Who decides whether you can have treatment?

ivf_science-300x168It can be confusing to work out who is responsible for the decisions about who can and can’t access fertility treatment.

NHS treatment

If you are having, or hoping to have, NHS-funded treatment, the decisions about eligibility are made by your local CCG or Clinical Commissioning Group in England. They have guidance from NICE, the National Institute for Health and Care Excellence, but they don’t have to follow this and many prefer to set their own rules. In practice, this means that whether or not you can access NHS-funded treatment depends entirely on where you live. The CCG will have a contract with one or more clinics who provide fertility treatment and you may be given a choice between these clinics as to where you go. Some of these clinics may be in NHS hospitals but others may be private providers.

In Wales, Northern Ireland and Scotland, decisions about how much treatment people can access are made nationally, which means there are not the same variations where those who live just a few miles apart are eligible for totally different levels of help and support.

In England, an individual clinic may have a number of different contracts, so some of their patients may be having the three full cycles of NHS treatment recommended by NICE but others may only have one cycle. It is important to be clear that the funding doesn’t come depending on the clinic you are going to, but depends instead on your local CCG.

The CCG may set rules for eligibility and these often include things like not offering treatment to women who are very overweight, to those who smoke or to those who are already parents, even if the child is from a previous relationship.

To find out more about funding, visit the Infertility Network UK website and the Fertility Fairness website.

Private treatment

If you are paying for your own treatment, decisions about whether or not to treat patients lie with the clinic itself. In many areas, there are many different clinics to choose from and you will want to look at price and location and the types of treatment offered as well as the success rates before making your decision. You should also look at the multiple birth rates as multiple birth is the biggest risk from fertility treatment and a really good fertility clinic will  be able to combine good success rates with a low multiple rate. You can pay for treatment at a private clinic, but many NHS units also take fee-paying patients who will cover the cost of their own IVF.

There are generally far fewer criteria for access to treatment if you are paying for private treatment although most clinics will have a set upper age limit for treatment, and may want you to have a reasonably good ovarian reserve (stock of potential eggs in your ovaries) unless you want to use an egg donor. There may also be rules about smoking and weight, but these can be more flexible in the private sector. If you are having private treatment, you will not face the sort of social criteria that CCGs to about not offering treatment to people who are parents already.

If you want help choosing a clinic, the best place to start is the HFEA’s Choose a Fertility Clinic as this will allow you to find a list of all the licensed clinics in your area, to see what they offer and to find out about their success rates and multiple rates.

Increases in NHS funding for fertility

Y3qgabAY_400x400Great news from campaign group Fertility Fairness which reports that seven CCGs in Cheshire and Merseyside have increased their provision of IVF from two cycles to three.  The CCGs in question are Warrington, Eastern Cheshire, Wirral, Knowsley, Liverpool, South Cheshire and Vale Royal. It is hoped that four more in the area may follow their example.

Meanwhile, eight CCGs in Portsmouth , Southampton, Hampshire and the Isle of Wight region will decide whether to increase their provision next month.  You can find out more by visiting the Fertility Fairness website. Let’s hope that this excellent example is followed by others who are still not offering the full three cycles NICE recommends.

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.