Access to Fertility Services

Steve McCabe Excerpts

1st reading: House of Commons
Wednesday 18th April 2018 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That leave be given to bring in a Bill to make provision about access to NHS fertility services, including equality of access to such services across England; to make provision about pricing of such services; to provide for a minimum number of fertility treatments to be available to women on the basis of their age; and for connected purposes.

I first became aware of the totally unequal nature of access to IVF in 2016 when I was contacted by constituents who had been refused treatment because of arbitrary criteria, with couples being judged on the basis of such things as past relationships. Apparently, if one partner has had a child from a previous relationship, no matter how long ago or what their level of contact, that serves as grounds to deny treatment. Similarly, some clinical commissioning groups are starting to introduce restrictions based on the male partner’s body mass index. Such arbitrary and perhaps rather moralistic judgments have no clinical basis.

As I looked at the situation, I found that the provision of fertility services in England varied considerably and that the number of CCGs restricting or completely decommissioning their services had increased dramatically since 2014. I am left wondering how it can be right that people in Thurrock and Luton—good luck to them—have access to comprehensive fertility services while my constituents and many others get a much poorer deal because of where they live.

The National Institute for Health and Care Excellence issued guidelines on fertility treatment in 2004 that clearly stated that women under the age of 40 who had failed to get pregnant after two years of trying should be offered three full cycles of IVF. An update in 2013 further clarified that women between the ages of 40 and 42 who met other specific criteria should have access to one full cycle. As members will know, however, NICE recommendations are not binding, and according to the charity Fertility Fairness, which compiled data for all 208 CCGs in England, only 12% of CCGs provide three full cycles, which is half the number offering them in 2013.

Seven CCGs have completely decommissioned their IVF services. Those who live in the areas covered by the Herts Valleys, Cambridgeshire and Peterborough, Croydon, South Norfolk, Mid Essex, North East Essex and Basildon & Brentwood CCGs are effectively denied IVF on the NHS. Most CCGs offer just one cycle of IVF, and some of these offer only a partial cycle. NICE has repeatedly advised that a full cycle should include one round of ovarian stimulation followed by the transfer of any resultant fresh and frozen embryos. When IVF is delivered in this way, the treatment is both clinically and cost-effective, but when the advice is ignored, the cost to the NHS probably outweighs its effectiveness. I guess that this amounts to saving money by wasting money. Only four CCGs in England follow the NICE fertility guidelines in full; the remaining 197 that provide some services do so in an imperfect and inefficient way. I freely admit that NHS resources are stretched, but that is all the more reason for insisting on a consistent and cost-effective approach.

I was given assurances by the then Minister in January last year that NHS England would disseminate commissioning guidance to help CCGs. More than a year has passed, but no progress has been made. Through a parliamentary question, I learned recently of NHS England’s decision not to publish guidance after all, and instead to pass the buck back to the commissioners.

The World Health Organisation is clear in classifying infertility as

“a disease of the reproductive system”,

but we are hardly treating it like other medical conditions. We should not be rationing it in this way. We need to take steps to address poor clinical decisions and the injustice that results from unequal access.

Fertility problems affect one in six couples in the UK. If left untreated, there can be serious consequences involving high levels of stress, anxiety and depression, which often lead to relationship breakdown and other long-term, chronic health conditions that require expensive lifelong treatment. It is important to remember that IVF is not an easy fix—it is hard both physically and emotionally, and not always successful—but if it is administered properly, it is a clinically effective treatment for a legitimate medical condition.

Since 2016, I have discussed this matter with four different Ministers, led a Back-Bench debate and spoken with senior officials from NHS England. As I have mentioned, there have been promises but little progress, and almost every other week another CCG announces plans to reduce or decommission its services. Approximately 17 CCGs are currently in this position. Without action, fertility treatment will be squeezed out of our NHS.

My Bill would eliminate regional variations, including the absurd use of the arbitrary access criteria my constituents have been subjected to, and ensure that all CCGs in England commission fertility treatment in line with NICE guidelines. The Bill would also pursue the development of national pricing to end the wide disparity in costs.

The price for one full cycle can range from as little as £1,343 to well over £6,000—and sometimes much more. Those high costs are used as a justification for reducing the service, but surely it is commissioning failures that need to be tackled. It seems ridiculous that exactly the same treatment can cost the same—supposedly national—health service so much less in Newcastle than in Birmingham. Successive Ministers have confirmed that work on benchmark pricing is ongoing, but that started in 2016 and we are still to see any results. If they cannot resolve an issue like this, what faith can there be in their ability to deal with problems of a larger order?

The simple measures in my Bill would guarantee eligible patients fair and equal access to NHS fertility services wherever they live and minimise commissioning costs. Sir Bruce Keogh, the former national medical director, wrote to me in November 2017, saying:

“it remains the fact that the NHS has never been able to fund all the IVF that people would like and this is unlikely to change”.

That is small comfort to those whose needs are being ignored. I accept that resources are scarce, but surely we must not be prepared to accept that individual CCGs can ration treatment on the basis of whatever whim catches their fancy.

My Bill enjoys wide cross-party support because the issue affects people all over the country. I want to thank the constituents and campaigners, particularly Fertility Fairness and Fertility Network UK, that support the Bill and all the couples who have helped me to understand just how unjust things are. They are the victims of rules and decisions that would be completely intolerable if we were discussing any other illness. The NHS was founded on the principle that healthcare should be universal, comprehensive and free at the point of delivery, and as with all illnesses, fertility treatment should be dependent on a person’s medical need, not their postcode or ability to pay. Infertility is a medical condition, and it is time that we started treating it like one.

Question put and agreed to.

Ordered,

That Steve McCabe, Kate Green, Paula Sherriff, Joan Ryan, Ann Coffey, Mr Edward Vaizey, Tom Brake, Layla Moran, Jim Shannon, Andrew Selous and Will Quince present the Bill.

Steve McCabe accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 23 November, and to be printed (Bill 196).