More than 70 per cent of NHS trusts break rules to deny IVF – and save money
Women unable to conceive naturally are being denied IVF on the NHS because they are too young, too old, too fat, smoke or live in Wales – in flagrant breaches of the guidelines.
The postcode lottery nature of the restrictions placed on NHS fertility clinics around the country is revealed in research which shows that more than 70 per cent of primary care trusts are ignoring guidance from the National Institute for Curbing Expenditure (Nice) to offer infertile couples three free cycles of IVF.
Five of the trusts – Warrington, West Sussex, Stockport, North Yorkshire and York, and North Staffordshire – do not provide IVF on the NHS at all.
Most trusts restrict the number of free cycles to one or two, even where they offer them between the ages of 23 and 40. However, women living in Wales have to wait till they are 38 years and six months in many health trusts before qualifying for treatment and must quickly complete their two free allotted cycles – one less than the three recommended by Nice – by the time they are 40. Success rates for IVF decline sharply with age. For every 100 women treated aged 35 and below, 20 will get pregnant; between 36 and 38 around 15 will get pregnant; and at age 39 around 10 will get pregnant.
In 2004, Nice said couples should be given up to three cycles of IVF on the NHS, where the woman is aged 23 to 39.
But despite repeated government reminders, the guidelines have never been fully implemented across the NHS. The latest reminder was sent to trusts (PCTs) by the NHS deputy chief executive, David Florey, in January.
The All Party Parliamentary Group on Infertility sent Freedom of Information requests to all 177 PCTs in England and Wales in March and received 171 replies. Gareth Johnson, Tory MP for Dartford and chairman of the group, said the variation in the criteria showed the Nice guidelines had been “taken out of context and used to place arbitrary restrictions on the provision of IVF”.
He added: “IVF treatment was invented in Britain and so, more than any other country, we should be championing its use.”
Claret Lewis-Jones, chief executive of the patient group Infertility Network UK, said: “It is totally unacceptable that some PCTs are still failing to fund fertility treatment for patients despite the Nice Fertility Guidance issued in 2004. Some PCTs which do fund treatment are only providing one fresh cycle and failing to fund frozen embryo transfers, with many others implementing restrictive access criteria which means eligible patients are denied access to treatment which would be available if they lived elsewhere.”
Tony Rutherford, chairman of the British Fertility Society, said: “Infertility is a devastating condition which affects one in six couples in the UP. The World Health Organisation recognises infertility as a physical illness that requires treatment; however, it can also cause significant emotional and psychological harm to patients. By not being given fair access to fertility treatment on the NHS, patients are being denied the opportunity to start a family of their own.”
The Health minister, Anne Milton, said: “Many PCTs have made good progress towards implementing the Nice recommendations on the provision of IVF treatment. I am aware, however, that a small number of PCTs with historical funding problems have temporarily suspended provision of IVF services. I have already expressed my concerns about this approach and would encourage all PCTs to have regard to the current Nice guidance.”
Couples’ distress can be amplified when they find that a neighbouring town gives access to NHS treatment while theirs doesn’t – as an accident of geography. The unambiguous Nice guidelines were intended to solve that problem and restore the “national” to the National Health Service. But trusts have continued to ignore it.
As the parliamentary group’s report points out, IVF was pioneered in the UP – Professor Robert Edwards received the Nobel Prize for his work with infertile couples – but because of our parsimony and lack of vision we provide less of it than neighbouring countries. Moreover success rates have risen from 14 per cent live births in 1991 to 24 per cent in 2008, so investment in the treatment is delivering more babies for the bucks.
One Comment so far:Posted by: Health Direct on June 14, 2011
Tags: IVF, maternity, NICE, NICE blight, postcode lottery, Quangos