The National Institute for Health and Care Excellence (NICE) has published a quality standard that aims to bring an end to a 'postcode lottery' in the provision of fertility services on the NHS, which it says is restricting access to treatment.
The 2013 NICE fertility guideline recommends that eligible women under 40 should be offered three full cycles of IVF on the NHS. However, fewer than one in five Clinical Commissioning Groups (CCGs) meet NICE's recommendation in full.
The recently published fertility quality standard, defined as 'a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care', applies across all CCGs and emphasises the importance of treating infertility.
Among its statements, it says eligible women under 40 should receive three full cycles, and women aged 40—42 one full-cycle, reflecting the 2013 fertility guidance. As the quality standard explains: 'Access to the appropriate number of full cycles of IVF for women who meet the criteria for IVF will increase the likelihood of those women becoming pregnant.'
The statements also highlight areas of care where improvements are needed most, including referring couples for specialist services earlier and that people having cancer treatment that could affect their fertility are offered cryopreservation.
Professor Gillian Leng, deputy chief executive of NICE, said that 'it is unacceptable that parts of England are choosing to ignore NICE recommendations for treating infertility'.
'This perpetuates a postcode lottery and creates inequalities in healthcare across the country,' she said. There is no obligation on CCGs to implement NICE's recommendations, although they must give clear reasons for not choosing to follow its guidance (see BioNews 751).
While the Vale of York is the only CCG to not provide any IVF treatment at all, 110 CCGs fund only one cycle of treatment. Mid Essex CCG will only fund specialist fertility services in exceptional clinical cases, but has stated it will review its policy again in September 2015.
Susan Seenan, chief executive of Infertility Network UK and co-chair of Fertility Fairness, said that 'there are clear guidelines, based on cost and clinical effectiveness, and it is simply not acceptable for the CCGs to refuse to follow them'.
One cycle of IVF can cost around £3,000, although Fertility Fairness has found significant variations in the amount that CCGs are paying for a cycle of treatment (see BioNews 772).
Dr Allan Pacey, the chair of the British Fertility Society, said that 'by cherry-picking aspects of guidelines to fund services of their choice, local commissioners fly in the face of what NICE is all about'.
'Their guidelines must be taken as a whole if we are to deliver the best and most cost-effective use of NHS resources,' he added.