Can I get IVF on the NHS: A Postcode Lottery vs NICE guidelines?

Can I get IVF on the NHS: A Postcode Lottery vs NICE guidelines?

IVF treatment is available on the NHS, but the number of cycles and the quality of services provided varies substntially across the UK. NICE guidelines say that all couples who meet the eligibility criteria should be offered 3 cycles, however across the UK there are some areas that offer 3 and others that offer none. So continue reading to see the specifics about your area.

What do the NICE guidelines say about IVF treatment on the NHS

NICE stands for the National Institute for Health and Care Excellence. It supplies UK health providers mainly the NHS with evidence-based guidance, advice, quality standards frameworks and information services. The guides are very detailed, we will break down some of the key detail in this article to make the information a little more accessible. However, if you wish to read the full NICE guidelines  on Fertility and IVF then it can be enlightening. It is worth remembering that these guidelines are based on peer-reviewed evidence and this is shown with the guidelines so can be a good source of information if you are wondering why we do things the way we do, here’s the evidence for the NICE guidelines.

The top-level guidance for IVF is as follows:

  1. Women under 40 should be offered 3 full cycles of IVF as long as they meet the eligibility criteria which are
    1. Been trying for 2 years to conceive
    2. For same sex couples or those unable to try naturally have done 12 months of artificial insemination with at least 6 intrauterine insemination.
  2. For women 40-42 should be offered 1 full cycle of IVF under the following eligibility criteria:
    1. Same as for those under 40 as well as
    2. never had IVF before
    3. tests show that their ovaries would respond normally to fertility drugs (i.e. don’t have low ovarian reserve)
    4. they have discussed the risks of IVF and becoming pregnant at this age with their doctor.
  3. It states that 1 or 2 embryos should be implanted taking the patients age, embryo quality and number of IVF cycles into account. And has a clear chart to demonstrate this under quality standard 8 and shown in the image to the right.

Is IVF a postcode lottery? Do all CCG’s and NHS trusts follow to the NICE guidelines?

The simple answer sadly is NO the don’t and YES it is a postcode lottery. But let’s explore this in more detail. You can find a full list of CCG’s (Clinical Commissioning Groups) eligibility for IVF below or by clicking on the picture.

CCG eligibility for IVF Treatment

As you can see from the document those that follow the NICE guidelines of 3 cycles are within the minority. Over the past 5 years the number of CCG’s following NICE guidelines has halved; with currently around 12% following the national guidelines. More shockingly the number of CCG’s have removed all IVF treatment has almost doubled in the last 5 years. The two most recent changes have been Cambridgeshire and Peterborough and Croydon CCG who have both suspended IVF treatment, reducing from 1 to 0 both citing financial reasons.

Why Don’t all CCG’s offer IVF treatment in line with NICE Guidelines?

Again, this has another simple answer and its money. NHS budgets, CCG commissioning budgets have all been squeezed by austerity and reducing budgets year on year. However, it is also prudent to note that there are clear inefficiencies in the procurement of IVF treatments across the UK. There is an interesting article in the Health Service Journal titled: Exclusive: CCG inefficiencies ‘blocking’ access to IVF

The key outcome from this article are these (sourced from the above article)

  • Data shows 13 clinical commissioning groups spent at least £4,000 per IVF cycle, while six spent £2,000 or less
  • Fertility charity says “financial inefficiencies” blocking access to IVF at time when access is at historic low
  • NHS England to introduce non-mandatory benchmark prices to help CCGs obtain “fair price”

These differences in costs per cycle are one of the key reasons for offering less cycles. However, one of the stark statistics revealed by Fertility Fairness (the charity who provided the statistics) was the difference in cost between providing a full NICE-compliant service and providing a partial one. The cost savings were tiny, around 0.19% of the CCG’s total budget, with the averages as follows: CCGs funding single cycle spent 0.089% of their total commissioning budget IVF and fertility treatments. Those Clinical commissioning groups which fund three cycles spent 0.108 per cent of their total budget on IVF.

What does a postcode lottery mean for me getting IVF on the NHS?

Well ultimately it means that we have a postcode lottery in the UK when it comes to fertility treatment and IVF, where you live dictates the standard of care that you receive in the UK. Shocking, right? But what can you do about it? Well there are some obvious answers but not necessarily palatable ones; you could move to an area which has better funded IVF treatment, you could pay for private IVF either within the UK or other parts of the world. Finally if you believe as we do here at I Need IVF you can support lobbying the government to step in and change the situation, you can also write to your CCG and MP to try and get specific funding for your circumstances, remember that if the first request is refused you can appeal your decision and you should copy your MP into your appeal.

You can find some great standard letters at The fertility Network UK (external link to the letters page)

A postcode Lottery – IVF on the NHS across the UK is unfair what can we do about it?

As I am sure you will agree if a doctor said sorry you can’t have a new knee, but your friend 25 miles away can you’d be a little frustrated. Why, because they live in a different CCG catchment area. Getting IVF on the NHS is a postcode lottery. We have known people move to another area just to get IVF treatment that by the NICE guidelines they should be entitled to through the NHS. Take a look at the Good Morning Britain videos opposite.

Through long term funding cuts to the NHS coupled with austerity has had a major impact on NHS budgets and they are always looking to trim the fat so to speak. Scotland currently offer the gold standard, i.e. 3 full cycles in line with NICE guidelines, as per HfEA statistics (latest 2017) you can see that in 2017 69% of IVF in Scotland was funded by the NHS, in England that figure was 35.5% and a total of 65,087 cycles were performed in the UK (remember this does not take into account those who go abroad for cheaper IVF treatment). Some recent research by Opium concluded that the average cost in the UK for an IVF cycle is £3,348 excluding drug costs and initial consultations, the cheapest of each of these we saw was £175 for the drugs and £300 (2 x £150) for the initial consultations so total cost £3,823. So, by the statistics 41,981 couples paid for their treatment in England which totals £160,493,363 spent in England only on IVF. Which I hope you agree for a country which prides itself on equal healthcare for all is shocking.

So how can you help fight this. Well firstly you can write to your MP to complain and ask them to bring up this issue in parliament. You can submit an Independent Funding Application to your CCG to try and get specific funding for your IVF. Most importantly you can sign petitions and support lobbying efforts. The charity Fertility Network UK have some great information on this found here.

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