NHS is accused of a 'cruel betrayal' of couples by rationing IVF treatment to save money

http://www.theguardian.com/society/2014/sep/13/ivf-rationing-nhs-fertility-women

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The NHS has been accused of "a cruel betrayal" of childless couples after figures revealed that more and more groups of GPs are rationing IVF treatment. In a bid to save money, growing numbers of local NHS bodies are denying infertile women the three cycles of IVF which the government's health advisers say they should have.

The National Institute of Health and Care Excellence (Nice) says that GP-led clinical commissioning groups (CCGs) should provide that treatment to women up to the age of 40 or who have been trying for a baby with their partner for two years. However, CCGs – which between them spend £66bn of NHS funds – are increasingly ignoring Nice's recommendation as they struggle to cope with the rising demand for healthcare.

Freedom of information responses from all but one of England's 211 CCGs show that the number of them offering three cycles of IVF has fallen from 48 (23%) last year to 38 (18%). Similarly, the number of CCGs offering women only one or two cycles has risen from 149 (71%) last year to 171 (81%), although six fewer CCGs supplied data in 2013.

"This is a cruel betrayal of women who have fertility problems. It's extremely disappointing that a growing number of CCGs aren't managing to comply with Nice guidelines," said Sarah Norcross, the co-chair of Fertility Fairness, which obtained the figures. The human impact would be felt in increased heartbreak for childless women, she added.

Ten CCGs have reduced the amount of IVF they will pay for from three to two cycles, further limiting an infertile couple's chances of conceiving. They include the four CCGs in Norfolk. One of them, North Norfolk CCG, covers the parliamentary constituency of the health minister, Norman Lamb, a Liberal Democrat MP.

Lamb told the Observer that he was concerned and wanted all CCGs to implement Nice's advice, which dates back to 2004. "I will take this up with my local CCG. Compliance with this guideline has always been mixed, with many primary care trusts [CCG predecessor bodies] also not following them. But they are based on evidence and should be followed," he said.

Norwich, South Norfolk, West Norfolk, and Cambridgeshire and Peterborough CCGs have also begun offering two rather than three cycles. Other CCGs are consulting on whether to reduce their provision of IVF, including West Essex, Mid Essex and Southend. Mid Essex is examining three options, which include cutting IVF from three cycles to just one, to save up to £250,000 a year, or restricting it to the small number of women who either have HIV or are about to start cancer treatment and want to preserve their fertility. That would save up to £550,000.

Norcross also condemned the "arbitrary" restrictions imposed by many CCGs, which limit still further the number of couples who can access IVF on the NHS. For example, some CCGs require a woman to have been trying to conceive for three years, not two.

At least 171 CCGs refuse IVF to couples in which one of them has a child or children from a previous relationship, even though Nice does not suggest such a restriction. "This can mean an infertile person is denied treatment, a somewhat perverse social judgment which impacts upon clinical decision-making and is unique to this area of medicine," she said.

Similarly, Fertility Fairness found that some CCGs have imposed restrictions based on the woman's age. At least 18 CCGs, including Hampshire and the Isle of Wight, do not offer IVF to women aged 35 or over, in defiance of Nice stipulating that all women up to 40 should get three cycles and 41- and 42-year-olds receive one.

More positively, the number of CCGs offering one cycle of IVF has risen from 100 to 110 and two cycles from 49 to 61. And while last year six CCGs denied all women IVF, now just one CCG, Vale of York, offers none at all. It planned to start offering one cycle, but later changed its mind because that would cost too much.

Freedom of information responses showing that CCGs pay between £2,900 and £6,000 for a single cycle of IVF prompted calls for an NHS-wide standard fee to encourage greater availability.

The Department of Health said it expected CCGs to consider Nice guidance and urged all of them to abide by it.

"We know that around a quarter of NHS organisations currently offer three full cycles of IVF to eligible couples, so it is certainly possible to follow Nice guidelines in full," said a spokeswoman.

But NHS Clinical Commissioners, which represents 85% of CCGs, said that CCGs "often have to take tough decisions about an individual's health, working with limited budgets". They must have the freedom to make decisions that help meet the overall needs of their local population, a spokeswoman said. "The guidance Nice issues is not mandatory. But NHSCC will be working with Nice to ensure we get the right balance between local decision-making and national guidelines," she added.