Thursday, November 13, 2008

A big backflip: Infertile couples to be priority for NHS IVF treatment

I guess the politicians have realized that IVF children are future taxpayers

Infertile couples could soon be offered wider and more consistent treatment on the NHS under the first proposals from the government panel that has the task of ending the IVF postcode lottery. NHS trusts should give IVF a much higher importance when drawing up spending plans, by taking into account the effects of infertility on mental health and general wellbeing, the influential group will say today.

The advice from the Expert Group on Commissioning NHS Infertility Provision, which was convened by health ministers this year, will put fresh pressure on the 95 per cent of primary care trusts (PCTs) that do not offer the three cycles of IVF recommended by the National Institute for Health and Clinical Excellence (NICE).

Its interim report, which suggests several measures designed to improve access to IVF, comes as an NHS regional health authority has agreed for the first time to implement the NICE guidelines across all 14 of its trusts. The decision by NHS East of England means that infertile couples in Essex, Suffolk, Norfolk, Cambridgeshire, Hertfordshire and Bedfordshire will be entitled to three cycles of treatment from next April, provided that they meet eligibility criteria.

Infertility is a problem for between one in six and one in seven couples. Almost 45,000 cycles of IVF are performed in Britain each year, but limited NHS provision means that about 75 per cent of these are conducted privately, at an average cost of $4,000 per cycle. NICE, the value-for-money watchdog, recommended in 2004 that PCTs should provide three cycles to infertile couples in which the woman is aged between 23 and 39. It added that these should be full cycles, including the replacement of frozen embryos, should a couple fail to conceive with fresh ones. A Department of Health survey published in June found, however, that just 9 out of 151 PCTs in England meet this standard. About two thirds offer only one cycle, and half of these do not replace frozen embryos. Three trusts offer no IVF at all.

In March, Dawn Primarolo, the Health Minister, asked an expert group to recommend ways of encouraging more trusts to implement the NICE guidance in full. Its first advice, seen by The Times, will be published today. It found that the main barrier to wider provision was the low priority that many trusts give to IVF. This needed to be reassessed in the light of evidence about links between infertility and depression, stress, relationship breakdown and quality of life. "The provision of infertility treatment has not been seen as a traditional NHS service and, therefore, is often viewed as a relatively low priority compared to more visible conditions whose impact is well established," the report will say.

"The group's final report will seek to consider the often unseen consequences of infertility, including the impact on mental health and general wellbeing, which may draw on other NHS services for treatment, as well as the positive benefits of IVF." The group has also identified a "lack of knowledge and understanding of infertility and its treatment" among commissioning managers, and a poor grasp of what the NICE guidelines actually mean.

In the light of the group's advice, Ms Primarolo will write today to all PCTs to clarify that NHS IVF cycles should include the replacement of frozen embryos as well as fresh ones. If trusts acted on this, it would significantly improve some infertile couples' chances of a baby. Ms Primarolo's letter will also confirm that NICE will not review its guidance until 2010-11. Many trusts had been holding off from offering three cycles, as NICE had been due to reassess its policy as early as this year.

The expert group, made up of five NHS commissioning experts and a patient representative, will also recommend that the NHS set a fixed price that PCTs would pay for IVF. Such national tariffs already exist for dozens of medical procedures, such as heart bypasses, and help managers to plan their spending. A spokesman for the Department of Health said that it was receptive to this idea. "It is appropriate for IVF to be considered carefully for inclusion on the national tariff," he said.

Mark Hamilton, chairman of the British Fertility Society, which represents medical professionals in the field, said that it was right for PCTs to consider the wider health impact of infertility. "This is a positive development," he said. "Clinicians and practitioners involved in infertility services are all aware that we are not just dealing with a physical pathology. "Infertility is a disease, but it also has fallout beyond that for a significant proportion of couples, causing mental health problems, depression, stress-related illnesses and so on."

Dr Hamilton welcomed the East of England decision, though he questioned whether other parts of the country would match it unless the Department of Health provided more dedicated funds. "It is a tremendous step forward that a region has seen the value of doing this, and I would hope that others will do the same. But there is certainly a view in the sector that central funding would solve an awful lot of problems."


Australia: NSW public hospitals not safe

Not one public hospital in NSW is operating at a safe occupancy level with Royal Prince Alfred, Royal North Shore and Gosford hospitals singled out today by the Australian Medical Association as performing particularly poorly. RPA operated at 95 per cent occupancy and RNS 92 per cent and Gosford even reached 110 per cent at times, according to the AMA's national report card released today. The internationally recognised safe level is 85 per cent before patient care is compromised.

There are 1500 unnecessary deaths in Australia each year due to overcrowding in public hospitals, the report said. The president of the NSW branch of the AMA, Brian Morton, said "no matter what the spin is given all our hospitals are under great stress". "Not one of our hospitals is operating at a safe level. We can no longer cut beds, cut funding in our hospitals," Dr Morton said. He said NSW needed an immediate injection of $1 billion to lift bed numbers to an acceptable level. He said yesterday's announcement in the mini-budget that NSW area health services would have to save $64 million would inevitably mean more bed closures. "This translates, it appears, to bed closures as in RPA closing its obstetrics and gynae ward." The AMA said in its report card that over the past 20 years, 67 per cent of beds have been cut.

However, NSW performed the best when it came to the percentage of elective surgery and emergency department patients seen within recommended times. NSW also had the second-most public beds per 1000 weighted population, behind the Northern Territory and ranked third for recurrent expenditure, behind NT and ACT.

But the president of the AMA, Rosanna Capolingua said all states rated "F for failure and then it's really how badly they have failed". "There's not enough equipment, beds, capacity, doctors and nurses ... because hospitals have been stripped of their funding over time." She said stories of patients banked up in corridors of emergency departments and even on chairs and floors were too common and were simply due to a lack of beds. "It's a ridiculous scenario. How much more do we need to hear about this before we do something to stop it," she said.


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