt very frustrated about the provision of, and access to, fertility treatment. Colleagues have made a number of important points which I will respond to in turn, but it has been recognised that there has been unequal access to IVF in England since the treatment was introduced; that is why this is such an important issue. There is resistance in some parts of the country to the changes the Government want to make, but I think we will be able to make progress on them.

NICE is reviewing its fertility guidelines, taking account of the latest evidence of clinical effectiveness. These will be published next year and we will be working with NHS England to implement these guidelines in England quickly and fairly. I am told that they will end regional variation and create a compassionate and consistent fertility service across England, but that does not mean that we cannot improve services in the meantime.

As has been set out, integrated care boards are now responsible for delivering IVF services. They were previously determined by CCGs, but from July last year the 42 ICBs across England are now responsible. Since the ICBs were created, we have seen a levelling up of IVF provision in many. Where CCGs have come together, ICBs have often adopted the higher rate of provision, rather than the lowest level. That is to be welcomed, but by no means does it mean that the level of provision is where we want it to be. Some, but by no means all, ICBs, including in north-east London and Sussex—I declare an interest as a Sussex MP—are now fully compliant with the current NICE guidelines and the provision of three cycles. Others are improving their integrated offer, but some ICBs have kept their pre-existing local offer. That is not good enough, and we are aiming to tackle it.

[Abena Oppong-Asare]

What conversations has the Minister been having to make sure that ICBs are currently being updated to be as robust as possible?

[Maria Caulfield]

I will go through that. One of the first things we have done is to be transparent about what is being offered. We have asked every ICB—the whole 42—to detail their provision. We are now publishing that on gov.uk, so if ivf.gov.uk is entered, the table will come up. That illustrates the number of cycles offered by every ICB, the age provision, the previous children rule and what funding is offered for cryo-preservation. That is not just to say, “This is what’s on offer” so that women and couples can see what is available in their area; it is also the start of the process of holding ICBs’ feet to the fire—and for local MPs to be able to say, “Look, they’re offering free cycles in Sussex; why are we not offering that in our local area?”

[Abena Oppong-Asare]

The Minister may be about to get to this point, so I apologise if I have intervened too quickly. In terms of transparency, it is great that the Minister is publishing the data, but what are the Government doing to make sure that more work is being done by ICBs to provide a better—or adequate—service, given that publishing data does not require them to take any action?

[Maria Caulfield]

As the hon. Lady will know, it was only last year that we published the women’s health strategy. IVF was front and centre of that—the first year priority. Getting that information is the first step, and then we are able to look at the ICBs that are not offering the required level of service, have those conversations about why and have a step change to improve the offer. That is just one tool in our box to fulfil our ambition to end the postcode lottery for fertility treatment across England.

Colleagues have also raised the issue of lack of information about IVF, both for the public and healthcare professionals. We are working closely with NHS England to update the NHS website to make IVF more prominent, and also with the royal colleges to improve the awareness of IVF across healthcare professions. One area we are dealing with is that of add-ons, which the hon. Member for Pontypridd (Alex Davies-Jones) and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) addressed. As part of our discussions with the HFEA, it now has the add-on rating system, so that people can see what percentage difference an add-on would make and make an informed choice about whether they want to do that as part of their IVF treatment.

I have also just received the HFEA’s report about modernising the legislation, with particular regard to its regulatory powers. That will cover the provision of add-ons, and I hope to be able to respond to the report as quickly as possible. We are making really big changes to some of the issues that have been holding back IVF for a long time. I know that for many people this is not quick enough, but I reassure hon. Members that progress is being made.

For female same-sex couples and same-sex couples across the board, I know that this is a really important matter. I took the position that it was unacceptable for female same-sex couples to shoulder an additional financial burden to access NHS-funded fertility treatment. On the transparency toolkit now on the gov.uk website, we can easily see which parts of the country are asking for six cycles of self-funded insemination, for instance. In Cambridgeshire and Peterborough it is 12 cycles, in Bristol and north Somerset it is 10. As the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) said, that is exactly the information we need so that we can tackle the issue head-on and directly with the ICBs. Indeed, one of our key commitments in the women’s health strategy was to remove this injustice once and for all. We were hoping to do that completely in the first year; it will in fact take us a little longer, but it will not take us 10 years.

[Hannah Bardell]

It is certainly comforting to hear that, but I urge the Minister to supercharge that work, so that female same-sex couples and, indeed, the trans community can make sure they can access that. Will the Minister say something about surrogacy, because I know that across the UK—though, again, we have somewhat better standards and access in Scotland—there are still major challenges, legal and otherwise, for male same-sex couples accessing surrogacy?

[Maria Caulfield]

The Law Commission has recently produced a report on changes to surrogacy, which we are in the process of responding to. It will address some of the issues raised today. The Government’s position is to abolish the requirement for female same-sex couples to undergo six cycles of self-funded treatment before they can access NHS-funded treatment. We have been clear that the NHS-funded pathway should now offer six cycles of artificial insemination followed by IVF to female same-sex couples, giving everyone access to NHS-funded fertility services. Some ICBs are doing that already, but others have delayed implementation, and that is what we want to focus on now. We are clear that that needs to be urgently addressed, because same-sex couples’ expectations have rightly been raised and the service has not met them swiftly enough. I take that on board from the debate today and reassure colleagues that that is a priority.

To accelerate action, NHS England is developing advice to assist ICBs. I hope they will be able to share that soon. I will share that with the House as soon as it is available. When it is published, we expect ICBs to update their local policies. There should be no further delay and no waiting for NICE guidelines when they are published next year. ICBs must urgently address all local inequalities in access to fertility treatment. There is a reason that IVF was made a priority in the women’s health strategy and a reason it was a priority in the first year.

Our health service pioneered the use of IVF in the 1970s. It is a great British invention that should be available to every couple who want to start a family, because the Government back women and families and the accessibility of IVF to those who need it. I look forward to the hon. Member for Jarrow continuing to hold my feet to the fire until we have delivered the change—deliver it we must.