IVF: the best and worst places to live 2016

Greater Manchester is the best place to live in England if you need IVF, according to new national audit date from campaign group Fertility Fairness. Only four out of 209 (1.9 per cent) clinical commissioning groups (CCGs) in the country follow national guidance on access to NHS fertility treatment fully and offer access to three funded cycles of IVF for eligible women under 40, plus all viable frozen embryo transfers, and enable access if one partner has a child from a previous relationship. All these CCGs are in the Greater Manchester area: Bury CCG, Heywood, Middleton and Rochdale CCG, Tameside and Glossop CCG and Oldham CCG – where the world’s first IVF baby, Louise Brown, was born in 1978.

Essex is the worst place to live with three of the four worst CCGs: Mid Essex CCG, North East Essex CCG and Basildon and Brentwood CCG have cut all NHS fertility treatment; South Norfolk CCG has also decommissioned its NHS fertility services. The striking north-south divide extends further: just 35 CCGs offer three NHS-funded IVF cycles in line with national guidance from the National Institute of Health and Clinical Excellence (NICE); 28 are in northern England.

Fertility Fairness’ 2016 audit of England’s 209 CCGs shows a marked reduction in access to NHS-funded IVF, with potential further cuts ahead. The number of CCGs offering three NHS-funded IVF cycles has dropped to 16 per cent (from 24 per cent in 2013), while the number of CCGs offering one NHS-funded IVF cycle has leapt to 60 per cent (from 49 per cent in 2013). More than one in ten CCGs (10.5 per cent) are currently consulting on reducing or decommissioning NHS fertility treatment.

Susan Seenan, co-chair of Fertility Fairness said: ‘Health minister Jeremy Hunt has said that the government will step in when people do not receive nationally-agreed standards of care. Just four out of England’s 209 CCGs follow national guidance on access to NHS fertility treatment fully; the remaining 98 per cent of CCGs do not: this is cruel and unethical, and a national disgrace for the country that pioneered IVF. Infertility is a disease and women and men who cannot become parents without medical help are as deserving of healthcare as people with other medical conditions.’

Sarah Norcross, co- chair of Fertility Fairness, said: ‘The IVF postcode lottery is being exacerbated by CCGs not making evidence-based commissioning decisions and routinely ignoring the guidance from the National Institute of Health and Clinical Excellence (NICE), which states that the provision of three full cycles of IVF is both clinically and cost-effective for eligible women under 40.’

‘Fertility Fairness is calling for full implementation of the NICE guideline, standardisation of eligibility criteria across England and the development of a national tariff in England for tertiary fertility services. Fertility Fairness’ audit reveals the continuation of a wide variation in the average cost that CCGs are paying for a cycle of IVF: this ranges from as low as £2,098 from a CCG in the north of England to more than triple this from a CCG in the south (£6,500), with a mean of £3,545. The introduction of a national tariff would eliminate these wide cost variants and remove a key barrier to compliance with national guidelines.’

Nicola Blackwood, Minister for Public Health, said: ‘Fertility problems can have a serious and lasting impact on those affected. It is important that the NHS provide access to fertility services for those who need clinical help to start a family. I am very disappointed to learn that access to IVF treatment on the NHS has been reduced in some places and it is unacceptable that some clinical commissioning groups have stopped commissioning it completely.

I would strongly encourage all CCGs to implement the NICE fertility guidelines in full, as many CCGs have successfully done. The Department of Health, NHS England and professional and stakeholder groups are working together to develop benchmark pricing to ensure CCGs can get best value for their local investment.’

As well as slashing the number of cycles they offer, CCGs are playing fast and loose with both the definition of an IVF cycle and access criteria to IVF. Approaching half of all CCGs (45 per cent) use their own definition of what constitutes a full, fresh IVF cycle – which typically means substantially reduced treatment is offered. These alterations hide the degree to which many CCGs are departing from national guidance.

Creating additional eligibility criteria are a further hurdle CCGs use to further ration treatment unfairly. Only ten per cent of CCGs enable access to couples with children from a previous relationship; nine per cent of CCGs deny treatment to women over the age of 35 in contravention of national guidelines; 16 per cent of CCGs stipulate couples should have been trying to conceive for three years before treatment can be offered (and if a women suffers a miscarriage during this period, the ‘waiting time’ clock is set back to zero months. Other eligibility criteria include smoking status, body mass index, and length of relationship.