Infertility is a medical condition – it’s time we started treating it like one
Fertility treatment should be dependent on a person’s medical need, not their postcode or pay packet
On Wednesday 18th of April, I’ll be introducing a Ten Minute Rule Bill with the aim of equalising access to NHS fertility services across England.
Unequal access to IVF first came to my attention in 2016 when I was contacted by some constituents who were refused IVF treatment because of arbitrary eligibility criteria where couples were judged on the basis of such things as past relationships. Apparently if one partner has had a child from a previous relationship, no matter how long ago and what the level of contact, that can serve as grounds to deny treatment.
Once I started digging I found that the provision of fertility services in England varies considerably from one area to the next and the number of Clinical Commissioning Groups (CCGs) restricting or completely decommissioning their services has increased dramatically since 2014.
How can it be right that people in Thurrock and Luton have access to comprehensive fertility services while my constituents get a much poorer deal based purely on where they live?
The National Institute for Health and Care Excellence (NICE) issued guidelines in 2004 stating that women under 40 who’ve failed to get pregnant after two years of trying should be offered three full cycles of IVF. However, the recommendations are not binding and according to the charity Fertility Fairness only 12 per cent of CCGs in England provide three full cycles. Over three per cent offer none at all – if you live in Herts Valleys, Cambridgeshire & Peterborough, Croydon, South Norfolk, Mid-Essex, North East Essex or Basildon & Brentwood there is no access to IVF.
The World Health Organisation classifies infertility as ‘a disease of the reproductive system’ but it’s clearly being treated differently to other illnesses like diabetes or epilepsy. NHS England shouldn’t be rationing treatment like this, which is why I’m calling on the government to take it seriously by initiating the necessary steps to rectify the injustice of this unequal access.
Since 2016, I’ve discussed the matter with four different ministers, lead a Backbench debate and spoken with senior officials from NHS England. There have been promises to improve provision but a distinct lack of progress, and every other week another CCG announces plans to reduce its services. Without action it seems certain that more cuts will follow.
My Bill would aim to eliminate regional variations, including the absurd use of arbitrary access criteria, by ensuring that all CCGs in England routinely commission fertility treatment in line with the NICE guidelines. The Bill would also pursue the development of national benchmark pricing in England for fertility services to end the wide price disparity in commissioning costs. It seems ridiculous that it can cost the NHS so much less in Newcastle than it does in Birmingham for the same NHS treatment.
These simple measures would in effect guarantee eligible patients fair and equal access to NHS fertility services while minimising commissioning costs.
The former National Medical Director, Sir Bruce Keogh, wrote to me in November 2017 saying, “it remains the fact that the NHS has never been able to fund all the IVF that people would like and this is unlikely to change”. I’m not sure we should be prepared to accept such a gloomy outlook and we certainly shouldn’t agree to ration based on arbitrary ‘moral’ judgements.
My Bill has wide cross-party support because it affects people all over England. The NHS was founded on the core principle that health services should be universal, comprehensive and free at the point of delivery, and as with all NHS services, fertility treatment should be dependent on a person’s medical need, not their postcode or pay packet.
Put simply, infertility is a medical condition and it’s time we started treating it like one.
Steve McCabe is Labour MP for Birmingham Selly Oak. His Ten Minute Rule Bill is on Wednesday 18 April