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That this House takes note of European Union Documents Nos. 14999/07, 15001/07, 14995/07, 14993/07, 14996/07, 14997/07, progress reports on Albania, Bosnia and Herzegovina, Kosovo, Macedonia, Montenegro and Serbia, No. 15616/07 and Addenda 1 and 2, Draft Council Decisions on the signing and on the conclusion of the Stabilisation Association Agreement between the European Communities and its Member States and the Republic of Serbia, No. 15690/07 and Addenda 1 and 2, Draft Council Decision concerning the signing and conclusion of the Interim Agreement on trade and trade-related matters between the European Community and the Republic of Serbia, and unnumbered Explanatory Memorandum dated 15th February 2008, Interim Political Agreement on Co-operation between the European Union and its Member States and the Republic of Serbia; and supports the Governments position that European integration offers the best prospects for regional stability in the Western Balkans and is therefore in favour of a clear European perspective for the countries of the Western Balkans. [Mr. Alan Campbell.]
That this House concurs with the Lords Message of 20th March, that it is expedient that a Joint Committee of Lords and Commons be appointed to consider and report on any draft Constitutional Renewal Bill presented to both Houses.
That a Select Committee of eleven Members be appointed to join with the Committee appointed by the Lords to consider the draft Constitutional Renewal Bill (Cm. 7342).
That the Committee should report on the draft Bill by 18th July 2008.
That the Committee shall have power
(i) to send for persons, papers and records;
(ii) to sit notwithstanding any adjournment of the House;
(iii) to report from time to time;
(iv) to appoint specialist advisers; and
(v) to adjourn from place to place within the United Kingdom.
That Mr Alistair Carmichael, Mr Christopher Chope, Michael Jabez Foster, Mark Lazarowicz, Martin Linton, Ian Lucas, Fiona Mactaggart, Mr Virendra Sharma, Emily Thornberry, Mr Andrew Tyrie and Sir George Young be members of the Committee. [Mr. Alan Campbell.]
Lynda Waltho (Stourbridge) (Lab): Thirty years ago, a female child was delivered by caesarean section at Oldham and District general hospital. She weighed 5 lb 12 oz, and her parents, Mr. and Mrs. Brown, named her Louise. Louise Brown was the first child to be conceived using in vitro fertilisation, whose pioneers were consultant gynaecologist Patrick Steptoe and Cambridge research physiologist Robert Edwards.
Louise Browns birth was a milestone. It marked the culmination of many years of research and trials, and the start of hope for infertile couples all over the world. Given that splendid history, I wonder why, 30 years on, todays couples up and down the country are still faced with heartache, frustration and depression when access to such groundbreaking and essential therapy is denied by nothing less than the infamous postcode lottery.
I was made aware of the situation, particularly within Dudley primary care trust, when two of my constituents approached me on this very issue. Both those constituents are married to men who have fathered a child in an earlier relationship, yet, despite the fact that in both cases the child lives with their natural mother, and not with my constituent, both women are denied fertility treatment by Dudley PCT.
The Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw), will know that a pattern of patchy access to fertility treatment had developed before the announcement by the then Secretary of State for Health, my right hon. Friend the Member for Airdrie and Shotts (John Reid), following the publication of guidelines by what was then the National Institute for Clinical Excellence in February 2004. My right hon. Friend said:
Our immediate priority must be to ensure a national level of provision of IVF available wherever people live. As a first step, by April next year I want all PCTs, including those who at present provide no IVF treatment, to offer at least one full cycle of treatment to all those eligible. In the long term I would expect the NHS to make progress towards full implementation of the NICE guidance.
In providing this NHS service, as with all others, our priority must be to help those in greatest need. That is why I will be asking the NHS to give local priority to couples who do not have children living with them.
This will mean that thousands more couples should be able to have fertility treatment on the NHS whilst enabling the NHS to manage this in a realistic way.
The NICE guidelines on the provision of IVF placed NHS assisted fertility services firmly in the mainstream of state-funded health care. They made explicit reference to clinical criteria such as the effect of age and weight on the outcome of treatment, but no recommendations were made for the use of non-clinical or social criteria in the provision of treatment. Of course PCTs have to balance budgets, decide priorities and commission services within available budgets, as well as balance individuals needs and access to therapies.
Unfortunately, that means that across the country many PCTs have developed their own social criteria effectively to ration treatment.
Recent research on some 100 PCTs shows that 51 do not allow IVF to couples if one of them already has a child. It just depends on where people live. Indeed, one of my constituents was advised by a health professional to join a different GP practice or move over the border into Staffordshire or Worcestershire to improve her chances. What a way to run a service!
My constituents and all other infertile women in Dudley are denied the right of access to treatment because of their partners previous fertility. Is there any other treatment or branch of medicine that decides on someones need or eligibility for treatment by looking at the health or history of their partner? This is akin to someone attending accident and emergency with a broken arm to be told by the doctor, Yes, your arm is broken, but were not going to treat it because both of your husbands arms are fine. That is not fair or just. How does it fulfil the guiding principle of the NHS of care and treatment free at the point of delivery and according to need?
While I am awaiting the decision of the PCT, I see all around me happy mums and dads with new...babies. I know that I should be one of them. I feel that at 38 my chances are slipping by and that the pen pushers dont care. They want me to appeal and to continue this charade until I am 40 and not eligible. Why dont I matter? Why dont they care? Im now being treated for depression. My husband and I are now so desperate we may sell our house and go private. Its not right, its not fair and they know it.
The British Fertility Society surveyed NHS fertility treatment across England in 2006. It found that the number of cycles of treatment was increasing, but there were still some significant black holes. Despite the NICE recommendations, some 16 per cent. of clinics reported decreased support from local PCTs. There is still a great disparity, with some PCTs, such as Dudley, offering funding for only one round of treatment and others offering three, although a significant proportion are unable to follow through. There was also little indication that PCTs had made long-term plans to implement NICE guidelines and no reassurance that the full guidance will be implemented.
The BFS makes 11 recommendations on social criteria for NHS treatment, which include: that waiting times for treatment should be the same as for any other medical conditions; that no woman should commence NHS-funded treatment after the age of 40; that women who are obese must initiate a weight-reduction programme; that single women and same-sex couples should have equal access; and, importantly, that if people have had children from a previous relationship, they should not be excluded from access to NHS treatment. The author of the study, Richard Kennedy said:
The results of this survey suggest that there is no sense of any long term planning for the provision of fertility services and provide no reassurance that full implementation of the NICE guidance will be achieved as was recommended by the Secretary of State for Health...If we are to see an end to inequity of access across the United Kingdom there must be an explicit plan for the provision of three fresh cycles of IVF and consistency in the
criteria used for NHS treatment. The criteria we propose, if adopted by all PCTs in England and Wales, would standardise access to treatment. We must use the findings of this survey to pursue the goal of full implementation of the NICE Guideline.
I know from my recent correspondence with the Minister of State, Department of Health, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), that she is concerned about the situation, as are her colleagues. The Department of Health asked Infertility Network UK, on behalf of the Department, to undertake a project to liaise with PCTs and encourage the sharing of best practice, as well as to ensure that the voices of fertility patients are heard when decisions are made at a local level. Only 151 responses came back from the 303 PCTs. The results showed that 98 were funding only one cycle per couple, 32 provided two cycles and only seven provided the recommended three cycles. Of those PCTs, 50 per cent. do not fund frozen embryo transfer.
Why is it important to get to the magical figure of three cycles? The chance of a successful birth in a single cycle of IVF is estimated at one in four for women under 35, which rises to 50 per cent. with three cycles. Of course, there are less likely to be multiple births when three cycles are offered because couples have three chances rather than one to become pregnant and are therefore less likely to opt for multiple transfer. In turn, that will mean safer pregnancies and births for mothers and children.
Infertility causes emotional distress and pain. The desire to reproduce is part of life. When that process fails couples undergo significant distress, depression and ill health. Relationship failure often follows. They suffer physical and mental ill health and their self-worth plummets. Creating a family is central to the life plans of many people. Not everybody desires a child with the same intensityit is fundamentally an individual issue.
As individuals in a welfare state, my constituents deserve equal and fair access to treatment. The Minister of State, my hon. Friend the Member for Exeter, can help them to achieve this by insisting on the removal of the so-called social criteria, by making a sound commitment to fund both fresh and frozen embryo transfer and, of course, by insisting on full implementation of all NICE guidelines in this case without further delay.
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate my hon. Friend the Member for Stourbridge (Lynda Waltho) on securing the debate and on bringing an important and sensitive subject into the public domain.
People who seek help to have their own family have often gone through a time of great anticipation and preparation, when there was no doubt in their minds that they would have a child together and that it would be just a matter of time. They plan ahead and think that at the same time the following year they will have a child with them. They plan their lives around that thought.
For someone in six or one in seventhe expected does not happen and the next step is to visit their GP to ask for advice. That might be a difficult step and the
tests that follow lead to an anxious time. The tests might show the cause of the problem, or the cause might remain unexplained. Some couples may conceive a child during that time, but others will not and they will consider various treatments. In many cases, patients may start with the less invasive procedures, and some will get pregnant at that stage. However, for those who do not, treatments such as IVF or ICSIintracytoplasmic sperm injectionare the next, and last, step. More than 30,000 people in this country will have IVF in any one year, and currently about a quarter of them will be treated on the NHS.
People with fertility problems who seek help from the NHS quite rightly see fertility provision as an integral part of the service but, as my hon. Friend the Member for Stourbridge said, some will find that the NHS cannot help them to the extent that they expect. We are working hard to address the issues about access to NHS infertility treatment, and are making welcome progress. I shall update the House about that in a moment, but first I want to deal with the point that my hon. Friend made about the restriction of access to fertility services if a person or their partner has a child from a previous relationship.
My hon. Friend made the point very eloquently that, if a woman has fertility problems, then to refuse to treat those problems because her partner has a child from a previous relationship is to ignore the womans own, personal health problem. I recognise the points that my hon. Friend made, as I do the feelings of the womenor menwho are in that position. I also acknowledge the feelings of their partners. If there are anxieties and a feeling of injustice, they may even be sensed by the existing children.
For access to IVF treatment, most PCTs apply the so-called social criteria, which means that there will be no IVF for couples who have a child from a previous relationship. Many PCTs say that IVF treatment cannot be offered if a person or their partner has a child from a previous relationship: some say that there should be no children from the current relationship, and others that there should be no children under 16 living with the couple. A very small number of PCTs require one partner to have no children, or say that they give individual consideration to partners with no children.
The Government are aware that those are not the only access criteria applied by PCTs, but most of the others feature as clinical criteria in the NICE fertility guidelines. They include requirements to undertake a smoking cessation clinic or to lose weight, and so on, but those are clinical criteria set out by NICE and they are applied reasonably consistently across the country. Most PCTs have criteria relating to existing children from a previous relationship but, as my hon. Friend the Member for Stourbridge rightly said, they are not uniform. Those differences are seen as unfair, and I share her discomfort about them.
We are therefore addressing the problem in the following ways. We have asked the leading fertility patient support organisation, Infertility Network UK, to develop in partnership with the NHS a standardised set of access criteria that will include criteria for patients who have children from previous relationships. Infertility Network UK is looking at the range of
criteria in application, and it is aiming to develop a standardised set that PCTs can take into account when planning their services.
Looking at the level of IVF provision in Dudley more generally, I am aware that the PCT offers only one fresh cycle of IVF to those who meet the access criteria. I recognise that patients in my hon. Friends constituency would certainly wishand could expectthat provision to improve. A progression from one fresh cycle, the most basic level of provision, to one full cycle of IVF would be a starting point, together with a longer-term plan for the implementation of the full NICE guidelines. In response to my hon. Friends concerns, I have asked Infertility Network UK, the leading fertility patient support group, to offer to meet the members of the independent Healthcare Commission in Dudley so that they can make known the views of patients about the level of provision locally, and hear the views of the commissioners. As a start, it may be helpful to give patients a transparent picture of the services that are being funded, so that they might understand why IVF does not at present have a higher level of priority locally.
We want further improvements in the provision of fertility services and, to that end, we have started to monitor them. We will publish the results shortly, but even without that survey we know that some PCTs are providing two cycles of IVF or more. It will be helpful to demonstrate that that can be done, and that progression towards the implementation of the NICE guidelines can be achieved. Those PCTs performance will be held up to public scrutiny by the independent Healthcare Commission in its annual health checks.
Infertility Network UK has been working with us to improve access to services for fertility patients towards the implementation of the NICE guidelines. As well as developing standardised access criteria, it is working with PCTs to identify and disseminate best practice. The project, which is funded by us, began in 2006 with a survey of provision. It has continued with visits to 16 PCTs that offer a range of provision, and Infertility Network UK will be compiling its findings for dissemination.
Additionally, we have set up an expert group on commissioning NHS infertility provision. Its membership is drawn from strategic health authorities, primary care trusts and Infertility Network UK. The group is identifying the barriers to the NHS progressing to implementation of the NICE fertility guidelines, taking account of the current variation in provision of IVF and ICSI among PCTs. It is also examining the variation in access criteria and the intermittent suspension of services in some locations. At present, only three PCTs have temporarily suspended services, and all are working towards reinstatement. The group is also working to ensure the production of a tool for PCT commissioners for making decisions on fertility provision to encourage gradual progress towards the full implementation of the NICE fertility guidelines.
In carrying out its work, the group will take account of the Infertility Network UK project with PCTs advising on next steps and co-ordinating findings on
good practice. It will also take account of the range of evidence to support the provision of IVF and ICSI, including the health gains for patients and health issues arising from infertility.
We acknowledge that unacceptable variations remain in the provision of IVF throughout the country. Overall, there is a move towards the implementation of the NICE clinical guideline and general improvement, but there is still progress to be made in several PCT areas and more work to be done, especially on the social criteria to which my hon. Friend drew attention. I
thank her for doing so, and recognise and acknowledge her concerns. I know that she is seeking improvements in provision in relation to fairness and equity. We share those values. We, too, are seeking to help PCTs to make just, transparent decisions on fertility treatment, which is not a traditional part of NHS care, but in which developments in technology have brought great advances in patient care and high expectations that the health service needs to meet.