Motion made, and Question proposed, That this House do now adjourn.—[Huw Irranca-Davies.]
I am grateful for the opportunity to raise a subject that is dear to my heart and to that of many people throughout the United Kingdom—IVF treatment, especially that provided by the national health service.
In February 2004, the then Secretary of State for Health announced at the Dispatch Box that he was minded to accept recommendations by the then National Institute for Clinical Excellence to provide at least one cycle of IVF on the NHS for infertile couples throughout the country. I remember the announcement not because I sat here—I had not been elected at the time—but because my wife was pregnant with our twins, who were born through the IVF procedure. I turned to her and said, “This is great news. I’m so delighted by today’s announcement.” The anxiety caused by IVF treatment is roughly split into psychological effects—it is an enormously stressful time for women, and couples in general—and physical effects. It is a punishing schedule, what with all the drugs that have to be taken, the waiting and the invasive procedures.
The other element of IVF treatment is its financial aspect. I was delighted by the then Health Secretary’s announcement simply because others would not have to go through some of the stresses and strains that we had to undergo in funding several IVF cycles. The twins came on our third cycle. We already had an older boy through IVF.
I therefore looked forward to couples not having to undergo at least the financial aspects of the stress and trauma. However, I was contacted last year by constituents in Hatfield, Mr. and Mrs. Smalley, who said that they had been trying to obtain IVF through the NHS and could not understand why the primary care trust was turning them down. I did not know the primary care trust’s criteria, so I contacted it and got a copy. There were 12 different points that the Smalleys would need to fulfil to get IVF treatment through the NHS and I sent them to the couple. They came back to me and said that they believed that they qualified on all fronts. They went back to their doctor, were told that they indeed qualified on all fronts and applied again for IVF on the NHS. Again, they were told that there was none available through our PCT, which was the Hertfordshire primary care trust. That did not make sense, so I wrote to the chief executive to try to gain some clarity. He insisted that, as long as my constituents fulfilled the criteria, they could get the treatment. I told them, they returned to their doctor and the whole thing went round in circles again.
We are now at the end of March 2007, and Mr. and Mrs. Smalley have yet to receive any IVF treatment through the NHS, despite the fact that they appear to qualify on every count and despite the Secretary of State’s announcement at the Dispatch Box three years ago that infertile couples could get at least one cycle on the NHS, within specific criteria, which Mr. and Mrs. Smalley happened neatly to fulfil.
I therefore decided to look further afield and discover whether we were considering an isolated case or whether it was a problem throughout the country. I undertook some research, which ended up in a report that I entitled, “The Messy Business of Conception”. It deals with the picture throughout the country. I have the raw data, which now cover nearly 90 per cent. of PCTs. They have given us their list of criteria, such as the age groups they accept and whether a couple who already have children through their relationship or another can have IVF. The raw data make up the document, which I have subtitled, “How the Postcode Lottery in NHS IVF Treatment is Creating ‘Baby Boundaries’ for Childless Couples”. Sadly, that is exactly what has happened three years after the Secretary of State announced to the House that everybody could have a cycle of IVF on the NHS.
Some stark examples illustrate that. A woman who happens to live in Luton and is 35 would probably be told that she is too old to have IVF. However, if the same woman lived in Hampshire, she would be told that she is too young to have the treatment. There are huge disparities between different areas.
The hon. Gentleman raises an important subject, of which my constituents are acutely aware because Gloucestershire’s PCT does not fund IVF routinely, as I hope that his survey reveals. How many other PCTs like mine made the decision as a result of short-term financial problems, not policy, despite the fact that, in Cheltenham’s case, the original PCT did not have a deficit?
I have all the criteria here—whether people are 30 to 39 years old, and so on and so forth. The trust said that it still provides the treatment. I suspect that the hon. Gentleman’s point is at the heart of the problem of establishing how many PCTs do, in fact, provide this treatment and how patchy or otherwise IVF provision is across the country.
The report officially names three PCTs that say that they do not provide IVF treatment. Subsequent to the report’s publication, we found a further three that no longer provide it, either on a limited basis until the new Budget arrangements come through or perhaps on a permanent basis—we simply do not know yet. It is the first I have heard of Gloucestershire PCT, so I will check it out and add it to the list.
I am grateful to my hon. Friend for his campaign and for drawing national attention to the lack of treatment for IVF. Does he agree that it is even worse in Northamptonshire because IVF treatment was available last year, but is no longer available because of financial cutbacks? When it is introduced again next year, the age criteria will be tightened. It is in many ways worse when couples who thought they were going to get IVF treatment from the PCT do not get it.
My hon. Friend is right. Arbitrary rules and regulations that were originally designed to fit in with expert medical opinion have now been twisted to fit not with medical opinion, but with the financial realities of the PCTs. I suspect that that is exactly what happened in my hon. Friend’s PCT.
That brings me to the wider picture of the patchiness of the service across the country. The survey reveals, as other contributions to this evening’s debate have suggested, that rather than IVF moving forward by being more and more available throughout the nation, it appears to be moving in the opposite direction. It is a service very much in retreat, where PCT after PCT is no longer offering the service that constituents legitimately have a right to expect.
In fact, because of the Secretary of State’s statement that IVF was going to be freely available across the country, people rightly expected to be able to visit their GP and receive the service. In reality, it might have been better if the Secretary of State had thought twice before making such a statement. I hope that the Minister will acknowledge the point—I say it with some personal experience—that if infertile couples’ expectations are raised and they believe that they can go to their doctors for referrals to an IVF specialist, they will expect to receive the treatment. If they are unable to, it will leave them worse off than they would have been if the Secretary of State had not stood at the Dispatch Box and made it sound as if the service was to be universally available.
I am afraid that what we are probably talking about is simply the latest priority. Back in February 2002, it happened to be provision of IVF treatment, but it was piled on top of other priorities that changed again later. For example, I was studying the position of audiology treatment the other week and discovered that it took an average of 40 weeks for people to get hearing aids fitted. Then the Government issued their review and decided that there should be an 18-week target—[Interruption.] If the Minister listens, she will understand my point. What happens is that, week after week, month after month, new priorities are set from the Dispatch Box, but they are willed without the means to make them happen.
Before anyone suggests it, this is not a matter of my standing here calling for additional resources. What I am saying is that it is wrong falsely to raise the expectations of couples who are often in the desperate situation of wanting to have IVF treatment to help them have children, only to find, when it comes to it, that they are unable to get it.
As “The Messy Business of Conception” has revealed, the way in which the process is operating has set up baby boundaries across the country. In some areas, couples can confidently expect to receive IVF assistance, but in others, entirely arbitrarily, they will be unable to get that treatment. It is unfair for those couples to be treated in such way and sets entirely the wrong expectations. It is incumbent on the Government to do something about that, and I know that they are interested in doing so: the Secretary of State for Health has said that the Government will listen carefully both to my report and representations from Infertility Network UK, which is being funded to do work that I am sure that the Minister will tell us about.
That is all good stuff, but unless a framework is set that delivers the policy on the ground rather than handing it over to PCTs and piling on another target—and we have heard the Government say previously, “If they can’t spend the money correctly, we can’t help them”—baby boundaries and the NHS postcode lottery in IVF are set to continue.
I congratulate the hon. Member for Welwyn Hatfield (Grant Shapps) on securing the debate. The hon. Members for Cheltenham (Martin Horwood) and for Wellingborough (Mr. Bone) have also made significant contributions, and some important points have been raised. I agree that we all wish to see the considerable resources available to the NHS used, in part, to increase the provision of fertility treatment for those who would not otherwise be able to conceive. Certainly, the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), gave the issue considerable attention, even before the survey by the hon. Member for Welwyn Hatfield was published.
In a number of areas, people’s expectations of fertility services are not matched by the provision of those services. There is variation from locality to locality. Undoubtedly, local needs and priorities are issues, and it is right that PCTs take them into account when allocating resources. The NICE guideline does not rule out variation in provision and, unlike a NICE technical appraisal, is not mandatory, although we recognise that it is of great significance to those who have fertility problems.
The profile of fertility services was raised by the publication of the NICE fertility guideline in 2004, commissioned by the Government. No previous Government had taken such action on the matter. Disappointment remains in some areas, however, for some people with fertility problems. As I have said, some of that is due to PCTs considering local needs and priorities and making decisions accordingly. We certainly recognise, however, that there is room for improvement, and that enabling patients’ voices to be heard in decisions about priorities is an issue.
The hon. Gentleman’s survey refers to Hampshire as an area where provision is limited to couples in which the woman is in a specific age range. Not long ago, however, Hampshire provided no IVF treatment at all. Most PCTs are now funding a minimum national level of one cycle of IVF, although, as I have said, that is subject to some variation.
We are trying to work with PCTs to ensure that there are improvements if provision is not meeting the guideline. It is right to say that bringing those services into line with the NICE guideline is taking longer in some areas than in others.
The hon. Member for Welwyn Hatfield referred to the NICE guideline and the Infertility Network UK project. When the NICE fertility guideline was published, we advised the NHS that those PCTs that were providing no IVF were to offer a minimum national level of one cycle of IVF, and that all PCTs should progress to full implementation of the guideline in the longer term. Opposition Members asked whether the NHS was ignoring that advice in some instances. It is true to say that there is room for improvement. One way in which we want to address that is to look at those PCTs that are successful in implementing the guideline and to learn lessons from them.
I believe that there is a sincere effort to improve the service, and the work that is being sponsored and done by Infertility Network UK is to be welcomed, but does the Minister agree with the findings of the report, and additional findings since, which suggest that the service is retreating? NHS provision of IVF probably got better initially, but it is now getting worse.
There is certainly variation. The purpose of the programme that we are trying to carry out is to address where IVF might have been given greater priority but, for one reason or another, problems have occurred, perhaps because of the local decision-making process. As I said, the Minister of State, as Minister with responsibility for public health, recognises that there are lessons to be learned from some PCTs. As the hon. Gentleman acknowledged, in 2005 she met a leading patient group, Infertility Network UK, and discussed the provision of IVF and what we could do to understand the difficulties in some areas and how we could get greater consistency. That is why she invited Infertility Network UK to work with the Department on a specific project to consider the strong areas of IVF provision and those that are not so strong, first, to identify good practice and, secondly, to share good practice between PCTs.
Infertility Network UK is working towards making the expertise developed by some PCT commissioners available to all. It will shortly be working directly with some PCTs to ensure—this is the crucial issue—that the patient’s voice is heard at a local level and to look at best practice on the implementation of the guideline. It is right to say that the starting point for Infertility Network UK is that some PCTs give higher priority to IVF than others. There may be many complex reasons for that. For example, Cheshire and Merseyside PCTs carried out a major consultation exercise in 2005 on access to NHS-funded fertility services across their areas. A number of public meetings took place, and the outcome was the decision to provide two cycles of IVF in appropriate areas. We want to establish whether other PCTs have done the same and concluded after consultation that IVF is not yet a priority in the areas concerned, or whether there has been too little consultation. We are trying to identify the differences in approach, and how they relate to the differences in outcome.
Another aspect of the PCT project is also very important to prevention. I refer to Infertility Network UK, which will ask about PCT plans to implement the chlamydia screening programme which is being introduced throughout all PCTs during the year. As the hon. Member for Welwyn Hatfield may know, untreated chlamydial infection may have serious long-term consequences, especially for women, in whom it is a well-established cause of pelvic inflammatory disease, ectopic pregnancy and infertility. Tackling the prevalence of chlamydia through the screening programme is one of the key commitments in the “Choosing Health” White Paper, and we are investing an extra £80 million in it. That is a clear signal of the Government’s commitment, and supports our broader strategy to improve sexual health in the population as a whole.
I am grateful to the Minister, who I think was agreeing with me that the IVF service may be somewhat in retreat, although it is trying to remedy its problems. Is she aware that Infertility Network UK itself agrees with my proposition that the service is in retreat?
Obviously the Infertility Network UK project is reporting back to Ministers, who will examine its findings carefully. That may arise in what I am about to say about how the project will work in practice.
As the first stage of the project, PCTs have been sent a questionnaire by Infertility Network UK to establish their current provision and practices. The figures are being analysed, and my hon. Friend the Minister of State will examine them closely. We will then convey them to the NHS, which will use them as a basis for assessing some of the variations in provision. I am happy to say that Doncaster PCT has responded to the questionnaire. Members may wish to ask their own PCTs whether they have done so as well.
The next stage of the project will involve direct contact between a member of the Infertility Network UK project team, with a patient and a clinician, and the NHS. In some areas that will mean visits to PCTs for more in-depth discussions about the situation and an exchange of information. We will emphasise the importance of patient involvement in the determining of local services, and ensuring a real focus on best practice in the local community.
The all-party parliamentary group on infertility has done excellent work in raising awareness of fertility issues. My hon. Friend the Member for Stockton, South (Ms Taylor), who chairs the group, met my hon. Friend the Minister of State recently, along with members of Infertility Network UK, to discuss how the project was going. We are trying to keep the group involved. My hon. Friend the Minister is aware of the differences in provision of IVF services and of issues raised by the hon. Gentleman relating to the application of social access criteria, and also of emerging information on different treatments and their effectiveness in terms of safety, value for money and success. It is important that we take all of those issues into account.
We are all aware that fertility problems cause great distress that is hard to bear for those affected. It is important that decisions are made at local level so that account is taken of local priorities. It is also important that we all do we can to raise awareness of fertility issues. We must all work towards achieving that, but we should also look into ways in which infertility can be prevented in some cases—not only through chlamydia screening, which I talked about, but also by addressing issues such as smoking, obesity and general sexual health, so that we can be sure that we are taking account of prevention strategies.
We have had a thoughtful discussion of some of the key issues to do with fertility, and I hope that I have been able to reassure Members that we take this matter seriously, and that we are taking specific action by examining whether, and how, we can eradicate some of the variations that have been mentioned.
Question put and agreed to
Adjourned accordingly at twenty-nine minutes to Eleven o’clock.