How can we halt disinvestment in NHS fertility services?

The National Infertility Awareness Campaign (NIAC) (1) has been outraged by recent announcements from at least ten PCTs in England to suspend or severely restrict funding for infertility services.

The main reason given for these decisions has been affordability. This is despite the UK Government repeatedly saying the efficiency savings the NHS needs to make should not affect front-line services. Infertility services meet a health need so why are they being slashed in this way?

Every day, the NHS treats numerous diseases that are not life threatening, yet their treatment makes a real difference to patients. Infertility is one. People with fertility problems would rather have a child in the same way as fertile people, but are unable to do so. The only way many can have a family is through assisted conception treatment, such as IVF.

The impact of these service cuts will be devastating on those who have taken the significant step towards seeking treatment only to find it is no longer available to them. It adds to what is already a painful situation.

During the last ten years, the UK Government has supported the view that infertility is a health need worthy of NHS treatment. The health minister in 2000, Alan Milburn MP, referred infertility to the clinical guideline process of the National Institute for Health and Clinical Excellence (NICE). He aimed to help people get fairer, faster access to cost-effective and appropriate treatments on the NHS.

The NICE clinical guideline on fertility, published in 2004, means there is significant clinical evidence to support the funding of infertility treatment. Current guidance to the NHS from government is that progress should be made towards implementing the NICE guideline which, among other recommendations,  called for up to three full cycles of IVF or ICSI to be provided on the basis of clinical need.

While that policy was announced by the previous government, there appear to be no moves to reverse it by the current health minister. Indeed, in September this year, Andrew Lansley MP was reported as saying:

'From my point of view, I have long said that the NHS has a responsibility to provide fertility services'. He added: 'If, for example, a couple have investigations into reasons for infertility, and often significant resources go into that, it is then absurd not to give them appropriate access to IVF in order to try then for them to have a baby' (2).

So what can be done to address this disinvestment? At the national level, the Government needs to ensure the health minister's message that it expects these services to be funded is communicated strongly to all PCTs.

Locally, PCTs need to ensure the views of fertility patients and clinicians are heard and there is full consultation with them on any proposals to change services. They should also be reminded of the NICE guideline and current guidance on making progress towards implementing it.

In Parliament last week, Gareth Johnson MP raised this issue with ministers. Highlighting the award ceremony for Professor Robert Edwards' Nobel Prize for Medicine - awarded for the development of IVF - he asked the health minister whether he would join him in urging disinvesting PCTs to reconsider their decisions. In his response, Andrew Lansley MP said:

'I expect all PCTs to have regard to the current NICE guidance and to recognise fully the significant distress and impact that infertility has on people's lives'. He added: 'I feel strongly that the reason the NICE guidance was written as it was, way back in 2004, was to recognise both the distress and the extent of the difficulties that couples face, and the need for them to be assured not only of good quality investigation, but of good quality follow-up provision in fertility services throughout the NHS' (3).

NIAC believes it is unfair IVF services are being cut and that, in the country that developed this pioneering treatment, many people may now be unable to access them. It is crucial these services are reinstated to ensure people can receive the treatment they need and to progress towards providing fair and equal access to infertility services across the country.