I’ve just spent a really interesting evening at a debate organised by Progress Educational Trust where the new NICE fertility guideline was up for discussion. Titled ‘NICE try… but is anyone listening”, the debate was chaired by Dr Allan Pacey of the British Fertility Society which had sponsored the evening. The debate focused on the fact that the 2004 guideline has still not been fully implemented in many areas, and questioned whether commissioners were really going to take any notice of the new guidance. The evening started with brief presenatations from the panel of speakers.
First up was Dr Yacoub Khalaf, Director of the Assisted Conception Unit at Guy’s and St Thomas’ who explained how linking fertility funding to single embryo transfer had already successfully saved money overseas, and questioned why NICE was not able to use this kind of joined-up thinking. The second speaker was commissioner Peter Taylor, a fellow member of the NICE guideline development group. Peter explained the commissioning process following on from the previous fertility guideline in 2004, and discussed how fertility commissioning decisions had often been down to arbitrary measures outside the guidance itself. The final speaker was Dr James Kingsland, President of the National Association of Primary Care, who talked about the new clinical commissioning groups and how it will be up to the public to challenge them if they are making decisions about fertility treatment based on rationing rather than clinical care.
The debate which followed covered a range of topics, although there was some focus on the health economic models used by the NICE team and questions as to how reliable members of the audience felt these to be. There was also discussion about the decision not to offer IUI to those with minor fertility problems, which one member of the audience felt was a mistake. The decision to only offer one cycle of IVF to women between 40 and 42 was felt by many to be unfair.
For me, the quote of the evening came from Professor Peter Braude who questioned the fairness of the current system and noted that when it comes to fertility our health service is far from National: he made the point that we don’t make decisions about who should be immunised on the basis of their postcode, and questioned why we should do this when it came to fertility.
I think I’d agree with Peter Taylor’s concluding thought – that the new guideline may not be perfect, but it certainly isn’t that bad. As a former patient, I’m really delighted that there is more up-to-date guidance to be followed, and that this advice will make it possible for people to access more cost-effective treatment more quickly if the guideline is followed.