I heard a discussion on the radio this morning about the provision of IVF on the NHS. Apparently, nearly three-quarters of all NHS trusts are failing to follow guidelines and are refusing couples treatment. The National Institute for Health and Clinical Excellence (NICE) stated in 2004 that couples should be given up to three cycles of IVF on the NHS, where the woman is aged between 23 and 39. Apparently, many PCTs are either refusing treatment entirely, or are imposing other criteria on age, weight, smoking status and whether or not one partner already had a child.
Gareth Johnson, Conservative MP for Dartford and chairman of the APPG on Infertility, said: "IVF is the creation of life and gives hope to thousands of infertile couples across the UK. "IVF treatment was invented in Britain and so, more than any other country, we should be championing its use. As chairman of the APPG on Infertility, I believe that all PCTs should be offering three cycles of treatment as recommended by the Nice guidelines. One in seven couples in the UK suffer from infertility problems, indeed more women attend GP surgeries to obtain advice on infertility than any other issue other than pregnancy. This shows just how big an issue infertility is for so many people."
Now, I think IVF is an amazing thing and I know it has given lots of people the opportunity to become parents….. but should it be seen as a right; as something that we should expect the NHS to pay for? That was the thrust of the discussion I heard, but I’m not sure that I think it should be.
The NHS is constantly under the threat of budget cuts. Even now, the battle lines are being drawn in parliament around the Conservative plans to slash budgets to attempt to save money (although interesting that they seem to think IVF is worth defending)… but even in more optimistic economic climates, the NHS is always operating to a budget and doctors are always going to be asked to make potentially difficult decisions about what treatment and services they can offer, and who should get them and who should not. I know that the nature of NHS funding means that there is something of a postcode lottery around which PCT offer which services, but the fundamental principle is the same: medical decisions are made on the basis of budget. Some drugs are approved for use, other drugs are not. Think of the stink that was kicked up when NICE refused to authorise the use of the “miracle” breast cancer drug Avastin.
If you are suffering from breast cancer or have a relative who is, then it is perfectly understandable that you want to give them the best possible chance. NICE is in the invidious position of having to draw the line of what is in and what is out. They will swear blind that it is not a budget led decision, but budget surely can and surely should be a factor in that decision.
Somewhat closer to home, as a sufferer of MS, I am keen for NICE to approve the NHS to dispense oral therapy so that I can escape from my weekly routine of injections….. not that I should grumble, because my injections cost the NHS something over £1000 a month. Never mind the drugs, I benefit immeasurably from access to the MS Nurses: they’re my first point of contact in the event of a relapse or if I need advice or an appointment or therapy or anything. They brilliant, but they’re also under threat. They’re 50% funded by the MS Society and 50% by the government… and they’ve been marked down as a possible cost saving. Losing them would have a devastating effect on the frontline of the treatment of MS in this country… and I’m sure there are services like them threatened across the board.
IVF costs – on average – about £3,500 an attempt.
In an environment were the treatment and care of critical illnesses is being cut and where people are not receiving the drugs that could possibly save their lives or radically alter their quality of life, how can that be justified? Having a child is no doubt an amazing thing and is a cherished ambition for many… but is it a right that you would expect the government to pay for? Or should it be something that is only available to those who can afford it?
Look, I know it’s not as black and white an issue as that… and my view on this is no doubt slanted by the fact that I’m a 37 year old man with MS and no kids…. But I’m genuinely interested to know what you think.
It’s a thorny one.
And if you can make your mind up about IVF, what about abortion? Lay aside the ethical issues for a moment; do you think that termination should be offered on the NHS? What about facial reconstruction?
And to think I moan about the decisions I make in my job.