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Infertility Treatment

Volume 456: debated on Wednesday 31 January 2007

I welcome the opportunity to debate what is an important subject. I am glad to see that other hon. Members are here because I did fear that it might be only myself and the three main party spokespeople so I am happy to see other hon. Members.

I have two children and can only begin to imagine what it must be like to want children but to be unable to have them. This is not just a women’s issue, although it is often portrayed as such; it also deeply affects men. Surprisingly, although there is public sympathy for those unable to have children, there is sometimes less sympathy when people are unable to access public funds to solve the problem and have a much-wanted family. The issues involved do not just relate to health as they can also have a wide impact on society at large.

What exactly is infertility? According to the British Fertility Society, it is defined as the failure to conceive after frequent unprotected sexual intercourse for one to two years in couples in the reproductive age group. Obviously, that does not include those with sexual dysfunction. As women start their families at a later age, the problem is becoming more acute. It is estimated that at some time in their reproductive lives at least a quarter of couples experience a period of infertility lasting more than a year. Some continue to be unable to conceive and that leads to approximately one in six couples seeing an infertility specialist at a hospital. Some of those couples will require treatment to assist with conception.

There are many options for treatment, but attention has focused on IVF—in vitro fertilisation. Research published by the National Institute for Health and Clinical Excellence in 2004 shows that England lags behind its European neighbours in providing access to treatment. England provides approximately half the level treatment compared with the European average. A 1998 study revealed that there was a wide variety of provision in the UK. That provision was measured as IVF treatments per 100,000 people and ranged from 21.5 in Scotland to a low of 0.3 in south-west England. Clearly, something strange is happening for there to be such a wide variation—some variation would be expected, but not to such an extent. The best place to live in England to access fertility treatment is the Anglia and Oxford region, which was just behind Scotland with a level of 21.3.

Although public sympathy might not always be readily apparent, a survey in 2002 showed overwhelming support for NHS funded infertility services and a desire for an end to the postcode lottery of provision. That is not a phrase I make a habit of using, but it was used as a result of that report. The then Secretary of State for Health, the right hon. Member for Darlington (Mr. Milburn), acknowledged the distress that infertility caused to thousands of couples and said that it was time to tackle infertility by using some of the new funds being pumped into the NHS. He referred the matter to the National Institute for Health and Clinical Excellence. In the same year, the Prime Minister stated that the same level of high quality service would be available in whatever part of the country a couple live.

NICE published a set of national guidelines in February 2004, which recommended that the national health service should provide three free cycles of IVF treatment for suitable patients in England and Wales. The then Secretary of State responded positively to the guidelines and as an intermediate step stated that all patients meeting the eligibility criteria established by NICE should be offered one cycle of treatment funded by the NHS by April 2005.

The longer-term aim was full implementation of the NICE guidelines that recommended three cycles of treatment for each appropriate patient. In February 2004 the Prime Minister told the House:

“We hope that over the next couple of years we shall see at least very substantial progress towards implementation of the full NICE guidelines, and that they will allow us to end the current postcode lottery”. —[Official Report, 25 February 2004; Vol. 418, c. 278.]

Those were the Prime Minister’s words, not mine.

It is three years since those statements and so it is worth standing back and taking a look at where we are today. I have had a long-term interest in this subject and in 2005 I conducted my own survey by writing to primary care trusts and asking a few fairly simple questions. I had a good response, but unfortunately the results did not provide happy reading. The majority of primary care trusts were, at that time, unconfident about being able to offer more than one cycle of IVF by April 2006. Two thirds of trusts were taking no steps to offer more cycles, and eight out of 10 trusts offered only one cycle. Some 82 per cent. of trusts cited funding as the major barrier to providing more cycles, yet that was despite an increase in the IVF budget in 72 per cent. of primary care trusts. Some 60 per cent. of trusts had a waiting time of more than a year and one in 10 had a waiting time of more than two and a half years. One PCT stated that some couples had been waiting seven years for treatment. It was also clear that many trusts had added their own criteria that further diluted the NICE guidelines. One of the concerns often raised is that criteria are often social criteria, which almost suggests a degree of social engineering that varies around the country.

Anyone who has listened to “The Archers” recently will know that Hayley is being denied the opportunity to have a baby of her own because she has married Roy, who is the father of Kate’s child. I do not intend to go into the relationships of the characters in “The Archers” and who has slept with who over the years, but, basically, Hayley was denied treatment because she is in a relationship where there is a child. It is not her child; it is another woman’s child.

I know the hon. Lady will recall the debate in Westminster Hall initiated by the right hon. Member for Rother Valley (Mr. Barron) in 2005. He asked a good question: why did the then Secretary of State in 2004 add the criterion that priority should be given to couples where there were no living children? That is a social criterion and was not in the NICE guidelines. The Secretary of State added it and many PCTs are now adopting that, including my own. We have never been able to find out why the Department of Health and the Secretary of State chose to put that criterion in.

The hon. Gentleman makes an extremely good point. He is absolutely right; there has been no explanation as to why that was added when it was not in the initial guidelines. I suspect that that has sent the signal to PCTs that they can add further restrictive social criteria. I am sure that all hon. Members would be interested to hear from the Minister why that guideline exists.

I will not labour the point about “The Archers”, but it was interesting that Hayley’s doctor sounded like Lord Winston from the other place. I am glad to see that he is providing NHS services up and down the country. That is what soap operas are made of, but this is a real problem affecting real couples up and down the land.

There are other criterion to the one already mentioned. In Thames valley, doctors only offer treatment to patients who are between the ages of 36 and 40. By that time the fertility of an average woman will usually have declined by half compared with their fertility at the age of 30. Health officials have defended that by claiming that younger women have more options available, for example, they may be able to adopt or they have more time to overcome fertility problems naturally. However, others have said that such a selection process penalises women who may have had a greater chance of success with IVF if treated at a younger age.

For those who doubt the robustness of Lib Dem research, NICE conducted a survey in October 2005, which found that the vast majority of PCTs—94.5 per cent.—had defined their own eligibility criteria . Some 80 per cent. of those responded that their criteria were stricter than those proposed by NICE. Just over 60 per cent. of trusts were offering one cycle. NICE had slightly better results in that it found that a further third were offering two cycles, but not one trust was, at that time, offering three cycles, and one county was not funding any cycles of IVF at all. Since that survey was conducted, some trusts have temporarily put IVF programmes on hold.

NICE also asked about the timetable for implementation of the guidelines. Fewer than 10 per cent. said that that would be within a year. Even more worrying, nearly a quarter of trusts said that there was simply no time line.

The British Fertility Society recently conducted a survey of IVF providers. There was an increase in the number of NHS-funded cycles, but in some areas there is still only a token gesture towards implementation. The society also discovered that there was no clarity over the definition of what constituted a funded cycle. NICE says that that should include ovarian stimulation and the replacement of fresh embryos and the subsequent replacement of frozen-thawed embryos generated by the ovarian stimulation episode. There is no consistency in the application of that definition by funding commissioners.

Although short-term financial pressures are clearly affecting decisions, I also suggest that this could be a time for joined-up government. Research by Professor William Ledger at the university of Sheffield shows that free fertility treatment could boost the economy. He says:

“The costs of IVF are in fact trivial and truly insignificant compared with the huge amount that the child gives back to society, including financially in terms of taxes paid.”

Research by the RAND institute suggests that a case can be made for including fertility treatment as part of a “population policy mix” aimed at increasing fertility rates.

I do not have the advantage of an in-depth cost-benefit analysis, but it would be useful if the Minister, in summing up the debate, informed us whether such work is being undertaken, because if the long-term financial benefits were proved, there would possibly be a case for a separate pot of money, ring-fenced for the prime purpose of boosting fertility. It would not necessarily have to come out of existing health budgets.

The National Infertility Awareness Campaign has been campaigning on these issues for some time. It has raised concerns about a recent recommendation, made by an independent expert group set up by the Human Fertilisation and Embryology Authority, that reducing the number of embryos transferred from two to one for some women could reduce the number of multiple births. That process is known as single embryo transfer. It is true that the increased incidence of multiple births has a long-term impact on the health service, as twins are often born prematurely and with a lower birth weight and are linked to a significant risk of post-natal death. Twins are also at a higher risk of long-term problems such as cerebral palsy. If triplets are put into the equation, the risk is even higher; it is 16 times greater.

The expert group concluded that

“the failure to implement the NICE guideline on fertility (3 cycles) is the major obstacle to the acceptance by NICE and clinicians of introducing Single embryo transfer policies in the UK.”

The National Infertility Awareness Campaign has pointed out that the cost savings that could be achieved in neonatal care as a result of such a move towards the NICE guidelines could be invested in funding more infertility treatment. In other words, single embryo transfer must be introduced at the same time as the number of cycles is increased. Otherwise, if women think that they have only one chance, they will want to maximise their chances.

There are wider issues relating to infertility. Some women are unable to conceive due to blocked fallopian tubes. In some cases, that is a direct result of an infection such as chlamydia. A report by the Select Committee on Health in 2002 highlighted the inadequacies of current sexual health education. More should be done to get some of these messages across to people at a younger age. At a time when women are concerned about preventing a baby, they may take oral contraceptives and not think too much about the possibility of contracting chlamydia or another infection. Chlamydia is often symptomless in women and, despite the availability of testing, is often undetected. When a woman decides that the time is right to start her family, the damage has often been done. I would like to ask the Minister whether she has any plans to ensure that young women are more aware of that potential problem.

Obesity and anorexia also have an impact on fertility. Women with anorexia often find that their menstrual cycles are completely disrupted and sometimes there is a long-term impact. A person with a body mass index outside the range of 19 to 30 is likely to have greater difficulty in conceiving, with or without some form of assisted technology. Again, if more is done to tackle the problem of obesity, there will be benefits in the long term.

The messages are slightly misplaced, although accurate. We often say, for example, “We must tackle the problem of childhood obesity because diabetes is on the increase.” I suggest that most young children who overeat do not really think of themselves as diabetic or not; that is simply not something on their horizon. However, if they thought that their long-term fertility might be affected, that might be a more powerful incentive to try to get their weight under control.

It is not appropriate to highlight individual cases, but as more and more couples are forced to access private care, there is a great need to ensure that the private provision of infertility services is properly regulated. A recent “Panorama” programme attracted attention. I do not want to dwell on that problem, because it centred on a specific clinic and I feel that there is a far bigger scandal than anything that one individual doctor may or may not have been doing.

The scandal is that although this subject was debated in Westminster Hall just over two years ago, there seems to have been little or no progress. It is a scandal that the Government have made no further progress in asking primary care trusts to implement NICE guidelines. It is a scandal that a blind eye is turned to the actions that PCTs take to avoid implementing the guidelines that exist. I hope that the Minister will commit today to ending that scandal here and now by acting to resolve the problems that blight the lives of many.

It is a pleasure to speak under your tutelage again, Mr. Cook. I am delighted to follow the hon. Member for Romsey (Sandra Gidley), who is the major speaker here on this subject. I want to make one or two general comments and then talk about a conference that I went to before Christmas in London—it was the first of its kind—that opened a way up for improvements in IVF treatment and which gives us the chance to do much more to help people to have the children that they obviously desire to have.

I am supported in what I am about to say by Geeta Nargund, who is the head of the reproductive medicine unit at St. George’s hospital and the chief executive of the Health Education Research Trust, which is a women’s health foundation. It is an innovative charity that aims to change the lives of women across the world. It was founded specifically to focus on women’s reproductive health from puberty to menopause. It is empowering, proactive and holistic. I think that this country is leading the way forward in this regard, and I shall say more about that in a moment.

One in six couples in the United Kingdom has fertility problems, so for every 250,000 of population there is a need for about 250 assisted conception cycles per year. There is a true rise in infertility in this country and across the world. That might be about the age of the woman: women are putting off having children until later in life. As an individual ages, the cells and so on change, and there is less propensity for having a child. We have heard about sexually transmitted conditions such as chlamydia and about obesity, but we have not heard about sperm counts, which are going down quite dramatically in parts of the world. We have to realise that environmental factors may be involved in that. All those issues play into difficulties in conceiving. There are other major factors, of course, such as tubal damage. In many instances, we cannot explain infertility. There is also male factor infertility and so on.

I want to make the point early on that the increased demand for IVF in this country is partly due to the fact that we now have more cancer survivors who would like to have children following their medical and surgical treatments for cancer. Cancer is becoming a chronic condition, so young people who are going through chemotherapy and radiotherapy are asking for technology to help them to look after their eggs—I am afraid that we are into the frozen gamete area here—so that later in life, as they recover and become healthy, they are able to have children. That has become quite a common practice in parts of the country, and it will certainly be a demand not only from patients groups but from individuals. The demand for egg donation will increase because ovarian function ceases after certain chemotherapies and radiotherapies for lymphomas and other tumours.

I do not want to say too much about the population decline in this country and the birth rate, but there is concern that the birth rate is a mere 1.66 per woman, which is below that of our European partners. The arguments about the need for future citizens in this country, and about having a young population and work force, loom large in political circles. I shall argue that national initiatives are urgently needed to prevent infertility in men and women, and for fertility protection.

Geeta Nargund and her team called a conference just before Christmas, on 15 and 16 December, at which I spoke. It was held at the Royal College of Obstetricians and Gynaecologists, and was called the First World Congress on Natural Cycle/Minimal Stimulation IVF. Without being too much of a clever dick, I shall keep technical words out of this and explain simply what the conference was all about and how we learned from other countries what they are doing.

The conference was hosted in London by Geeta and others, and some 55 countries were represented. During the two days of the conference, we examined the new research that is going on in IVF and discussed the best way forward for a new regime in the management of IVF. A new society—the International Society of Minimally Assisted Reproduction—was also set up, which will take forward, on a global level, IVF issues such as how to make IVF safer for women and children and affordable to all. IVF is expensive for many, but the new research shows that it is possible to do many more IVF cycles on the NHS than was previously possible.

There are simple treatments for infertility other than IVF. I shall not go into this in detail, but intra-uterine insemination, for example, is still relevant in many cases. We need to ensure that IVF is simple, safer, affordable and successful. We have heard from the hon. Lady about ovarian suppression and stimulation, which were introduced 20 years ago. That process involves blocking ovulation so that more eggs are produced. There are then more embryos for transfer after they have been impregnated with sperm.

We have heard that single embryo transfer is on the agenda again to reduce multiple pregnancies. IVF babies are more likely to have a low birth weight and be premature even when they are singleton babies, so it does not help matters to have twins or triplets, which have an increased risk of having cerebral palsy. It is therefore important to reduce multiple births. The technology that I shall explain simply will enable that to happen. It stems from the interaction at the conference between different countries.

When women are given treatment to produce more eggs, they are often given hormones. The question is whether we are over-treating them with—let me use a few serious words—gonadotrophins and luteinising hormones. Those names will be familiar to some people in the Chamber. Are we overdosing people with those hormones either at that stage or when we fertilise in vitro? It was clear from the conference that experiments that have been conducted around the world show that we are overdoing it. What is the evidence? There is evidence that when there is hormonal stimulation, the early embryos—we can take samples and look at them—sustain chromosomal damage much more frequently than those produced without hormones. Some countries now say that we should minimise the use of hormones, or not use them at all.

In medicine, people get into habits because things have always been done in a certain way, so they think, “Why change it?” There is no doubt that there can be abnormal effects from overdosing with hormones. A lot of work is being done in that area.

I have been in quite close contact with a number of women who have experienced hormone treatment. The effects on women’s lives are horrendous, but they go through the treatment because they are so desperate to have a baby. If, as the hon. Gentleman believes, those women could improve their fertility by some other means, I am sure that that news will be very welcome. For some of them, things have almost got to the stage of breaking up the marriage.

It is true that women can be given minimal stimulation doses. I do not want to go into details about hormone dosages—just a little is needed, or none at all—but there are ways of carrying out the process without using the traditional technique that has been used for years. That knowledge is a result of the conference that was hosted in Britain.

There is agreement on the new process in a number of countries including Holland, Denmark and the USA—I have a list of the countries somewhere. They have been trying it out and have discovered that the conception and embryo transfer rates are just as good as under the old method. That means that we can have more cycles for the same amount of money, so the Treasury need not worry about being asked for more money. We can save a load of money; I shall show in detail how we can get more conceptions within the NHS for the same money.

What the hon. Gentleman describes is fascinating. What proportion of current treatments is he concerned might involve overdoses of hormone treatment?

In something like 40 per cent. of treatments, there is overdosing that need not occur. There are all sorts of side effects, not just headaches. As the hon. Lady said, women have to carry on at work while undergoing the terrible routine of receiving hormone treatment for weeks or months before the necessary oocytes, or eggs, are produced for use.

Women are put under tremendous pressure, but recent evidence shows that there is no justification for that, because the results with conception are just as good without that treatment. I do not place blame on anyone because in medicine old habits die hard. We are trying to change that through good research and showing that embryos produced using the new method are in better condition than those produced when there is over-stimulation using hormones.

How does this country compare with others in reducing hormonal treatment and going down the route described at the conference?

It is fair to say that when people from around the world spoke at the conference we felt, not shamefaced, but as though we had missed a trick or two, because they are producing better figures than us. Their conception rates are 50 per cent. better, and they have less recorded problems with side effects. We can argue about data, but it is important that an international organisation has been set up, and that people are looking at new technologies and trying to improve IVF. I am pleased about that, because nothing stays the same for ever. As we learn and experiment, we find things out, and it is nice that we can learn from other countries too. That international aspect really matters.

I return to the savings that can be made. According to the Human Fertilisation and Embryology Authority, there are about 40,000 IVF cycles in this country every year. Some 10,000 of those—25 per cent.—are funded on the NHS. So being able to attempt a conception without having to wait the dreadful lengths of time that many people have to wait is a rich person’s arena.

I understand that the average cost per cycle is £2,500, to which must be added the cost of the drugs, the stimulation, the other effects, and so on. The cost of the drugs is about £800 for women under 35 and £1,000 to £1,200 for those over 38. That is even the case if the drugs are block-purchased in hospital environments. That information was supplied by St. George’s hospital among others. It says that we could adopt low stimulation with a little bit of hormone involved—what is often called the semi-natural approach. Louise Brown was born in 1978 by the natural approach: sperm and eggs in vitro without any hormones being added.

Many people in this country have their babies by IVF and it is not something that one boasts about or talks about. Possibly the figures are not quite as accurate as we think. Others cut the figures all down, but if we were to do all the addition, it is reckoned that we would find that £17 million a year of the current costs of £35 million a year could be saved if the hormones are cut out. I will not go through the details because they have been made available in some of the talks and so on. That means that 30 to 40 per cent. more IVF treatment cycles a year are possible without an extra cash injection, and that is quite reasonable in ball park terms.

We must also add on the over-treatment effects on individuals of hormones; ovarian hyperstimulation is potentially fatal and there are about 1,000 cases a year of it in this country. NHS hospitalisation is a significant part of the resulting cost, which is estimated at about £2 million a year. That does not sound like many cases, but for the individuals concerned it is tragic. Some people might not require hospital admission, but many blood tests and other tests have to be carried out.

Without giving a conclusion, the conference said that we sometimes over-hype the tests that are carried out on women. Tests are carried out for all sorts of reasons. I will not go into the details, but many of them are not necessary. Some are necessary at the beginning of the process, but a year later they are repeated and that is costly to the NHS. We need to examine the evidence on whether some of the blood tests are necessary. The carrying out of such tests might be a habit, because of the way that people have been trained at medical school and the way that things happen in their hospital environment, so I mean no criticism.

My main conclusion is that big savings can be made because of the potential new treatments available. We must examine the evidence carefully and talk to the experts in this country. I am not sure that they worry about NICE; they probably just go ahead and do things without worrying. They say that it would be nice to have some kind of guidelines. We know that people generally behave differently with different drugs, and that tests can be carried out in that regard. It would be nice if there were some guidelines about how much hormone someone needs, bearing in mind the evidence that is being produced in other countries and so on. Such guidelines are not available to us at the moment. We take that approach in many other drug fields but not in this particular one.

Where does the hon. Gentleman suggest that the guidance should ideally come from? Is it from NICE or from the Department of Health?

The people at NICE are my best friends. They give advice on cycles but someone in the Department of Health needs to examine the evidence and then talk to NICE about it; they need to consider the guidelines process in respect of how all this is carried out. As technology, science and medicine move on, it becomes a continual process. The time is now right for that kind of regime change.

NICE produced guidance in 2004, the short version of which states the following in relation to the side effects of ovarian stimulation:

“Your doctor should use the lowest effective dose and duration for ovulation induction”.

As far as I am aware, unstimulated cycles lead to a lower chance of achieving a successful pregnancy, therefore if the NHS is routinely offering one cycle of IVF, as it does currently, it is difficult to persuade potential parents that they should accept a lower chance of pregnancy on that one cycle. We must think in the wider context of achieving the NICE guidelines in full, including giving access to three cycles. If we did that, we might be able to lower hormone doses, with the possibility of moving to unstimulated cycles to some extent.

It is true that we must give people the best treatment available, so that they have the best chance of conceiving and having a child. Sometimes the evidence runs ahead of the guidelines. In this case, the evidence is saying that we just might not be in tune with other countries on the specific guidelines. It is all right saying what minimal means but we must specify the micrograms per millilitre or use some such terminology to define it. After all, we all have experience in the field of health and safety, where one fibre in a given amount of cubic centimetres of air is a specific target. In medicine, we specify things in most areas relating to drugs, but that has not happened in this one.

Of course, the doctor and the staff have the final decision about the reaction that an individual might have to something, but sometimes we think that overdosing will give a better figure than underdosing. The cost-benefit analysis has to be taken into consideration, so we must think about new guidelines. But, as the evidence suggests, it does not follow naturally that reducing the amount of hormone means that one’s conception rate is less. In fact, in some countries it is better, because the effects of overdosing can suppress the development of the embryo and because chromosome damages occur—more kids have chromosomes missing, things go wrong in the embryonic development process and so on. That concept is not new; it is just that the evidence is coming through now.

The issue of giving treatment to infertile couples is something that we must consider seriously day by day. We must examine the evidence and so on. The evidence for minimal ovarian stimulation in terms of hormone illustrates a way forward. The cost involved is another characteristic. We know that savings can be made in the health service. I am suggesting that the evidence will allow them to be made in this area. The evidence is coming in from different quarters. It is not being promoted by industry. It is being carried out by people who are practising at the coal face. We owe it to infertile couples to give them the best treatment stemming from the evidence and we might not be doing so at the moment.

Order. This is a most absorbing and important topic. I can see that hon. Members are keen to give it full coverage, but I must remind them that the Chair is required at 3.30 pm to give the Floor to the first of the three speakers who will give the winding-up speeches. Two hon. Members are seeking to catch my eye. We have limited time left. I call Martin Horwood.

I shall try to limit my remarks in line with your guidance, Mr. Cook.

I congratulate my hon. Friend the Member for Romsey (Sandra Gidley) on securing the debate. She made a thoughtful and sensitive contribution to this important subject. It takes an effort of memory to think back to the birth of Louise Brown in the 1970s—the hon. Member for Norwich, North (Dr. Gibson) referred to that—to how controversial the idea of test-tube babies was then and to the misguided moral panic that existed about the science involved in IVF at its outset. We are now in a situation where life is given to 8,000 babies a year and joy is given to thousands more parents. That is a moral outcome if ever there was one.

Sadly, the situation in Gloucestershire is rather different. In effect, IVF provision has been withdrawn. Eighty local couples a year, who would have been able to undertake IVF treatment, can no longer obtain it. Twenty or 30 of them could have been expected to have successfully conceived children. Sadly, the reason for this situation is extremely clear, because the Gloucestershire health community laid it out in its service change proposal:

“We are putting forward these proposals because we believe that they will enable us to…Direct funding instead to other areas of greater priority for local NHS resources”


“Assist the health community to return to a sustainable position financially”.

That is despite the fact that Cheltenham and Tewkesbury primary care trust never had a financial deficit. The health community’s proposal was the chaotic overflow from the way in which NHS finances were addressed last year.

The service change proposal went through and resulted in the local NHS ignoring the NICE guidance, which it had followed for only a year. The guidance recommended at least one cycle of treatment for families undertaking IVF, and my hon. Friend the Member for Romsey was right to emphasise its importance in that respect. The guidance asks PCTs to work towards three cycles, not least because the National Infertility Awareness Campaign has said that offering only a single cycle reduces support among potential parents for single embryo transfer, which eliminates the risk of multiple births and the associated health risks. The hon. Member for Norwich, North rightly noted those risks, and the Human Fertilisation and Embryology Authority study supports him, saying:

“the failure to implement the NICE guideline on fertility (3 cycles of IVF for all eligible patients) is the major obstacle to the acceptance by patients and clinicians of introducing eSET policies in the UK”—

eSET being single embryo transfer.

In Gloucestershire, it is possible to see some light at the end of the tunnel. I have pressed the new Gloucestershire PCT, which emerged from the reorganisation, to reintroduce IVF, and it has promised actively to explore the issue. We hope that PCTs such as Gloucestershire—perhaps with the Minister’s support—will be able to reintroduce IVF in the not-too-distant future.

I realise that time is short, so I shall leave the Minister with three thoughts. First, I support my hon. Friend’s emphasis on the wider public health linkages between IVF and issues such as obesity. As we have discussed in a number of ways, that might provide a more natural approach to tackling infertility and allow us to take a wider public health view, rather than always taking the most clinical approach. Given the Minister’s experience in public health and her support for it, I am sure that that will resonate with her.

Secondly, given the accepted NICE guidelines at national level, I hope that the Minister will support PCTs that seek to reintroduce IVF. I also hope that she will lobby hard, so that the ferocious spending round that the Chancellor of the Exchequer has promised us in the next year does not disrupt the provision of local NHS services in the disastrous way that it did last year and does not again disrupt the timetable for reintroducing valuable treatments such as IVF.

Lastly, if new legislation is forthcoming on issues such as the reform of the Human Fertilisation and Embryology Act 1990, I urge the Minister to ensure that it does not curtail the scientific possibilities of infertility treatments. In that respect, the innovations to which the hon. Member for Norwich, North referred are instructive. Clearly, many innovations are being made, including in stem cell technology, and it would be a tragedy—indeed, it would be immoral—if new legislation accidentally, or even intentionally, curtailed the scientific possibilities, which have a very moral outcome, as I said.

Successful IVF has a uniquely wonderful outcome. I certainly have two fantastic, lovely kids, whose current obsessions include diggers and Barbie movies—one cannot have everything. I would not deny the joy of their lives or the joy that my wife and I experience as their parents to any family.

Thank you, Mr. Cook, for calling me. I also thank the hon. Member for Romsey (Sandra Gidley) for securing the debate, and I particularly enjoyed her factual outline of the problem that we are talking about. We are trying to persuade the Minister not only to take that problem as a fact, but to resource solutions more effectively. The hon. Lady’s speech was supplemented by the valuable input of my hon. Friend the Member for Norwich, North (Dr. Gibson), who clearly outlined, from a much more medical perspective than I could, the needs that he believes should inform the way in which we treat infertile couples.

I speak from a very personal perspective. I am infertile and I adopted my baby. Before that, I went through what can only be described as probably the worst five years of my life, when I hoped constantly, but I achieved absolutely nothing at the end. As you know, Mr. Cook, I adopted a little girl, and she is very beautiful. I am so grateful for everything that she has given me. However, the distress that women and couples go through has to be seen.

We talk of one in seven, one in four and one in six people being affected, but the absolute fact is that we just do not know the figures. We must all grapple with the fact that this is invariably an invisible problem, with which couples attempt to cope privately because they feel so embarrassed and shy and do not know quite how to cope. The effects are often devastating, and it is important for us all to understand that, so that we realise the value of each of us, in our different way, banging the drum and making this group’s case to the Government again and again. I was keen to make that statement.

The second statement that I want to make references my belief, which the National Infertility Awareness Campaign supports, that infertility is a disease. This is not about a person’s inability, manhood or womanhood, but about a physiological process or an organ. For those who face infertility, it is crucial that we understand that the last thing we should be saying is, “You have a problem.” Somewhere along the line, there is ambivalence about what that problem is, but infertility is a serious medical problem, which needs to be treated if possible.

I now chair the all-party group on infertility, and when one speaks to infertiles, one quickly becomes aware of their total incomprehension at the fact that they cannot conceive. In addition, there is total hope that modern medicine will deliver for them. Finally, there is total despair when no treatment comes up or works. Those “totals” are often extraordinarily destructive. Infertiles are unable to believe that no one can diagnose their problem or that someone somewhere cannot resolve it. It is important for us all to understand just where people are in this debate.

The House has been very vocal about the issue of infertile couples and very supportive of them. The all-party group was set up by the hon. Members for Romsey and for South Cambridgeshire (Mr. Lansley) and has helped the campaign to educate and inform Ministers, Back Benchers, the public and the medical profession about the issues that they are attempting to handle. It has been incredibly valuable, and it now has 45 members, who are split between the House of Commons and the House of Lords. We have had support not only from Back Benchers and peers, but from Ministers and, indeed, Secretaries of State, who have made clear statements about the desire to see treatments put in place and work, so that people have the opportunity to conceive and to have the family that is so precious to them. Today, however, greater numbers than ever are infertile and they are unable to achieve a conception and deliver that most precious of things that they want—a family.

We have had statements from the Secretary of State for Health, who clearly supported the request from NICE with respect to the full implementation of the guidance on

“equal access for those with an established clinical need to a full range of services for the investigation and treatment of infertility”—

all free on the NHS. A second statement said that, when that investigation has achieved a conclusion, if it is considered appropriate, in vitro fertilisation should be the next step and a full cycle of IVF should be made available to couples. That was a staggeringly valuable and important moment for ordinary people who are desperate for that one thing.

However, PCTs do not or cannot support both statements. Either it is a financial matter, or it is a policy decision that they do not support. When we surveyed PCTs many of them simply did not respond, and we are left to think that that was because infertility is a low priority for them. We wanted to know where their struggles or concern arose, but they did not respond. Also, in discussing this question, PCTs ask what a full cycle means—one embryo implantation or three? There is worrying ambivalence, and not because those involved take the view that one course of action is cheaper and they will choose it; they believe that it is appropriate, and they put the treatment in place. Thus PCTs are not adopting the procedure that the Secretary of State has supported.

PCTs also tell women that they must be over 30—or sometimes over 34 or 36. I do not need to repeat what the hon. Member for Romsey said. The ability to conceive is growing less and less at that age, but a 22-year-old who has undergone all the treatments and diagnosis will be told, “Sorry, you have to wait.” That is not a sensible approach, and I am appalled that, 30 years on from my infertility treatment, I face the same hideous black, blank walls that I faced all those years ago. That is unacceptable. I ask the Minister today to impose compulsion—a regulation—on PCTs to do one easy thing: there should be open and clear evidence of the priorities that they define. We should know their stated priority for their locality. It should be open and unequivocal, so that we can see where their priorities lie. If there is a problem financially, let us hear about it.

In the north, we have the very valuable Centre at Life in Newcastle, with Professor Alison Murdoch. It is an incredible research-based institution that does state-of-the art development work. People in Newcastle and the surrounding area are getting the best of treatments. That is not the case for people in Stockton today.

I am very keen to acknowledge what is being done, but also to point out that what is being done is often ambivalent and unclear. Sometimes decisions are not being implemented. We do not have a national health service that treats infertile couples equally. Some people have that treatment; others receive a minimal service, and some pay through the nose for a service. It is not free; it is certainly not fair, and it is not equal. I ask the Minister to acknowledge that, and to insist that the PCTs should publicise in an open and transparent way which treatments they regard as appropriate when they engage in commissioning and use their funding. I ask her to state clearly—to make a formal regulatory statement—that all PCTs should acknowledge three embryo implantations to be the formal definition of one cycle, so that the ambivalence is removed.

I also ask the Minister to consider the Human Fertilisation and Embryology Authority with great caution. I have great concerns about much that comes out of it, and the White Paper consultation should involve taking note of what the medics in the profession are saying. I hope that that is what will happen.

I argue with passion, and I hope that I have not gone too much over my time. I have been involved in this issue for 30-odd years. I was so pleased when the Labour Government decided that funding should be made more available and that IVF cycles should be clearly defined as appropriate for infertile couples, but I am quite distressed to have to tell the Minister that we need a clearer, more careful examination of the treatments that are offered to our constituents, and we need very firm handling for PCTs when they are defining treatments as appropriate or inappropriate for those people.

It is a pleasure to follow the hon. Member for Stockton, South (Ms Taylor), who made a passionate speech based on her personal experience. She obviously knows the subject well, having followed it through the years. I strongly support what she said about the importance of openness in the setting of priorities by PCTs. At the moment, there is not the transparency that the public need.

I congratulate my hon. Friend the Member for Romsey (Sandra Gidley) on securing the debate. I found the debate fascinating and—as you said earlier, Mr. Cook—hon. Members are clearly well informed. It has been a pleasure to listen to the contributions of all the hon. Members who have spoken. My hon. Friend talked about the great public support for NHS treatment. We might not automatically assume that such support exists, but the evidence so far shows it does. She also referred to two surveys—her own and one by NICE. I am sure that they are both equally authoritative; but both found slow progress in implementing the NICE guidelines. That should be of concern to us all.

My hon. Friend mentioned the possible boost to the economy—and referred to academic support in that context—and discussed whether infertility treatment should be considered as part of a population strategy. I was fascinated by the point that she made about combining single embryo transfer with the introduction of three cycles to give the maximum chance of success.

It was fascinating to hear about the experiences of my hon. Friend—perhaps I may refer to the hon. Member for Norwich, North (Dr. Gibson) in that way—and particularly about the conference that he attended just before Christmas. It seems that we can secure a better success rate and greater safety for women at lower cost to the NHS—a win-win-win situation—if we can follow the guidance that emerged at the conference. It was interesting to hear of the international comparisons, and the overseas evidence that it is possible to achieve a higher success rate with lower hormone use.

The side effects of overdosing on hormone treatment are a matter of real concern, and I ask the Minister if she can respond to the evidence we have heard about that today. Will she explain what the Department is doing to follow best practice from overseas and ensure that we maximise the availability of NHS treatment by reducing the cost as much as possible in that way? I think the hon. Gentleman described that much safer approach as semi-natural, and it is an attractive proposition.

I come to the subject with no great background knowledge, and I was amazed when I realised quite what proportion of couples need help—one in six or one or seven, or possibly one in four, as the hon. Member for Stockton, South mentioned. I am acutely aware of the pain and distress that infertility causes—the hon. Lady referred to the despair that is felt. She described infertility as a disease, which is how it ought be considered so that we overcome the hurdle of it seeming like an optional extra for the NHS. That was an interesting way to describe it.

On international comparisons, I was interested to note that in the UK there are about 580 cycles of fertility treatment each year per million of the population, whereas in most other northern European countries there are about 1,050 per million—getting on for double the rate. In Denmark, 3.7 per cent. of babies are born as a result of IVF treatment, whereas in the UK the figure is just 1 per cent. I shall return to the economic case for at least considering a debate on extending the availability of IVF treatment.

I appreciate that the 2004 NICE guidelines were not mandatory, but were set out as an objective. However, they gave the clear statement that there should be three cycles of stimulated IVF treatment for women between 23 and 39. We all support NICE and see it as a wonderfully independent, objective basis for determining what the NHS should be doing. It seems contradictory, then, effectively to ignore its judgment in practice. It is not ultimately being followed. The Government supported the guidelines and gave a positive response to them, mentioning a phased introduction of the target of three cycles.

My hon. Friend the Member for Cheltenham (Martin Horwood) mentioned the evidence from around the country on the impact of deficits. Before Christmas, in its report on deficits, the Health Committee said that soft targets suffer most when trusts are deep in deficit. Answering a question recently, the Minister said that Gloucestershire, North Lincolnshire and Northamptonshire PCTs had all suspended fertility treatment. I ask her for an update on that: are more PCTs going down that route? I know that many have deep financial difficulties because of historic debt and that it is tempting for PCTs to do that. However, it is not sensible or right. Is the Minister sending PCTs any advice or guidance on the matter?

There has not been central guidance from the Department of Health to strategic health authorities or PCTs on implementing the NICE guidelines. Is such guidance expected and, if so, when? My hon. Friend the Member for Romsey mentioned that there has not yet been guidance on how to prioritise treatment for patients of varying social criteria. We heard earlier that the then Secretary of State introduced a social criterion immediately after the introduction of the guidelines by saying, effectively, that fertility treatment should not be available to families that already had a child, even one born to only one of the parents. Is that where it will end or will there be more objective criteria for determining the social factors to be taken into account?

I wish to mention the value and importance of information for couples. It is critical for couples to be given good-quality information on the optimal age range and matters such as the impact of smoking, alcohol, caffeine consumption and body weight. People ought to be informed about such things so that they can make better judgments and improve their prospects of giving birth.

I turn briefly to economic issues. We are experiencing low birth rates across the developed world. I was fascinated by what the hon. Member for Norwich, North said about the reasons for the decline in birth rates: the impact of sexually transmitted diseases, a reduction in sperm count for whatever reason—

That might be an affliction that the hon. Gentleman suffers from.

Birth rates are now frequently below replacement rates, which poses big questions for Governments in the developed world. At the same time, we have an ageing population. The ratio between the working and retired populations is changing to a disturbing degree. I am not sure whether it has been as a direct result of that, but part of the solution has been immigration. People of working age have come to this country, which has helped to increase the productive work force and to support the retired, ageing population through taxation. However, given current population trends, that is not enough. Any cuts to welfare entitlements will be heavily resisted and the pressure on Governments will be intense, considering the extent of the ageing population and the reduction in the proportion of people in work.

Another consideration is whether one can do anything to raise fertility rates. There should be a debate about whether extending the availability of IVF treatment should be considered in the mix of policy approaches. This is a growing problem for the western developed world. What are the Government doing to research that big policy area and what issues are they considering?

This has been an absolutely fascinating debate and I have learned a lot. There have been impassioned pleas for more to be done to ensure that people get access to treatment, and the chink of light at the end of the tunnel is that it might be possible to do so without inordinate cost to the NHS. That is the potential prize, and I will be interested to hear from the Minister what the Government are doing to ensure that we secure it. Apart from anything else, we should do everything that we can to resolve the personal pain and anguish that couples go through.

I share with others the sense that this has been a good and timely debate. I, too, congratulate the hon. Member for Romsey (Sandra Gidley) on initiating it. We are about two years on from the last time this subject was debated here in Westminster Hall and approaching three years from the point at which the NICE guidelines were promulgated. It is important for us to take stock—I was going to say of the progress, but to some extent it is the lack of progress, that has been made since then.

It has been said a number of times that the Government welcomed the guidelines but, as I said at the time, they welcomed NICE’s production of them and immediately, as it were, removed two of the three stumps. There is no point in asking NICE to produce guidelines and then for the Government—the then Secretary of State himself—to strip away one of their central conclusions. The guidelines stand together.

It has not been mentioned that the reason why three cycles of IVF are recommended is that that maximises the chances of success. Beyond three, the chances of success are subject to a law of diminishing returns. Going down to just one cycle means that there is probably half the chance of success of three cycles, yet the NHS is likely to have invested considerable effort in diagnosis and early investigations, much of which is likely to be wasted. There is a central point there about the NHS and NICE examining what is clinically and cost-effective.

The hon. Gentleman is absolutely right when he cites the financial investment and investigation process that precedes that one cycle. It is much more cost-effective to provide three. However, there is also the family’s emotional investment, which again builds up to just one cycle. It is much more effective for them, too, if there are three cycles.

That is right. Indeed, the hon. Member for Stockton, South (Ms Taylor) reminded us of the sense of distress—of a disease, as it were—that can be occasioned for couples who are infertile. They have a profound sense that the NHS is not there for them. As vice-chair of the all-party infertility group, I am glad that the hon. Lady was present to make those points. We have all discussed surveys, and the group undertook its own survey of primary care trusts in early 2005, producing what I think were authoritative results.

Two years ago, the then Public Health Minister said in this Chamber:

“Where existing provision is greater than one cycle—that is, two, as in the Rother Valley constituency—we expect provision to continue at least at that level.”—[Official Report, Westminster Hall, 26 January 2005; Vol. 430, c. 109WH.]

That is, from April 2005 onwards. One distressing result not mentioned is that, of the results that the all-party group received, 20 of the PCTs that funded more than one cycle intended to reduce their provision to one cycle from April 2005. Unless I am very much mistaken, a number of PCTs are still doing so. If they are not, I hope that the Minister will tell us. However, the concern continues.

Does the hon. Gentleman agree that all that argument might be irrelevant if it were proven that three cycles were no better than one cycle, minus the hormone stimulation received three times, and the fact that the individual’s recovery rate was better and the embryos were in better nick than they would have been after three loads of hormone treatment? Perhaps the evidence shows that once is enough.

I share the sense that the NHS should do what is most clinically and cost-effective. It is NICE’s job to do that. People say that the Department of Health should undertake research, but that is NICE’s job. It routinely revisits its guidelines to take account of the cost-effectiveness of single-embryo transfers—the cost-effectiveness evidence that the hon. Gentleman puts forward on minimally stimulated ovarian cycles. Bourn Hall clinic, where Robert Edwards and Patrick Steptoe began their work on IVF, is in my constituency, and I have seen its success rate with blast-assist transfers. There is a lot of potential, and it must be incorporated in the NICE guidelines.

To return to my central point, what is the point of asking NICE to revisit the guidelines and publish new ones if the Government still say that NICE guidelines will be superseded by statements from the Secretary of State? That is what they have done. Most PCTs have no intention of implementing the NICE guidelines in full and they have no timetable for doing so.

The hon. Member for Cheltenham (Martin Horwood) mentioned Gloucestershire, where IVF has been effectively suspended. As he may recall, the then Cambridge City and South Cambridgeshire PCT did so in the latter part of last year, too. It reinstituted IVF availability, but it is currently rationed. There might be 300 to 400 couples who require IVF each year, but the number has been restricted to 200. People simply go on to a waiting list, and more people are joining it than there are IVF cycles available.

The hon. Member for North Norfolk (Norman Lamb) asked where IVF is not available, and the Minister may know. I know that when I was in Yorkshire two weeks ago, GPs handed me a document dated 22 December from the North Yorkshire and York PCT, which said, among other things:

“With immediate effect, the PCT proposes to suspend the routine commissioning of a range of surgical and other treatments for a range of common non life threatening conditions.”

I did not know that the NHS had arrived at the point where it treated only life threatening conditions, but it seems to be true. IVF is listed under the heading “Suspension of Services”, so it will not be available in North Yorkshire, except

“where the female partner is nearing the upper age limit of 40. Where this is the case the referral should be sent to the PCT Exceptions Panel for consideration. The PCT will work with providers to ensure that eligible patients are still able to receive treatment before they reach the upper age limit.”

Treatment is being deliberately withheld from couples until the woman approaches 40—when the chances of success are reduced. The PCT has instituted an outrageous situation. I know that it has financial problems, but that path is deeply inequitable.

To be fair to the Minister, we have discussed the matter before and she has raised it before. She wrote to PCTs in June last year, when she rightly said that

“persistent inequality of provision is hard to bear, and hard to understand for those affected.”

The question is, what is being done about that? The inequalities persist, and some are being exacerbated by the way that PCTs respond to financial circumstances.

Will the Minister tell us how the Government are to respond? If she says that they are dropping the guidance that the Secretary of State gave in February 2004, that April 2005 meant one cycle of IVF and that in April 2008 the NICE guidelines will be available as intended, it will not cause every PCT to adhere to the guidelines straight away, but it will incorporate into the Healthcare Commission’s scrutiny of PCTs the question whether they comply with NICE guidelines. The enforcement of NICE guidelines is important.

Back in February 2004, the Prime Minister said not only what the hon. Member for Romsey said he said, but added:

“In the longer term, however, we think that we can extend it”—

the availability of IVF—

“even further, but we will release details of that when we are ready to do so.”—[Official Report, 25 February 2004; Vol. 418, c. 278.]

We are three years on. Are the Government ready?

I have two more questions. Sources of infertility are terrifically important, and we have discussed the doubling of chlamydia rates over recent years. The Minister has told us that at the end of June last year, 36 per cent. of PCTs had rolled out chlamydia screening. The target—intention, perhaps I should say—is that by the end of March, 100 per cent. of PCTs should do so. How many have done so now and will the 100 per cent. figure be reached by the end of March?

Another source of the lack of infertility treatment is the lack of availability of egg donors and sperm donors. The National Gamete Donation Trust said in October last year that the average wait throughout the country is two years and that it is very concerned about the lack of donors. The Minister knows that I objected to the removal of anonymity. Will she, even at this stage, accept that we should discuss the subject during the review of the Human Fertilisation and Embryology Act 1990?

I have a final plea. We understand the nature of the distress that we cause couples who are infertile. The NHS should be there for them—we believe in equitable access—but currently access is deeply inequitable throughout the country. Will the Government produce a means to overcome the inequity and the dreadful social criteria that are being introduced? They must do so before a case is brought, as one will be.

Let us take, for example, a couple who have children. The man has children from a previous relationship, but the wife, in her second marriage, has none. She could go to court and seek protection under the European convention on human rights and her right to family life, and I am pretty sure that she would have all the social criteria overturned. Why should we wait until such a case is brought before the Government do what is necessary?

This has been an interesting debate during which many issues have been raised helpfully and constructively. We have heard about what is and is not provided at the moment, and the debate has shown the extent to which the commissioning of such provision is informed by the best possible evidence of the most effective forms of treatment. I shall touch later on the question of how that process is informed by the prevention of problems with fertility—a point made by several hon. Members. Key to all this is how we get the best value for money.

In some small way, I hope that I can reassure hon. Members. Through the three years of work that I commissioned with Infertility Network UK, which began last year, I hope to find out what is happening to primary care trusts and look at the best possible practice—as well as some that is not the best—to try to answer some of their questions or go some way to debating further social criteria, the commissioning of services and the levels of hormones used. I was glad that my hon. Friend the Member for Norwich, North (Dr. Gibson) raised that last issue. My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) brought it to my attention when she grabbed me in the Lobby to ask whether I was aware of the conference that has been mentioned.

To follow up this debate, I would like to ensure that my Department is aware of what is being discussed at that conference—I have no reason to suppose that it is not—and I hope that we can share that information with NICE, if that is not happening already. NICE will review the guidelines in 2008, and there are clearly several issues that could be looked at. I want the best possible commissioning process because there is wide variation, which I am sure many hon. Members know already.

There seem to be different levels of expertise in the commissioning of services for infertility and, on the other side of the coin, good examples of PCTs getting together to commission in a wider area, so they can share expertise and strengthen their commissioning. There are clearly very good results in certain parts of the country compared with others.

All those issues are important, and although we are dealing with the here and now, we have a responsibility to take a breath, tackle all the issues and see how they fit in with how fertility treatment can be better provided in the 21st century. It is fair to say, regardless of all the comments made this afternoon, that the NICE guidance was the first of its kind. For too many years, fertility services—how they are commissioned and purchased, and how patients are dealt with—had been left pretty much to their own devices. The NICE guidelines are not the end of the story. In some ways, they were the beginning of the challenge to discuss the issue in as rounded a way as possible.

The hon. Member for Romsey (Sandra Gidley) commented on what the then Secretary of State for Health said about one cycle of IVF, which was reflected by the comments of the hon. Member for South Cambridgeshire (Mr. Lansley). In many respects, that was an attempt by the then Secretary of State to be helpful in a situation where NICE recognised that moving to three cycles was not going to happen overnight, by any stretch, and it was also in recognition of the fact that some PCTs were not even offering one cycle.

Those comments, which may have been taken out of context, were that those PCTs that were not providing any cycles should at least attempt to provide one. In respect of couples living without children being a priority, again, I think that the then Secretary of State was trying to be helpful by not ruling out other couples and their family circumstances from being taken into account.

The hon. Member for Romsey, whom I congratulate on securing the debate, asked about trusts varying their criteria on social questions. That is an interesting point. NICE advises on clinical terms, but we are considering the question through the work that we are doing with Infertility Network UK to see what variation there is in relation to the social questions that are asked. In part, that goes to the heart of the issues raised by my hon. Friend the Member for Norwich, North about the science, the evidence and the most effective fertility interventions.

Should we put all our energy into using three cycles, or is one cycle better and more effective? I do not know the answer to that question, but it is worth exploring further. Due to the nodding that I saw during my hon. Friend’s contribution, I think that it is worth looking into. It could inform us better on how to proceed, and might lead to better consistency in the NHS in the commissioning of services. There remains a question of where social conditions fit into that process, as regards age and other issues.

I do not have to tell hon. Members this, but we have enormously increased the funding available in the NHS. In 2007-08, we shall put in £92 billion, and there has been a real-terms increase of 92.5 per cent. over this Government’s 11 years in office. Are people using that money wisely? I totally understand the comments made by the hon. Member for Cheltenham (Martin Horwood) and the concern in his constituency, where IVF services are suspended while financial deficits are dealt with.

Hon. Members have asked me whether more can be done about prevention. Chlamydia, for example, is a major source of infertility problems, and if we could do something about it, we might reduce the pressure on the waiting list. However, whether we are dealing with fertility services or public health, if we are to find the space and money to devote to those areas, the NHS has to reform how it runs its finances. There is no hope for services such as IVF and public health in other areas—

I am not going to give way because I only have three minutes left. There is no hope if we do not take a hold of what, in some cases, has not been an appropriate use of resources or where resources have not produced effective outcomes.

I am afraid that that is the case. We need a financial balance to create a level playing field, so that we can look at a different way of providing health services for the future.

If I have missed any questions, I am happy to write to hon. Members about them. However, I want to say the following in the short time I have left: what I have done to move the debate forward is fund Infertility Network UK to work with PCTs over a three-year period to identify what is happening on the ground. I recommend all hon. Members, including those who have not been part of the debate, to check that their PCT has answered the questionnaire—a point raised by my hon. Friend the Member for Stockton, South (Ms Taylor). I was happy to meet colleagues from the network recently to talk about how the survey has been going. I have done that with my own PCT, and asked it to copy me in to its response to the network.

We need to look at what is happening to services on the ground, and to social conditions and criteria. Once we have that information, the next step is to feed it back to the NHS and PCTs, and use it to look at where best practice is happening to inform, in a constructive way, those who may not be providing best practice in respect of what they can learn. It would be worth including in that information this afternoon’s debate, particularly the points made by my hon. Friend the Member for Norwich, North, to explore that process further.

Infertility Network UK knows that it is part of the work that will go towards the implementation of the NICE guidelines. The network’s particularly valuable engagement allows the voice of patients to be heard, which is very much part and parcel of what it sees as good practice for the future. Through an agreement with me, it is also considering chlamydia services as part of its survey, so we can take a twin-track approach by considering how important chlamydia screening is in reducing the pressure on services by treating it earlier and by consciousness-raising on the links between chlamydia and fertility to prevent chlamydia in the first place. That is supported by the Department’s sexual health campaigns, too.

We are trying to create an environment, which might not be that well recognised, where the debate can go beyond firefighting to something that is more sustainable for the future, more informed, more effective and more cost-effective.