IVF Provision, best and worst places to live, 2016



Greater Manchester the best place to live in England for NHS fertility treatment: top 4 and bottom 4 regions revealed; ‘unacceptable’ that CCGs do not offer NHS IVF says Minister.

Greater Manchester is the best place to live in England if you need IVF, according to new national audit date from campaign group Fertility Fairness. Only four out of 209 (1.9 per cent) clinical commissioning groups (CCGs) in the country follow national guidance on access to NHS fertility treatment fully and offer access to three funded cycles of IVF for eligible women under 40, plus all viable frozen embryo transfers, and enable access if one partner has a child from a previous relationship. All these CCGs are in the Greater Manchester area: Bury CCG, Heywood, Middleton and Rochdale CCG, Tameside and Glossop CCG and Oldham CCG – where the world’s first IVF baby, Louise Brown, was born in 1978.

Essex is the worst place to live with three of the four worst CCGs: Mid Essex CCG, North East Essex CCG and Basildon and Brentwood CCG have cut all NHS fertility treatment; South Norfolk CCG has also decommissioned its NHS fertility services. The striking north- south divide extends further: just 35 CCGs offer three NHS-funded IVF cycles in line with national guidance from ; 28 are in northern England.

Fertility Fairness’ 2016 audit of England’s 209 CCGs shows a marked reduction in access to NHS-funded IVF, with potential further cuts ahead. The number of CCGs offering three NHS-funded IVF cycles has dropped to 16 per cent (from 24 per cent in 2013), while the number of CCGs offering one NHS-funded IVF cycle has leapt to 60 per cent (from 49 per cent in 2013). More than one in ten CCGs (10.5 per cent) are currently consulting on reducing or decommissioning NHS fertility treatment.

Susan Seenan, co-chair of Fertility Fairness said: ‘Health minister Jeremy Hunt has said that the government will step in when people do not receive nationally-agreed standards of care. Just four out of England’s 209 CCGs follow national guidance on access to NHS fertility treatment fully; the remaining 98 per cent of CCGs do not: this is cruel and unethical, and a national disgrace for the country that pioneered IVF. Infertility is a disease and women and men who cannot become parents without medical help are as deserving of healthcare as people with other medical conditions.’

Sarah Norcross, co- chair of Fertility Fairness, said: ‘The IVF postcode lottery is being exacerbated by CCGs not making evidence-based commissioning decisions and routinely ignoring the guidance from the National Institute of Health and Clinical Excellence (NICE), which states that the provision of three full cycles of IVF is both clinically and cost-effective for eligible women under 40.’

‘Fertility Fairness is calling for full implementation of the NICE guideline, standardisation of eligibility criteria across England and the development of a national tariff in England for tertiary fertility services. Fertility Fairness’ audit reveals the continuation of a wide variation in the average cost that CCGs are paying for a cycle of IVF: this ranges from as low as £2,098 from a CCG in the north of England to more than triple this from a CCG in the south (£6,500), with a mean of £3,545. The introduction of a national tariff would eliminate these wide cost variants and remove a key barrier to compliance with national guidelines.’

Nicola Blackwood, Minister for Public Health, said: ‘Fertility problems can have a serious and lasting impact on those affected. It is important that the NHS provide access to fertility services for those who need clinical help to start a family. I am very disappointed to learn that access to IVF treatment on the NHS has been reduced in some places and it is unacceptable that some clinical commissioning groups have stopped commissioning it completely.

I would strongly encourage all CCGs to implement the NICE fertility guidelines in full, as many CCGs have successfully done. The Department of Health, NHS England and professional and stakeholder groups are working together to develop benchmark pricing to ensure CCGs can get best value for their local investment.’

These alterations hide the degree to which many CCGs are departing from national guidance. As well as slashing the number of cycles they offer, CCGs are playing fast and loose with both the definition of an IVF cycle and access criteria to IVF. Approaching half of all CCGs (45 per cent) use their own definition of what constitutes a full, fresh IVF cycle – which typically means substantially reduced treatment is offered. Creating additional eligibility criteria are a further hurdle CCGs use to further ration treatment unfairly. Only ten per cent of CCGs enable access to couples with children from a previous relationship; nine per cent of CCGs deny treatment to women over the age of 35 in contravention of national guidelines; 16 per cent of CCGs stipulate couples should have been trying to conceive for three years before treatment can be offered (and if a women suffers a miscarriage during this period, the ‘waiting time’ clock is set back to zero months. Other eligibility criteria include smoking status, body mass index, and length of relationship.


Notes for editors

Contact: Catherine Hill media relations officer Fertility Fairness and Fertility Network UK on 07469-660845 media@fertilitynetworkuk.org Fertility Network UK media volunteers are available on request. Details of the audit are available at www.fertilityfairness.co.uk

1. NICE guidance recommends three cycles of IVF for women under 40 years and one cycle for some women aged 40-42. The latest data from Fertility Fairness shows that in England less than one in five (16 per cent) of CCGs offer three full cycles of NHS-funded IVF to eligible couples, as recommended by the National Institute for Health and Care Excellence 2004 guideline (this represents a drop of 8 per cent since 2013).

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In Scotland, new legislation is being introduced enabling all health boards to fund three cycles for women under 40 and couples with children from previous relationships; in Wales, women under 40 are entitled to two cycles and in Northern Ireland women under 40 are offered one cycle.

2.There is a move towards sustained disinvestment in NHS fertility services in England. In September 2014, Mid-Essex CCG decommissioned its NHS fertility service, except in isolated, complex medical cases; North East Essex CCG followed suit in September 2015. South Norfolk CCG announced its decision to cut NHS fertility services completely on 24 November 2015; Basildon and Brentwood did so in November 2016.

Croydon CCG, Ipswich and East Suffolk, West Suffolk CCG, Mansfield and Ashfield CCG, Newark and Sherwood CCG are consulting on decommissioning NHS IVF. Bedfordshire CCG, North East Lincolnshire CCG, Somerset CCG, Wiltshire CCG, Herts Valley CCG and Cambridgeshire and Peterborough CCG all recently slashed NHS fertility services and now offer just one funded IVF cycle.

The following CCGs are considering cutting the number of NHS-funded IVF cycles they offer: St Helens CCG, all of Lancashire’s eight CCGs (Blackpool, Fylde &Wyre, Lancashire North, Chorley and South Ribble, Greater Preston, Blackburn with Darwen; East Lancashire, West Lancashire), five of Cheshire’s CCGs (Eastern Cheshire CCG, South Cheshire CCG, Vale Royal CCG, West Cheshire CCG and Wirral CCG), and all three Worcestershire CCGs: South Worcestershire CCG, Redditch and Bromsgrove CCG and Wyre Forest CCG.

3. There is now a striking North-South divide between the levels of provision of NHS fertility treatment. There are 35 clinical commissioning groups offering three NHS-funded IVF 3 cycles, the vast majority are in the north of England (28 CCGs); just six CCGs (2.9 per cent) in the south follow NICE’s recommendation regarding NHS fertility treatment: they are Thurrock CCG, Great Yarmouth and Waveney CCG, East and North Hertfordshire CCG, Luton CCG, Camden CCG and Swindon CCG. The other areas offering 3 NHS-funded IVF cycles are the 11 CCGs in the North of England Commissioning Collaborative (for details see below), the 12 CCGs in the North West of England Commissioning Collaborative (for details see below) and Bassetlaw CCG and Hull CCG.

The North of England Commissioning Collaborative consists of 11 CCGs, with each CCG offering the full 3 fresh cycles of IVF treatment for women under 40 as recommended by NICE. The CCGs are: South Tyneside CCG, Sunderland CCG, Newcastle Gateshead CCG, North Tyneside CCG, Northumberland CCG, Cumbria CCG, Darlington CCG, Durham Dales, Easington and Sedgfield CCG, North Durham CCG, Hartlepool and Stockton-on-Tees CCG and South Tees CCG.

The commissioning collaborative in the North West of England Commissioning Collaborative consists of 12 CCGs, with each CCG offering the full 3 fresh cycles of IVF treatment for women under 40 as recommended by NICE (the six Cheshire CCG’s provision is currently under review). The CCGs are: Eastern Cheshire CCG, South Cheshire CCG, West Cheshire CCG, Vale Royal CCG, Warrington CCG, West Cheshire CCG, Wirral CCG, Halton CCG, Knowsley CCG, Liverpool CCG, South Sefton CCG and Southport and Formby CCG.

4. Fertility Fairness is a multidisciplinary umbrella organisation representing the major patient and professional bodies working in the field of fertility. Fertility Fairness campaigns for fair and equitable access to NHS-funded fertility services in accordance with national recommendations issued by NICE. This includes the right of eligible couples to receive up to three full cycles of IVF treatment regardless of where they happen to live. The figures quoted above are from the fourth annual audit by Fertility Fairness of the provision of fertility services across England by CCGs using Freedom of Information requests. This is the most comprehensive data about fertility services to date. Details of the audit are available at www.fertilityfairness.co.uk