Suspension of IVF on the NHS to remain indefinitely in Cambridgeshire until clinical commissioning group returns to 'financial surplus'
PUBLISHED: 10:00 07 August 2019 | UPDATED: 10:00 07 August 2019
The suspension of NHS-funded routine IVF treatment in Cambridgeshire has been extended indefinitely.
The Governing Board of the Cambridgeshire and Peterborough Clinical Commissioning Group said yesterday (August 6) that routine IVF will not be provided until it eliminates its deficit and returns to a sustainable financial surplus.
The CCG's accountable officer, Jan Thomas, told the board she could not say when it expects to return to surplus, but said more detail would be provided in the medium-term financial plan due to be completed in November.
NHS-funded routine treatment for women under 40 is available almost everywhere else in England, only four other CCGs - including three in the east of England - do not offer it.
The National Institute for Health and Care Excellence (NICE) guidelines state routine IVF should be provided, but each CCG makes the final decision in their area.
The Cambridgeshire and Peterborough CCG suspended almost all of its specialist fertility services in 2017, including IVF, citing its then £21.6m deficit, which has now risen to a forecast £75m this year.
The suspension was due to be reviewed in April this year, but the decision was delayed multiple times. Yesterday, reviewing concerns raised in 2017, the board noted there was no evidence to show a related increase in mental health referrals or increased costs from people returning from receiving IVF abroad. Also noting the financial situation has become "considerably worse," the board decided not to lift the suspension, this time with no fixed renewal date.
Clinical chair, Dr Gary Howsam, in a statement released after the decision was made, said: "Clinicians and managers alike acknowledge that this was a difficult decision to make and would have an impact on individuals and their families, but that in the current financial climate, it was not reasonable to reinstate the service.
"The Governing Body has committed to reviewing the decision as and when the CCG is operating in a financial surplus position.
"Anyone with fertility problems can still go to their GP who can discuss the treatment options available to them. Couples can still be referred to hospital for further tests to investigate the cause of their infertility, and many of these causes can be successfully treated without the need to go on to have IVF."
A spokesperson said the CCG is the third lowest funded in England.
The decision is expected to save £700k a year - less than one per cent of the deficit.
The CCG estimates that 159 patients have been impacted by the suspension between September 2017 and June 2019, with a further 302 patients expected to be affect by 2021.
Medical Director Dr Mark Sanderson introduced the discussion by saying: "It was a difficult decision [in 2017] and it is still a difficult decision whenever we make hard decisions about how we spend resources on healthcare, whether it be on cancer treatments, children's services or physiotherapy.
"They are all very difficult and fertility treatment is no less difficult than that but as a CCG we are clearly responsible for spending the taxpayers' money responsibly and trying to do the best for all the patients that we can".
One of the CCG governing board's lay members, Dr Julian Huppert, who was the only board member present to explicitly state his disagreement with the decision, said: "I don't think that anybody here is saying we should stop IVF because it is a good thing to do… but I haven't seen the argument made in these papers anywhere that - what to me is the core question - do we think this is £700k of money that is better spent on other services. Because that's actually the decision we have to make."
Director of Quality, patient safety and experience, Carol Anderson said the wider public rate IVF as less of a priority because of the relatively small number of people with fertility issues.
She said: "I sadly think [IVF] will always come further down the list than hips, cancer, end of life - and that's mainly because I don't think people who have no fertility issues have a true understanding of the potential impact it can have on somebody".
The full recommendation approved by the CCG said: "The Governing Body is asked to approve the recommendation from the Integrated Performance and Assurance Committee to continue not to fund the provision of specialist fertility services until such point that the CCG returns to a sustainable financial surplus or is instructed otherwise by our Regulators."
The CCG says there are two exceptions to the suspension of specialist fertility services: egg/sperm/embryo storage for cancer patients; and sperm washing provided to men who have a chronic viral infection, whose female partner does not, and where intrauterine insemination is being considered.
After the decision was taken Dr Thanos Papathanasiou, lead clinician at Bourn Hall Clinic, said: "This will be devastating for the couples for whom IVF offers the only chance of having a baby and that have been waiting to hear this decision.
"Infertility is a medical condition that can have a lifelong impact on emotional wellbeing.
"Only a very small percentage of the population needs to have IVF but the emotional impact of infertility on that small group must not be underestimated."