Do people “deserve” fertility treatment?

So, let’s take two very cute children who need operations to help them walk, an obese man and a couple who can’t have children and ask who is most “deserving” of NHS treatment. Last night Channel 4 aired a programme on the NHS which started from the premise that we need to ration treatment and used some figures seemingly calculated on the back of an envelope to decide how much funding different treatments might cost the NHS and then put them against one another.

The couple featured who needed IVF had fertility problems due to the woman having an STI when she was younger, and they were being denied treatment because the male partner had a child from a previous relationship – so already value judgements were being set when it came to deciding who should and should not receive medical treatment. We were told that their treatment would cost the NHS £10,000 – in fact as this was a younger woman with blocked tubes, it was far from certain that she would need three cycles of IVF – but it didn’t stop the programme makers showing us what other vital tasks the NHS could use £10,000 for. The team were very well aware of the fact that we don’t actually know how much IVF costs the NHS as this varies hugely from area to area and we have no national tariff- but the real issues weren’t a story they were covering here.

Most of the ire on Twitter about the programme was directed at the obese man who needed weight-loss surgery, and there were some angry tweets suggesting that NHS spending should be reserved for ‘life-threatening” conditions – quite bizarre as the vast majority of us only use the NHS for non life-threatening conditions and I suspect these same people would object fiercely if they were told they were not allowed to visit their GP unless their life was at risk. And of the cases featured it was the obese man who probably had the most life-threatening condition, not the sweet children.

It’s hugely depressing that anyone should feel a need to put different patients up against one another to decide who is most “deserving” of medical treatment – and what we should be asking is not who we should allow to be treated, bur rather where this kind of debate takes us.

NHS funding for fertility

It is good news that NICE is working to reinforce last year’s fertility guideline, and is pushing to end the postcode lottery which has blighted so many people’s access to fertility treatment. NICE released draft standards today about this – a finalised version will be published after consultation in October. You can see the press release from NICE here.

For too long, fertility treatment has been seen as some kind of optional extra by some commissioners, despite very clear guidance from NICE on what they should be offering. The NICE guidelines are based on what is both clinically and cost effective, and are all about ensuring best practice. Despite this, many commissioners have set their own rules on how many cycles to offer, and have invented criteria to limit access to treatment. I was shocked when I was in touch with one clinical commissioning group recently to discover that their justification for denying treatment to a woman whose partner had a grown up child from a previous relationship appeared to be based on the fact that this was mentioned as a reason for rationing treatment on the NHS Choices website.

The release of the draft standards follows a court ruling that Clinical Commissioning Groups cannot just decide not to follow NICE guidance without good reason after a woman who was due to have chemotherapy was denied NHS funding for egg freezing.

For too long our national health service has been far from national when it comes to funding for fertility – let’s hope it’s finally time for a change.