We have known that NHS funding for fertility treatment is patchy, despite last year’s NICE guideline which recommended that three full cycles of treatment should be provided for eligible women who were 39 and under. Now, the first survey to look at how funding is working since the NHS system changed and Clinical Commissioning Groups (CCGs) were brought in has revealed the truth about what is really happening on the ground.
The comprehensive audit carried out by the National Infertility Awareness Campaign (NIAC) shows that 73% of CCGs fell short of the NICE guideline recommendation of providing 3 full cycles of IVF/ICSI to eligible couples. Of those that funded treatment, around 49% only offered one cycle of treatment, around 24% offered two cycles and 24% offered three cycles
Since April 2013, Clinical Commissioning Groups (CCGs) have been responsible for commissioning fertility services, replacing Primary Care Trusts (PCTs). Apparently some CCGs are currently reviewing their policies on assisted conception, but many are ignoring NICE guidance and using social criteria set in place by PCTs to ensure that the number of people who qualify for treatment is limited.
Clare Lewis-Jones, chair of NIAC said: “It is now nearly 10 years since the original NICE guideline was published and yet here we are, in 2013, still facing a situation whereby the level of service is determined by postcode. Sutton and Merton, along with the CCGs covering the former North Yorkshire and York PCT, have all chosen to follow the policy of their predecessor PCTs, and are consequently offering no funding for IVF.
This report gives a snapshot of IVF provision across England during the summer of 2013; sadly many patients will find they are no better off than in 2011 when the last national audit of this kind was carried out. NICE’s retention of the three cycle recommendation in its updated guideline in February 2013 should send a clear signal to commissioners as to the level of service patients should receive.
Whilst we are pleased to highlight areas of best practice in our report, we are incredibly disappointed to learn that since we carried out the research several CCGs in the East of England have carried out a review of their services and are now considering a reduction in the number of cycles from the recommended three to two. Not only is this contrary to the NICE guideline and detrimental to the desired outcome of the treatment, but it also means we can no longer confidently hold up the region as a shining example to others.
I acknowledge the fact that CCGs are still finding their feet but this should not prevent commissioners from acting on NICE’s latest guideline – which should serve as the basis for all future funding discussions at a local level. I hope they will use the information contained within this report to inform their thinking.”
NICE guidelines are based on not only what is clinically effective, but also what is cost effective, and it seems extraordinary that so many CCGs should be choosing to completely ignore them. We are meant to have a NATIONAL health service, but when it comes to fertility it’s still your postcode that is going to dictate whether or not you qualify for treatment.