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'Worrying' trend in NHS IVF provision

2 November 2015
Appeared in BioNews 826

The number of CCGs in England offering the recommended number of IVF cycles to its patients is falling, with two CCGs in Essex decommissioning their assisted conception services altogether. 

According to the National Institute for Health and Care Excellence (NICE), the body responsible for issuing evidence-based recommendations on the provision of health services, all eligible couples should have access to three full cycles of IVF, where the woman is aged under 40. In 2013, NICE updated its guidance to also recommend that certain eligible women aged 40–42 should also have access to one full cycle.

However, the latest data from Fertility Fairness, which campaigns for equal access to assisted conception services in the UK, shows that fewer than one in five CCGs are meeting the NICE guideline in full, representing a fall of six percent since 2013. Twenty-four percent of CCGs currently offer two cycles, falling by seven percent since last year, and the number of CCGs offering just one cycle has risen by five percent since 2014 to 57 percent.

The figures draw attention to the rising disparities in current levels of access. For those seeking fertility treatment on the NHS, Fertility Fairness says the North is the best place to live in England; Cheshire, Warrington, Wirral and Merseyside currently work together as a North West commissioning collaborative to enable the recommended full three cycles be provided to its patients.

The places with the lowest provision of fertility services on the NHS are Essex and London. Fertility Fairness states that in Essex, both North East Essex CCG and Mid Essex CCG have cut NHS fertility services completely, except in isolated, complex medical circumstances. Basildon and Brentwood CCG are consulting on doing the same, and in London, every CCG, bar one, offers just one NHS-funded cycle of IVF.

Fertility Fairness claims that one of the barriers to many CCGs becoming NICE-compliant is the cost of IVF services. There is currently no national tariff in England for tertiary fertility services meaning that some CCGs are paying as much as £6000 for a single cycle of IVF while others are paying £1379.

Sarah Norcross, co-chair of Fertility Fairness and director of the Progress Educational Trust, which publishes BioNews, said: '[This] data demonstrates that by working collaboratively clinical commissioning groups can implement the NICE guideline in full. Even with budget constraints, Cheshire, Warrington, Wirral and Merseyside have, over the last year, improved their fertility service. We want to encourage commissioners in the South, especially in Essex, to learn from these collaborative groups, to improve their provision and to end the NHS fertility treatment postcode lottery.'

As a result of the reversal of what had previously appeared to be an upward trend in fertility service provisions, the Co-Chairs of Fertility Fairness have now called on Public Health Minister Jane Ellison MP to arrange a meeting to discuss the issues. More broadly, the organisation is urgently calling on the Government to fully implement the NICE guideline including the provision of three full cycles of IVF regardless of locality, standardise the eligibility criteria that is being used across England and to develop a national tariff in England for tertiary fertility services.

Speaking to Fertility Fairness, 34-year-old Kirsty and her husband, who have been trying to conceive for three years, describe their frustration after moving from the North of England where they were eligible for access to three funded IVF cycles, to the South where they can only access one, as 'heart-breaking'.

She said: 'Infertility is not a choice, treatment is not a luxury, and allocating treatment based on postcode is discriminatory. It astonishes me that following the NICE guideline is not compulsory.'

Fertility Fairness notes that difficulty in conceiving is the second most common reason for women to visit their GP and, on average, one in seven couples will have difficulties in conceiving in the UK.

IVF Provision in England: The good, the bad and the Essex
Fertility Fairness (press release) |  2 November 2015
NHS cuts back on IVF treatment to save cash: Couples increasingly being denied fertility treatment due to cost pressures
The Daily Mail |  2 November 2015
Women denied IVF as 80 per cent of NHS trusts ration fertility treatment
The Telegraph |  2 November 2015
6 November 2017 - by Sarah Norcross 
Sarah Norcross, Director of the Progress Educational Trust and Co-Chair of the campaigning organisation Fertility Fairness, speaks on TV and radio about worsening access to publicly funded IVF...
27 February 2017 - by Georgia Everett 
Women over the age of 34 will no longer be entitled to receive IVF funded by the NHS in some areas of Nottinghamshire...
23 January 2017 - by Dr Rachel Montgomery 
Steve McCabe MP has led a parliamentary debate on the variable provision of fertility treatments across the UK, calling for a revision to how fertility services are funded and provided...
12 December 2016 - by Dr Rachel Montgomery 
Only 16 percent of Clinical Commissioning Groups in England follow the national guidance on access to NHS fertility treatment, according to an audit by campaign group Fertility Fairness...
18 July 2016 - by Antony Starza-Allen 
Basildon and Brentwood CCG is proposing to cut its provision of fertility treatment for new and existing patients...
5 October 2015 - by Kirsty Oswald 
North East Essex Clinical Commissioning Group has announced that it is ending its IVF funding, and fertility treatment will only be available to specific groups of patients...
30 March 2015 - by Vicky Whitehead 
In England, the IVF postcode lottery impacts on every different level of a patient's NHS treatment in a myriad of ways. Not only is there widespread variation in who can access treatment and the number of IVF cycles available, but even in how a cycle is defined...
8 December 2014 - by Sean Byrne 
The NHS Vale of York Clinical Commissioning Group has agreed to fund one cycle of IVF, having at one time been the only CCG not to offer the treatment at all after funding was suspended in 2010....
27 October 2014 - by Sean Byrne 
The National Institute for Health and Care Excellence (NICE) has published a quality standard that aims to bring an end to a 'postcode lottery' in the provision of fertility services on the NHS, which it says is restricting access to treatment....
3 February 2014 - by Mark Johnson 
In 2011, the All Party Parliamentary Group on Infertility found that over 70 percent of NHS Primary Care Trusts were not providing the recommended three full cycles of IVF to eligible couples. Three years later, there has been a very real and very disappointing lack of progress...
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