As the deadline for the partial implementation of guidelines recommending free fertility treatment for patients in England and Wales passed last week, a new survey reveals that many couples are still facing lengthy waits. Following guidance issued by the National Institute for Clinical Excellence (NICE) in February 2004, which recommended that patients should be offered three free cycles of IVF treatment, Health Secretary John Reid pledged that all couples meeting the NICE criteria would be offered one free cycle of IVF treatment by April 2005. However, a survey of 70 per cent of the PCTs, carried out by the All Party Parliamentary Group on Infertility (APPGI) and the National Infertility Awareness Campaign (NIAC), shows that there are still waiting lists of over a year in most areas. The results also reveal wide variation in the eligibility criteria for treatment, and show that some PCTs that previously provided more than one free IVF cycle are actually reducing their treatment provision.
The provision of fertility services was referred to NICE in 2000, as services across the UK were 'inequitable' and 'patchy', leading many to claim that treatment was based on a 'postcode lottery'. Despite the resulting guidance, John Reid announced that by April 2005, couples meeting the NICE criteria would only be offered one free cycle of IVF. In addition, he said, NHS-funded IVF will only be available at first to couples who don't already have children living with them. The Health Secretary said that 'full implementation' was a long-term goal, but he has not yet committed to a timetable for this.
The new survey reveals that although most PCTs will be able to offer one free cycle of IVF, over two thirds reported waiting times of over a year, with ten per cent having waiting times of over two years. It also found that 20 PCTs that had been providing more than one free treatment cycle were cutting their provision, and a further 18 did not confirm that they would be able to maintain current funding levels. Keith Barron, chair of the APPGI, said the survey shows that PCTs have been making progress towards meeting the deadline, but that 'we are still not achieving the fair and equal access to infertility services on the NHS that couples deserve'.
Clare Brown, chair of NIAC, said she was concerned that the positive effects of PCTs meeting the deadline would be offset by a greater use of eligibility criteria to reduce access. 'This situation needs to be addressed if we are to ensure that couples have access to the standard of care set out in the guideline', she said. The APPGI called on the government to give a 'clear indication' of when it expects the remaining two cycles of IVF to be implemented, as well as the other recommendations outlined in the guideline. It is also concerned that not all PCTs that are funding IVF treatment are also funding ICSI (intracytoplasmic sperm injection), a treatment for male infertility in which a single sperm is injected into an egg.