Seeing sense on IVF funding

Embryo,_8_cellsWe’ve all heard the arguments about the cash-strapped NHS and IVF is a treatment that commissioners in North East Essex have recently decided they can’t afford.  But is this really a sensible financial decision? Whatever you think about the rights and wrongs of cutting funding to one group of patients based on the fact that you’ve decided they aren’t as deserving of treatment as some others, there’s also a question of economics.

In Canada, the funding decisions seem to be going in the opposite direction with more states looking into offering treatment after a very detailed report showed that funding and regulating IVF treatment would actually SAVE money rather than costing money when multiple births were taken into consideration.

This is an issue that was raised with Mid-Essex CCG when they were cutting treatment,a s they were warned that some people would go overseas for cheaper, unregulated treatment. In Mid-Essex, they said this was a risk they were prepared to take, despite the fact that we know that it is the biggest risk to health from fertility treatment – and that one very premature triplet pregnancy could cost more than offering IVF to everyone who needed it in the area. Last year’s Canadian study would back this up as it showed millions of pounds in savings in health care and societal costs over 18 years by offering regulated IVF treatment.

You can read more about what’s happening in Canada here, but it does show that CCG decisions about cutting treatment in this way are unlikely to save any money in the long run and may end up being an expensive mistake.

 

 

North East Essex – tell them what you think…

So, North East Essex are the latest commissioning group to announce their plans to stop funding fertility treatment. The commissioners claim that in North East Essex there are “substantial numbers of people whose health, including their fertility, is affected by their lifestyle (for instance smoking, excessive drinking, and lack of exercise)”. Are there really huge numbers of smokers who drink to excess trying to access NHS-funded fertility treatment in the Colchester area?  Most people I talk to who have fertility problems lead extraordinarily healthy lifestyles, so I’d be interested know what you think…

They are suggesting that fertility treatment should only be available for people who have had cancer and for couples where the male partner has Hepatitis C or HIV (in these they are proposing to offer ICSI despite the fact that NICE doesn’t recommend this at all).

You can read more about their proposals here. They are arranging a series of consultation “events”, so if you are able to get along to any of these, please do speak up for fertility patients.  You can email neeccg.enquiries@nhs.net to say you’ll be there.

The first is on Tuesday 7 July in Colchester at 6pm at Room 12a, Primary Care Centre, Turner Road, Colchester CO4 5JR.

The next is on Friday 10 July at 2pm in Clacton at Princes Theatre, Town Hall, Station Road, Clacton CO15 1SE

Then on Thursday 16 July at 6.30pm at Clacton at the Princes Theatre, Town Hall, Station Road, Clacton CO15 1SE

And finally on Tuesday 21 July at 10am at Walton on the Naze at Columbine Centre, Prince’s Esplanade, Walton on the Naze CO14 8PZ

 

Who “deserves” fertility treatment?

News from the USA where in Maine, there are proposals to start instructing insurance companies that they should start paying out to cover fertility treatment. At the moment, the picture varies across the States when it comes to insurance and fertility – there are currently 13 states that require insurance to cover fertility treatment and this sounds like a good news story.  At least, until you  look at the small print where it specifies that only married couples will qualify and that anyone who has fertility problems as the result of a sexually-transmitted infection is exempt.

If you’ve ever thought some of the criteria that CCGs in England come up with were unfair – such as not offering treatment to couples where there is an existing child from a previous relationship no matter how old that child may be – this new proposal from Maine seems to go a good way further down the line of questionable decision-making.  Discriminating against people because they are either not married to one another, or because they’ve had an STI in the past is something we can be very grateful we don’t have here…

You can read more about the proposals in Maine here and more about the rules on insurance and treatment across the USA on the National Conference of State Legislatures site here 

Fertility Fairness

Y3qgabAY_400x400We’re often told that IVF is not a terribly successful treatment, that 75% of cycles won’t work – and this is sometimes cited by people who don’t agree that the NHS should fund fertility treatment. Earlier this week, I went to the event at Westminster organised by campaign group Fertility Fairness where there were some compelling arguments about the clinical and cost effectiveness of funding three full cycles of IVF as recommended by NICE.

One of the speakers at the event, Tim Child from Oxford Fertility Unit, presented some figures from his clinic for IVF success rates for the NHS patients they treat aged under 37 who were getting the three full cycles of IVF recommended by NICE. The statistics showed an 80% cumulative success rate over three full cycles.  So, the majority of patients will be successful when NICE guidance is followed – which isn’t what we are often led to believe. What is sometimes forgotten when CCGs talk about funding for fertility is that they don’t need to pay for three full cycles for every patient – as more people get pregnant with each  transfer, the number of additional payments needed diminishes – and yet calculations often seem to be based on the idea that every patient will need the three full cycles.

Infertility Network UK‘s Chief Executive Susan Seenan, who is also Co-Chair of Fertility Fairness along with Sarah Norcross, spoke about the realities of the impact of CCGs policies on fertility funding for patients. She told of one patient who was unable to access the treatment she needed because her partner had a child from a previous relationship. The “child” was in fact a 25 year old who lived abroad, but this still meant that the couple were denied treatment.

If you want to know more about funding for fertility, and what you can do if your CCG doesn’t fund treatment, you can visit the Fertility Fairness website – and the pages on funding on the Infertility Network UK site have templates for writing to your MP or CCG too.

 

Behind the scenes in York

Many couples living in the area covered by the Vale of York CCG were left devastated by the decision to make a U-turn on the promise to start funding some fertility treatment. Having been singled out as the worst provider in the country, it had seemed that the local CCG was about to improve matters for fertility patients – and so the change of heart just a month after the original promise seemed particularly cruel.

It has now emerged that one of the panel of voters – who had been in favour of offering IVF to local patients – abstained from the vote because he will be standing as an election candidate.  You can read the full story in the Yorkshire Post, but it has emerged that the vote was lost five to four – which would not have been the case had Dr Mark Hayes used his vote.  This was also covered by ITV News.

A petition has been launched by the fantastic fertility support group in York, and you can sign it here – please do!

Your help needed to stop fertility funding cuts

Please respond to this consultation to stop a reduction in fertility services. Mid Essex CCG has just released a consultation for a reduction in funding from three to one cycle, with a further option to restrict funding only to a very limited number of patients.

The option that they say they “prefer” would be to restrict “fertility” services to offering fertility preservation to people who have cancer and to offering funding where an HIV positive man has a high risk of viral transmission to his female partner. This is not “fertility” treatment – it’s cancer and HIV treatment – but this is where they would “prefer” to spend their entire budget for fertility treatment.

The NICE fertility guidelines suggest that in most cases where men are HIV positive and take their medication, the risk of viral transmission is low and they would not actually need fertility treatment – so this would probably equate to no more than a handful of patients a year. What’s quite interesting is that they seem to estimate that this is already taking up £200,000 of the £750,000 they say they are currently budgeting for fertility – so more than a quarter of their “fertility” spending is already not spent on fertility patients at all.

Please let Mid Essex know how wrong this would be by responding to their consultation. The survey is here https://www.surveymonkey.com/s/G67YYXB and details of the consultation are here http://www.midessexccg.nhs.uk/about-us/ccg-board-meetings/board-papers/doc_download/982-fertility-services-consultation

Calling all fertility patients in North West London

If you’re a fertility patient in North West London, and would be able to spare a few minutes to send an email or to talk to someone about your experiences of fertility problems and accessing NHS care, you could help to change the future for yourself and other fertility patients.

In Hillingdon, the local HealtWatch (which represents people’s views & experiences of care) has been reviewing local referral policies and noted that many of these do not follow the national NICE Clinical Guidelines, including the one for IVF.  The Clinical Commissioning Group (CCG) there is part of a group which covers all 7 CCGs in NorthWest London and they all have the same policy for IVF. The areas covered are the London Boroughs of Brent, Ealing, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow, Kensington & Chelsea, and Westminster.

The guidelines from NICE recommend 3 full cycles of IVF treatment for eligible women aged 39 and under, and one full cycle for eligible 40 – 42 year olds. In North West London, women under 40 get just one cycle, and those of 40 – 42 don’t get anything. This doesn’t follow NICE guidance.

HealthWatch Hillingdon have been attempting to influence the Hillingdon CCG to follow NICE Guidelines, but they need more evidence of the impact of this inequitable referral policy on women in North West London who need IVF, but are not getting the treatment NICE advises. So, all the help you can give them will be welcomed.

You can either email a summary of your experiences/views and impact of this IVF policy has had on you to Healthwatch Hillingdon (raj.grewal@healthwatchhillingdon.org.uk) or if you prefer, you are welcome to call Healthwatch Hillingdon (01895 272997) and they can record your views/experiences/comments for you,

All the information that you provide to Healthwatch Hillingdon will be kept completely confidential and they will not share any personally identifiable information with any NHS organisation or other body without your written permission.

 

Funding at last in Vale of York

Some good news on the fertility funding front – finally fertility patients in Vale of York will be able to access some NHS-funded IVF treatment.  For the last five years, those living in the area have not been able to have any funded treatment at all.

Today, commissioners in Vale of York made the decision to fund one cycle of IVF for eligible women under the age of 39.  Of course, this is still some way from the NICE guideline which recommends three full cycles for eligible women under the age of 39, but it is a big step in the right direction for an area which hasn’t been funding at all.

You can find full details about the new policy at www.valeofyorkccg.nhs.uk/ivf

 

Live in Dorset? Your chance to have a say

If you live in Dorset, you have a unique opportunity to make a difference to the future for people with fertility problems in your community.

Dorset CCG has launched a consultation on reducing the number of cycles of IVF for fertility patients from two cycles of NHS-funded treatment to one.  The current provision already falls short of what is recommended, so it’s absolutely vital that as many people as possible living n Dorset respond to the consultation and let their voices be heard.

Don’t forget that the guidance from NICE recommends three full cycles of NHS-funded IVF for eligible women of 39 and under and one cycle for women of 40-42 who meet certain criteria. This is based on what is clinically and cost effective.

So, if you live in Dorset or your GP is based in Dorset, please do take a few moments to complete the consultation – you can find it on the CCG website here http://www.dorsetccg.nhs.uk/

 

Update on fertility funding

A decision to cut IVF funding just a fortnight after the deputy Chief Executive of NICE made it clear that fertility guidelines were there to be followed shows just how badly the current system is failing fertility patients.  The guidelines for funding, set by NICE, are based on lengthy in-depth research and analysis of what is both clinically and cost effective for the NHS looking at all the available evidence, yet some local commissioners have decided to completely ignore this carefully researched guideline, instead coming up with their own ideas about what’s effective and what isn’t.

In East Anglia, clinical commissioning groups in West, North and South Norfolk, Norwich and Cambridgeshire and Peterborough have reduced the number of cycles of IVF they fund without any formal consultation – or any formal announcement.  Last night, I went to talk to Susie Fowler-Watt about this on BBC Look East as they wanted to understand what the decision would mean to patients – and it’s clear it will be devastating, adding pressure and anxiety to those who are already living with the impact of fertility problems.

Let’s be clear – infertility is a medical condition, and IVF is an appropriate treatment for that medical condition. Not being able to conceive affects every area of your life, and can lead to isolation and depression, damaging relationships and friendships. Fertility funding is easy to cut because fertility patients are not going to be out there with placards shouting about it – many are unable to even talk about the corrosive effect it has on their lives, they may not even tell their closest friends and family. There’s still a stigma attached to infertility, and these kind of decisions add to that stigma.

We are meant to have a NATIONAL health service, but when it comes to fertility we have a postcode lottery where your access to the treatment you need for a medical condition depends entirely on where you live.

Susan Seenan, Chief Executive of Infertility Network UK and Co-Chair of the National Infertility Awareness Campaign, said last night: “NICE originally recommended 3 full cycles back in 2004; it is clear that 3 cycles is what is expected nationally and it has been proven to be the most clinically and cost effective number for commissioners to offer on the NHS. Indeed Gilian Leng, deputy chief executive of NICE, has recently confirmed that CCGs which don’t follow the guidance are exacerbating the problem of variation in care, which contradicts the fundamental aims of the NHS. Infertility doesn’t discriminate, and neither should the CCGs. We would urge them all to take heed of the guidance issued by NICE and reverse these decisions to ensure that access to fertility treatment is fair and equitable right across the country.”