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 Servicesbackground
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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