Select Committee on Health Written Evidence


Memorandum submitted by the National Infertility Awareness Campaign (PCT 45)

  I am writing on behalf of the National Infertility Awareness Campaign (NIAC) with regard to the Health Select Committee's inquiry into Changes to Primary Care Trusts.

  NIAC is an umbrella organisation representing views from across the full range of organisations involved in the field of infertility, including patient groups, professional bodies and pharmaceutical companies. For over a decade it has been campaigning for fair and equal access for all to fertility services on the NHS and the eradication of the "postcode lottery" of treatment that currently exists.

  It was therefore with great interest that we read the terms of reference for this inquiry, which clearly has implications for the future provision of these services. We have therefore taken the opportunity of submitting this brief memorandum setting out our comments on the proposed changes. The comments follow the order of the inquiry's terms of reference.

RATIONALE BEHIND THE CHANGES

  NIAC supports the rationale behind the need to review the way in which Primary Care Trusts (PCTs) operate, which is based on the recognition that services are not being provided effectively under their current configuration. In no area is this more evident than in the provision of infertility services.

  Traditionally, infertile couples have faced huge inequities in access to treatment on the NHS, resulting in around 80% having to seek their treatment privately. NIAC therefore greatly welcomed the publication by the National Institute for Health and Clinical Excellence (NICE) of a clinical guideline on infertility in February 2004. The guideline set out the much-needed structure required to provide infertility services on the NHS to all those with an agreed clinical need regardless of where they lived.

  However, despite it being the first piece of guidance in which the Government directly intervened by issuing an instruction on how it expected PCTs to implement it, progress in meeting NICE's recommendations has been slow and very patchy. According to a recent report by the Audit Commission, this is mainly due to poor planning and financial management by PCTs.

  NIAC therefore supports the need to reorganise PCTs to ensure that access to services are improved and patients' needs are met. However, the process by which this is done requires careful management by Government to avoid creating even further delays to the provision of services. Some central coordination is essential: at present, plans for reorganisation are being drawn up by Strategic Health Authorities, which means that they may differ from one part of the country to another. This approach runs the risk of exacerbating the inconsistencies in services across the UK as a whole, to the detriment of patients.

LIKELY IMPACT ON COMMISSIONING OF SERVICES

  Infertility treatment falls within the Specialised Services National Definitions Set because some assisted reproductive techniques, the most well-known of which is in-vitro fertilisation (IVF), are provided at a limited number of specialist clinics that tend to cover several PCTs. The arrangements for commissioning specialised services are based on PCTs working collaboratively according to local needs, but have to date raised significant concerns over their effectiveness.

  NIAC shares these concerns and welcomes the Government's decision to review these arrangements as part of the overall changes to PCTs. It seems clear that in some parts of the country PCTs face considerable financial pressures, but at the same time are failing to plan adequately for future services, leading to funding not being made available for some treatments. Historically, infertility services have always suffered from low prioritisation when it comes to funding, particularly if there is little or no expertise in commissioning this type of service. NIAC would therefore support a move that encouraged PCTs to improve their financial management and plan ahead to ensure that patients' needs are met.

LIKELY IMPACT ON PROVISION OF LOCAL SERVICES

  Given the low priority traditionally accorded to infertility services, NIAC would like to see any reorganisation of PCTs incorporate measures to increase the level of patient involvement in priority setting. This would help to ensure that specialised services, which fall outside mainstream commissioning, were not overlooked.

  More importantly, there needs to be some direction from Government on access to these services in order to eliminate the inequalities that currently exist. A specific example of this would be the need for centrally set eligibility criteria for access to infertility services. At present, PCTs can set their own criteria, which vary considerably from one part of the country to another, essentially denying treatment to couples on the basis of where they live. Finally, we would like to see a robust system put in place for monitoring the effectiveness of specialised commissioning and for taking action against PCTs that fail to meet patients' needs.

LIKELY IMPACT ON OTHER PCT FUNCTIONS, INCLUDING PUBLIC HEALTH

  NIAC agrees that a greater emphasis should be given to prevention, particularly with regard to health conditions that could be avoided through changes to lifestyle and diet. With regard to infertility, it is important that people are fully informed about the factors that can cause the condition and about they ways in which they can reduce the chances of becoming infertile.

  Alongside this, it is essential that GPs also receive adequate information to be able to advise patients that are having problems conceiving, and that a clear pathway is developed from GP referral to treatment to ensure that those couples that go on to require assistance are investigated and treated as quickly as possible.

CONSULTATION ABOUT PROPOSED CHANGES

  NIAC support the Government's plans to conduct a consultation on changes to PCTs and, in particular, would welcome a full consultation on any plans to change the current arrangements for the commissioning of specialised services.

LIKELY COSTS AND COST SAVINGS

  The objectives of an effective commissioning structure are to ensure that patients are being offered the "right treatment by the right provider at the right time" (Department of Health, Review into Commissioning Specialised Services—background notes, July 2003). Ensuring access to the most appropriate treatment at the time of need not only benefits patients, but also saves the NHS money by reducing wastage from inappropriate interventions and increased costs of treating patients at a later stage.

  This is particularly the case with infertility services, where ensuring that patients have access to a full range of treatments means that they are able to benefit from the treatment that is most appropriate for them. A review of commissioning, as part of the proposed changes to PCTs, should focus on addressing this point to ensure that arrangements are both clinically and cost effective.

  I do hope these comments are taken up by the Committee and look forward to following the progress of its inquiry.

Clare Brown

Chair, National Infertility Awareness Campaign

10 November 2005





 
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