- Postcode lottery still in place ✔
- Same-sex couples still paying for treatment ✔
- Non-clinical criteria still being applied ✔
- NICE Guideline ignored ✔
The overwhelming majority of England's 42 Integrated Care Boards (ICBs) are failing fertility patients in general, and women in particular.
When the UK Government published its long-awaited Women's Health Strategy for England in July 2022, this Strategy included a commitment to remove 'the current geographical variation in access to NHS-funded fertility services'.1
But this week, a detailed analysis of fertility treatment commissioning policies – undertaken by the fertility and genomics charity PET – found that only 4 out of 42 ICBs are offering the recommended 3 NHS-funded IVF cycles across their entire area.2
Of these 4 ICBs, only 3 ICBs are offering full IVF cycles, as defined and recommended by the National Institute for Health and Care Excellence (NICE).3
Furthermore, the recent move from Clinical Commissioning Groups (CCGs) to ICBs – combined with the fact that policies have not been fully harmonised – means that in some places, there is now a postcode lottery for treatment within a single ICB.
For example, if you are a fertility patient and your ICB is Greater Manchester or Humber and North Yorkshire, then whether you are able to access three funded IVF cycles, two funded IVF cycles or only one funded IVF cycle will depend on your postcode.
PET data also shows that ICBs are failing to improve on the legacy policies of CCGs more generally. For example:
- Only 15 out of 42 ICBs have policies that comply with the NICE definition of a full cycle of IVF. PET data shows that instead of complying with this definition, the majority of ICBs have instead chosen to redefine what constitutes a cycle of IVF.
- The NICE Guideline recommends that women under the age of 40 should be offered NHS-funded IVF treatment. PET data shows that instead of complying with this recommendation, 3 ICBs have introduced a substantially lower maximum age limit of 35 years.
- In addition to these 3 ICBs with a lower maximum age limit of 35 years, there is also at least one ICB within which there is postcode lottery for age limits. If you are a fertility patient and your ICB is Frimley, then the age limit for eligibility for NHS-funded IVF can be 34, 35 or 39, depending on your postcode.
- The Women's Health Strategy includes a Government commitment to 'ensure all NHS fertility services are commissioned in a clinically justifiable way'. But PET data shows that non-clinical criteria are still being widely used, with 32 out of 42 ICBs refusing to offer NHS-funded IVF to a patient whose partner has a child from a previous relationship.
- The Women's Health Strategy includes a Government commitment to ensure that when it comes to same-sex couples, 'there is no requirement for self-funding and the NHS treatment pathway for female same-sex couples will start with 6 cycles of artificial insemination, prior to accessing IVF services if necessary'.
But PET has found that 22 out of 42 ICBs clearly state that same-sex couples have to self-fund at least 6 – and sometimes up to 12 – cycles of artificial insemination.
Sarah Norcross, Director of PET, said:
The Women's Health Strategy promised to shine a light on the inadequacies in NHS funding for IVF treatment. Our data shows that this is not happening.
If the Government is having difficulty honouring its commitments in the Women's Health Strategy, then people need to know, so that solutions can be found.
Every delay diminishes women's chances of having much-wanted babies.
Notes
- The section of the Women's Health Strategy that includes fertility-related commitments can be found here.
- Audit of England's Integrated Care Boards (ICBs) by PET (Progress Educational Trust), July 2023. This audit includes all ICB policy documents that have been made accessible online.
Three ICBs (Frimley ICB, Greater Manchester ICB, and Humber and North Yorkshire ICB) are yet to publish a single harmonised policy for their area. Consequently, there is a discrepancy between the number of ICBs in England (42) and the number of distinct ICB fertility policies available online (48).
Additionally, there are two ICBs – Leicester, Leicestershire and Rutland ICB, and West Yorkshire ICB – whose fertility policies are not available online, and therefore do not contribute to the total of 48 fertility policies available online.
Of the 48 fertility policies available online, only 6 (the policies of Hull, Tameside, North Central London, North East London, Sussex, and North East and North Cumbria) offer 3 cycles of NHS-funded IVF. Of these 6, 2 (Hull and Tameside) form part of non-harmonised ICBs, and other areas within these ICBs fall short. This leaves only 4 ICBs offering 3 cycles of NHS-funded IVF. - NICE recommends three full IVF cycles for women under 40 years old.
A 'full' cycle of IVF is one in which 1 or 2 embryos produced from eggs collected after ovarian stimulation are replaced into the womb as fresh embryos (where possible), with any remaining good quality embryos frozen for use later. When these frozen embryos are used later, this is still considered to be part of the same cycle.
The NICE definition of a full' cycle of IVF can be found here.
