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31 Jan 2007 : Column 112WH—continued
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.
Norman Lamb (North Norfolk) (LD): What the hon. Gentleman describes is fascinating. What proportion of current treatments is he concerned might involve overdoses of hormone treatment?
Dr. Gibson: 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.
Norman Lamb: How does this country compare with others in reducing hormonal treatment and going down the route described at the conference?
Dr. Gibson: 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.
Norman Lamb: Where does the hon. Gentleman suggest that the guidance should ideally come from? Is it from NICE or from the Department of Health?
Dr. Gibson: 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.
Mr. Lansley: 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.
Dr. Gibson: 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.
Ms Dari Taylor (Stockton, South) (Lab) rose—
Martin Horwood (Cheltenham) (LD) rose—
Frank Cook (in the Chair):
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.
3.9 pm
Martin Horwood (Cheltenham) (LD): 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.
3.14 pm
Ms Dari Taylor (Stockton, South) (Lab): 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”—
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