£3.4 million is a heck of a lot of money!

I was shocked when I heard the news that the Human Fertilisation and Embryology Authority (HFEA) has built up the princely sum of approximately £3.4 million in its bank account. The HFEA explains that this surplus has arisen over recent years due to prudent budgeting to take into account an anticipated decrease in the number of cycles of IVF/ICSI caused by PCTs suspending NHS funding - which never happened and, to be honest, it doesn't surprise me one bit! As evidenced in 'Fertility Treatment in 2010: trends and figures' published by the HFEA in November 2011, the number of cycles of IVF/ICSI has in fact increased year on year since the HFEA was formed back in 1991 - not once has the number decreased (1). Figures in the report show that in 2009 54,451 cycles of IVF/ICSI took place and in 2010 this had increased to 57,652 cycles - an increase of 5.9 percent.

Figures on the number of cycles in 2011 understandably aren't yet available but given that the flurry of some 14 PCTs suspending funding did not start to happen until September 2010, there may, just may, be a small decrease in 2011. However, I doubt it. Why? Partly because several of those suspending PCTs have thankfully reinstated funding, but mainly because those needing fertility treatment will nearly always find the money from somewhere. People have no choice. They can't wait for a PCT to change its mind because all the time they are waiting their chance of success is decreasing - and patients know that.

The Fertility Clinical Guideline published by the National Institute for Health and Clinical Excellence (NICE) in 2004 recommends a female age of 23-39 for NHS funded treatment (2). There were 46,698 cycles undertaken where the female was aged between 18 and 39 in 2010 and therefore one would assume that the 23,407 cycles which were NHS funded were within this group. Whilst accepting that some people did not fulfil other eligibility criteria for NHS funding, the number of NHS cycles would have been a lot higher if the NICE guideline was being fully implemented across the country and can only be explained by the varying eligibility criteria being employed and the totally unacceptable number of PCTs who are still only funding one cycle.

So back to the central question - what should be done with this surplus of £3.4 million? As Infertility Network UK is a charity providing practical and emotional support for those affected by difficulties in conceiving and struggling for every penny, my immediate reaction was 'Give it to us!' We would promise to spend it wisely and ensure that it benefits patients! I also thought, as did the British Fertility Society, that that amount of money would pay for a lot of cycles of treatment - an idea apparently put aside by the HFEA and the Department of Health due to complexity. I agree, it would be incredibly complex but deserves thinking about. Another suggestion has been to give it to those PCTs who have suspended funding but that too is complex. If they are short of money because they have not managed their budgets well, shouldn't we be worried about how they would manage this money? And would it be fair to those patients who live in regions which at least provide some funding but not up to the three cycles recommended by NICE? Again, this idea would need more thought.

The HFEA says that it 'developed proposals to enhance our capabilities in three ways to spend the surplus money wisely over three years' but that this was turned down by the Department of Health. Infertility Network UK would be really interested to know what those proposals were. The HFEA went on to say that it was awaiting alternative suggestions from the Department. Infertility Network UK strongly believes that the funds built up by the HFEA should be reinvested back into the area which it regulates and that infertility patients should in some way benefit from this excess. We would urge both the Department of Health and the HFEA to find a speedy solution which benefits the patients - the most important people in all this.