CCG inefficiencies ‘blocking’ access to IVF

Exclusive to HSJ

  • Data shows 13 clinical commissioning groups spent at least £4,000 per IVF cycle, while six spent £2,000 or less
  • Fertility charity says “financial inefficiences” blocking access to IVF at time when access is at historic low
  • NHS England to introduce non-mandatory benchmark prices to help CCGs obtain “fair price”

Commissioning inefficiencies are said to be “blocking” patients’ access to IVF, as new data reveals some areas are spending at least twice as much as others on a single cycle of fertility treatment.

Information obtained via freedom of information requests by Fertility Fairness, a campaign group led by various charities, suggests 13 clinical commissioning groups spent at least £4,000 per cycle of IVF with their main provider in 2017-18, while six spent £2,000 or less.

Free IVF treatment on the NHS has become increasingly rationed over time, and the figures suggest more CCGs could offer more cycles of IVF if they were able to negotiate better prices.

The campaigners received FOI responses from 115 out of 195 CCGs. While some CCGs commissioned up to five different IVF providers, HSJ analysed the money CCGs spent on their main IVF provider. If a CCG did not indicate how many cycles it commissioned from each provider, HSJ used the highest rate paid by the commissioner.

Sarah Norcross, co-chair of Fertility Fairness, said: “[We] are gravely concerned that financial inefficiencies at CCG level are blocking patient access to fertility services.”

The campaign group includes representatives from Progress Education Trust, Fertility Network UK, the Multiple Births Foundation as well as practising fertility clinicians. It acknowledged the data, which was shared exclusively with HSJ, did not show if the cost of a cycle includes egg freezing and frozen embryo implantation, and there may have been inconsistencies in terms of CCGs including these costs.

The difference in spend could be even higher, as four CCGs reported spending £1,000 per cycle with their main provider. However, these four disputed the interpretation of their data.

In 2017-18, almost two thirds of CCGs provided only one cycle of IVF, up from approximately half in 2013. Four per cent of CCGs provide no IVF funding at all and only 13 per cent commissioned three cycles, as recommended by the National Institute for Health and Care Excellence.

CCGs that are paying the highest and lowest tariffs for a single IVF cycle from its main provider

CCGs that spent more than £4,000 per IVF cycle CCGs that spent less than £2,000 per IVF cycle
Blackpool CCG Tameside and Glossop CCG*
Chorley and South Ribble CCG Newcastle Gateshead CCG
Eastern Cheshire CCG North Cumbria CCG
Fylde & Wyre CCG North Tyneside CCG*
Greater Preston CCG Northumberland CCG*
Halton CCG South Tyneside CCG*
Knowsley CCG
Liverpool CCG*
South Cheshire CCG
St Helens CCG
Vale Royal CCG
Warrington CCG
Wirral CCG  * CCG has queried the data of its own FOI

Price differences

There was also evidence that some providers charged different amounts to different CCGs, questioning how good commissioners are at negotiating local contracts.

James Hopkisson, clinical director at private IVF provider Nurture, told HSJ there is a difference in what CCGs will pay for each cycle, what is included in their contracts and to whom it is offered.

NHS England has published benchmark prices for IVF for 2019-20 as part of the national tariff consultation. This recommends that CCGs pay on average £3,300 for a cycle of IVF which also includes the use of one frozen cycle if more than one embryo is viable for implementation.

An NHS England spokeswoman said: “Ultimately it is up to CCGs to negotiate prices locally and setting a guide price gives them a starting point to help with these negotiations and getting a fair price.”

Five out of eight CCGs in Lancashire and South Cumbria reported costs of more than £3,500 per cycle, and a joint spokesman said prices were “agreed between the lead commissioner [for all its CCGs] and the service provider”. It added that “variation in the cost charged to the NHS for a cycle of IVF has been recognised nationally”.

Liverpool, Warrington and Knowsley CCGs all separately commission Liverpool Women’s Foundation Trust and pay at least £4,000 per cycle. Knowsley said it had “agreed the tariff… to support local access and reduce health inequalities”. Warrington offers the full three IVF cycles and said its contract includes transfer of “fresh and frozen embryos” which not all areas offer.

Liverpool said the cost included the choice to implant “all harvested embryos”. It said it intends to adopt the new non-mandatory NHS tariff, but this only allows for one fresh and one frozen embryo.

South Cheshire and Vale Royal CCGs, which pay at least £4,000 per cycle, said they were “reviewing service specifications for acute services”.

Hambleton, Richmondshire and Whitby CCG said its rate of £2,000 – £2,495 was locally agreed.

The FOI was sent to all CCGs in summer 2018 with results collected over September and October last year. Each CCG was asked to mark how many cycles of IVF it provides per £500 bracket of funding. For example, a CCG would indicate if it spent between £1,000 and £1,500 per cycle and, for consistency, the lowest estimated of that price bracket was recorded.

HSJ defined as the main provider the organisation that provided the most IVF cycles for the commissioner, acorrding to the CCG’s own FOI. For some CCGs different prices were paid to different providers.

IVF spend compared to overall CCG budget

Fertility Fairness also analysed overall CCG spend on IVF against its total 2017-18 commissioning budget. It said, on average, CCGs that funded a single cycle spent 0.089 per cent of their total commissioning budget on the fertility treatment. Those CCGs that funded three cycles spent 0.108 per cent of their total budget on IVF.

Ms Norcross said: “When Fertility Fairness analysed the difference in cost between providing a full NICE-compliant service and providing a partial service, savings were miniscule. The difference amounted to 0.019 per cent of a CCG’s allocated budget.

“Not providing a proper service is a false economy, as it causes more money to be spent elsewhere – for example, mental health services for involuntarily childless people, or neonatal wards following multiple births.”

HSJ has previously reported that money saved through IVF cuts was likely resulting in increased costs to the local health economies. This is because of increased complications associated with twinned births, which are much more common in assisted pregnancies.