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Eeyore

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Thursday, October 14th 2010, 1:44pm

FERTILITY FUNDING IN ENGLAND

What is the current situation regarding fertility treatment in the UK?

An estimated 3.5 million people in the UK (about 1 in every 6 couples) suffer fertility problems of some kind. Most of these individuals will get pregnant within two years without the need for medical assistance. However, around 8,300 births (1) each year in the UK are the result of in vitro fertilisation (IVF) and intra cytoplasmic sperm injection (ICSI).

Whilst it is recognised that the majority of individuals experiencing fertility problems will not require IVF, there are countless couples who are denied it because the NHS is reluctant to fund their treatment. Some are left with no alternative but to seek private treatment, which can cost between £4,000 and £8,000 depending on the specific treatment (2)

Costs can vary between different clinics, so treatment may cost more or less than this. The UK falls short of most other European countries in providing adequate access to fertility treatment. Indeed, the UK ranks 17th out of 23 European countries for fertility treatment funded by the state (3)

A report by the European Society of Human Reproduction and Embryology (ESHRE) showed that in 2003 the UK carried out 633 IVF treatment cycles per million people in the population; this compares to 2,031 in Denmark, 1,682 in Belgium and 1,009 in France (4)

(1) http://www.hfea.gov.uk/docs/facts_and_figures.pdf
(2) http://www.hfea.gov.uk/fertility-treatment-guide.html
(3) Balen AH and Rutherford AJ. Management of infertility. BMJ. 2007; 335:608-11.
(4) BBC NEWS | Health | More than 3m babies born from IVF

Eeyore

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Thursday, October 14th 2010, 1:48pm

How is funding of fertility managed in England?

Publication of the National Institute for Health and Clinical Excellence (NICE) Fertility guideline in 2004 sought to address the issue of large variations in the local provision of fertility services. The aim of the guideline was to ensure that everyone, no matter where they lived, would have equal access to fertility and therefore eliminate the so-called ‘postcode lottery.’

NICE recommended that the NHS provide three full cycles of IVF to all couples where the woman is aged between 23 and 39 (treatment should start before the woman’s 40th birthday) and has an identified cause of infertility or has had unexplained infertility for at least three years.

Speaking after the publication of the NICE guideline on fertility services, the then Government Health Minister John Reid said “As a first step, by April next year I want all PCTs, including those who at present provide no IVF treatment, to offer at least one full cycle of treatment to all those eligible. In the longer term I would expect the NHS to make progress towards full implementation of the NICE
guidance.” However, some PCTs seem to have misunderstood this advice and still offer only one cycle of IVF treatment on the NHS.

Sometimes a full cycle of treatment is not funded as only a fresh cycle is offered by the PCT and not subsequent frozen embryo transfers.

BBC article on how some NHS trusts are still failing to follow Government guidance on IVF treatment


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Thursday, October 14th 2010, 1:49pm

What is a Primary Care Trust (PCT)?

Primary care is defined as the care you receive from the first people that you normally see when you have a health problem. This can be a visit to a doctor or a dentist, an optician for an eye test, or just a trip to your pharmacist to buy cough medicine. Also included as primary care are your local NHS walk-in centres and the NHS Direct phone line service.

In England, these services are all managed for you by your local Primary Care Trust (PCT), which is a statutory body that is part of the NHS. Northern Ireland, Scotland and Wales have their own authorities, known as Health Boards, which are responsible for healthcare and health improvements in their local area.

Your PCT interacts with local authorities and other agencies that provide health and social care locally to ensure that the needs of your local community are being met.


PCTs are responsible for:


► All people registered with a GP whose practice is within the boundaries of the PCT, regardless of where the person actually lives, plus


► Any people not registered with a GP who live within the geographical boundaries of the PCT.


PCTs manage the financial costs of treatment within their geographical area, providing funding for GPs and prescriptions. They also pay for hospital and mental health services from appropriate NHS trusts or from the private sector.

Eeyore

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Thursday, October 14th 2010, 1:59pm

Criteria for access to fertility treatment

Despite the existence of the NICE guideline, access to NHS-funded fertility treatment can vary greatly across England. NICE stress that social criteria should not be used when deciding who is or is not suitable for fertility treatment.

It would however appear that many PCTs restrict who receives treatment by using social criteria:


1. Some PCTs only provide fertility treatment to patients with no children from a current or a previous relationship

2. Others provide fertility treatment for those with no children on the maternal side, while some will provide fertility treatment for those who have no children living at home

3. Some PCTs will not fund fertility treatment for patients who have previously received privately funded treatment

4. Some PCTs will not fund fertility treatment for patients who smoke

5. There have been reports of women who are single or in a same-sex relationship having problems accessing NHS treatment because most PCTs regard these cases as not technically infertile and so do not fund fertility treatment for same sex couples.

Interactive map that shows the funding available in your region

Eeyore

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Thursday, October 14th 2010, 2:01pm

Why will my PCT not fund my fertility treatment?

PCTs are always under pressure from the Department of Health and local providers to supply funding to treat an extremely wide variety of disorders and diseases. At the same time they are facing financial pressures and are looking at ways to save money.

Budgetary limitations may therefore be the main reason why PCTs apply social criteria when deciding who receives fertility treatment. This can often result in great variations in access to fertility services between areas. This so-called ‘postcode lottery’ can mean that a person living in one PCT catchment area may receive NHS treatment while a friend in a neighbouring PCT may not, despite having similar sets of circumstances.

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Thursday, October 14th 2010, 2:04pm

How can I find out what criteria my PCT uses to decide if I can receive funding for fertility treatment?

TO FIND YOUR LOCAL PCT CLICK HERE

The link above brings up a location search box to find your PCT. Find the name of your PCT and click on the link.

You will see an overview of your PCT informing you of who they are, the name of the chief executive, the address of the PCT head offices and phone and fax numbers. There are also tabs for the ‘hospitals, doctors, dentists, pharmacies, opticians and other sites’ that are currently listed under your PCT.

If your PCT has a website you can click on ‘Trust Website’ (below the address in the overview section) and this will take you directly to the webpage of your chosen PCT. Searching your PCT’s website using phrases such as ‘fertility treatment’, ‘IVF’ or ‘assisted conception treatment’ will enable you to find their policy documents on fertility treatment.

Alternatively, you may prefer to speak directly to someone at the PCT. The website of your PCT should guide you on who to contact with queries. Many PCTs have a Patient Advice and Liaison Service (PALS) which should be able to help you. Your GP may also be able to help you to find this information or may be able to tell you directly.



Eeyore

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Thursday, October 14th 2010, 2:11pm

What fertility care are you entitled to:

Who are NICE and what do they do?

The National Institute for Health and Clinical Excellence (NICE) is an independent organisation, set up by the Government to offer healthcare professionals advice on providing NHS patients with the best possible medical
care. NICE offers guidance on which treatments work best for patients and which do not, as well as recommending which particular treatments should be funded by the NHS.

NICE produces guidance in three areas:

► Public health - guidance for those working in the NHS, local authorities and the wider public and voluntary sector on the promotion of good health and the prevention of ill health

► Health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS

► Clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS


Why was NICE set up?

NICE was set up in 1999 by the then Health Secretary Frank Dobson to ensure that everyone, no matter where they lived, had access to quality healthcare, thus bringing an end to the so-called ‘postcode lottery.’ It was intended that NICE would help people make more informed choices about their health and to ensure that access to quality treatment would be made fairer and faster.




Does NICE cover the whole of the UK?

No. NICE produces guidance on health technologies and on clinical practice for the NHS in England, Northern Ireland and Wales.



What are their recommendations regarding my fertility treatment?

In 2004, NICE published the clinical guideline Fertility: assessment and treatment for people with fertility problems. This guideline made a number of key recommendations, including:


► Fertility patients should be offered up to three cycles of IVF if:

o The woman is aged 23-39 years (up to the woman’s 40th birthday) at the
time of treatment and

o One or both of the patients has been diagnosed with a fertility problem (such as having no sperm or both fallopian tubes being blocked) or

o The patient has had infertility for at least 3 years


► No more than two embryos should be transferred during any one cycle of IVF treatment:

o This balances the chance of a successful birth with the risk of having more than one baby and its consequences

READ THE NICE GUIDELINE HERE




What does a typical full cycle of IVF treatment consist of?


There are a number of stages involved in IVF treatment.


► Step 1: ‘switching off’ the woman’s natural cycle of egg production in the ovaries (down-regulation)

► Step 2: stimulation of the ovaries to produce more than one egg (ovulation induction)

► Step 3: collecting the mature eggs from the woman’s ovaries

► Step 4: collecting sperm from the man

► Step 5: fertilising the eggs with the man’s sperm in a laboratory

► Step 6: incubating the fertilised eggs for a few days (fertilised eggs that have started to develop are called embryos)

► Step 7: after a few days one or two of the healthiest embryos are put into the woman’s uterus.

If an embryo successfully attaches itself to the inside of the uterus and continues to grow, the result is a pregnancy

► A full cycle should include the subsequent transfer of any viable frozen embryos.


Completing all these steps, including any subsequent frozen embryo transfers is one full cycle of IVF treatment.


If, during the course of an IVF cycle, more embryos are produced than are needed for transfer, the couple should be offered the chance to freeze the additional embryos (provided that they are suitable for freezing). Not all embryos survive the freezing process so some will not be suitable for transfer after thawing.

Before another stimulated cycle of IVF (involving down-regulation, ovulation induction and egg collection) can take place, any embryos that survive the freezing and thawing process should be transferred to the uterus. This reduces the number of times the patient will need to receive drugs for ovulation induction and the procedure to recover eggs from the ovaries, both of which carry some risks. It also improves the chances of a successful birth.

An embryo that has been frozen previously can be thawed and transferred into the uterus either as part of the natural cycle (unstimulated cycle) or as part of a cycle controlled by hormone treatment (stimulated cycle). If the patient ovulates regularly their chances of a successful birth are the same whether the cycle is natural or stimulated.




Guideline on fairer access to fertility care is endorsed by the Government


It is important to remember that you are not alone in fighting your cause; there are many other individuals and support organisations who share your views and are lobbying for funding of fertility treatment.


On publication of the Guideline in February 2004, the then Government Health Minister John Reid stated that each PCT should, by April 2005, offer patients a minimum of one cycle of IVF on the NHS , working up to three full cycles in the longer term. Tony Blair, the Prime Minister at the time, told the Commons: "The pain and distress infertility causes is very real and the variation in the level of NHS services is unacceptable. The Government is determined to change this. We hope very much over the next couple of years we will be able to see at least very substantial progress towards the implementation of the full NICE guidelines and they will allow us to end the current postcode lottery.”


Dawn Primarolo MP was appointed Government Minister of State for Public Health in July 2007. This role means that she is responsible for health improvement and health protection issues including areas such as sexual health.
On her appointment, she announced that she would be continuing the work of her predecessor, Caroline Flint MP, in introducing new measures to help the NHS improve childless couples’ chances of gaining access to IVF treatment. She said: “we recognise that there are local variations in the provision of IVF and that this does cause distress to many childless couples who feel that they are not getting the treatment they need.”


On the 12th December 2007 Dawn Primarolo MP addressed the House of Commons with her concerns over the level of services available through the NHS for those seeking fertility treatments.


Acknowledging that access was unfair, Dawn Primarolo MP said:


1. She was developing a programme of work to improve the way in which NHS IVF services were provided


2. The Department of Health had been funding the leading fertility patients’ support organisation, Infertility Network UK (I N UK), to work with the NHS to identify and share best practice in the provision of IVF


3. This partnership was aimed at generating social criteria that she hoped would help PCTs develop a standardised approach across the country for providing IVF


4. The provision of IVF was being monitored to assist in identifying where further work was needed to aid PCTs in evaluating the requirements of fertility patients and delivering services in a fair manner


5. She was setting up an expert [commissioning] group with the NHS and I N UK to advise on the programme of work. “I have written to the Chairman of the Health Committee to tell him and the Committee members of our
intentions. The [expert commissioning] group will have a broad remit to identify the barriers to full implementation of the NICE fertility guidance and to provide advice, support and information to overcome those barriers.”


Dawn Primarolo MP regularly speaks and answers questions in Parliament about issues relating to her Ministerial portfolio. She continues to campaign to bring an end to the unfairness that currently exists for many couples seeking fertility treatment on the NHS.

DAWN'S WEBSITE





Eeyore

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Thursday, October 14th 2010, 2:31pm

How much fertility treatment does my PCT provide on the NHS?

Who decides if I am entitled to NHS fertility treatment?

PCTs control 80% of the total NHS budget and as such are at the centre of the modernisation of the NHS. Your PCT regulates the organisations that provide health and social care to ensure they are working effectively and that enough services are provided and that these are accessible for people within the area.


PCTs have to make certain that all other health services are provided, including hospitals, dentists, opticians, mental health services, NHS walk-in centres, NHS Direct, patient transport (including accident and emergency) and pharmacies. PCTs are also responsible for getting health and social care systems working together for the benefit of patients.


What is the extent of variability in the funding of fertility treatment?

The NHS drugs and treatment watchdog, NICE, recommends three full cycles of IVF treatment for women aged between 23 and 39 (treatment should start before the woman’s 40th birthday). Despite the NICE guideline having been in place for the last four years, individual PCTs tend to make decisions based on their own criteria which include factors such as age and family background. The postcode lottery still appears to be very much in existence.


My PCT will not fund my fertility treatment. What can I do?

There is a guideline in place in England (NICE) recommending NHS provision of a range of investigations and treatments. These include up to three cycles of treatment for women aged between 23 and 39 (treatment should start before the woman’s 40th birthday) with an identified cause of infertility or who have had unexplained infertility for at least three years.

There are a number of steps you can take to encourage your PCT to provide funding for your fertility treatment.


How to secure funding?

You may have encountered difficulties in gaining access to fertility treatment through the NHS. This section is designed to provide you with information and advice on the options that are available. We will walk you through all the steps you can take in order to push your PCT to fund the fertility treatment you deserve (as per the NICE guideline).

It is important to remember that there can be variation in the organisation and set-up of PCTs which you may need to take into account, adapting your approach as appropriate when following the advice below.

1. The first thing we suggest is that you familiarise yourself with the fertility treatment you are entitled to, according to the NICE guideline. You can do this by reading a summary of the recommendations in the post above 'What are the NICE recommendations for fertility treatment?'

2. You should then compare the eligibility criteria set by your local PCT and determine whether or not you are able to get treatment paid for by the NHS. There may be variations in the criteria used by your PCT and what NICE recommend, particularly on whether you have previously had any children, either through birth or adoption. Further details on how these and other factors may vary between PCTs can be found in the post ‘Criteria for access to fertility treatment.’

There a number of ways to obtain your PCT’s access criteria:

a) Contacting your PCT directly to request a copy of its policy on
infertility services, or
b) Visit your PCT’s website.
The post 'How can I find out what criteria my PCT uses to decide if I can receive funding for fertility treatment?' gives you instructions on how to find contact details for your PCT, as well as accessing the information online (if your PCT has a website).

3. If your PCT will not fund your fertility treatment you can write to them to appeal against this decision. We have provided you with a template letter which you can use to request funding for your fertility treatment from your local PCT. You can easily adapt this letter using your own words to reflect your personal situation. You should book an appointment to see your GP so that he/she can help you fill in the details that are required. We recommend, if possible, that you get your letter counter-signed by either your fertility specialist or GP. This letter should be sent to the person responsible for commissioning fertility treatment in your area. Your PCT should be able to direct you on who you should send the letter to.


Infertility Network UK (I N UK) lead the National Infertility Awareness Campaign and have for many years been involved in funding issues throughout the UK. It is important that I N UK keep abreast of any problem areas and so if you are happy to do so please send a copy of this letter to I N UK at the address listed below:


Clare Lewis Jones

NIAC
Infertility Network UK
Charter House
43 St Leonards Road
Bexhill on Sea
East Sussex
TN40 1JA

USE THE FIRST ATTACHED TEMPLATE LETTER

4. If you have not had a response within 14 days from the date you sent your letter, we recommend that you follow-up with a telephone call. If you call the main switchboard of your PCT and ask to speak to the person responsible for commissioning fertility treatment they should be able to help you. Remember to be polite and courteous, but persistent.


a) Enquire as to whether your letter has been received and
b) If any decision has been made regarding your request for funding
or
c) When you can expect to hear from them.


PCTS IN ENGLAND Selecting your PCT will bring up an overview displaying their address and telephone number.


5. If your initial request for funding for your fertility treatment is denied you have the right to appeal the decision. You are advised to send a second letter, a template for which is provided below. The letter underlines the
NICE guideline and stresses that as the patient you are entitled to three full cycles of treatment. The final part of the letter enquires about the complaints procedure for your PCT. Again, you can use this template to write a letter personalised to your circumstances.


If you are happy to do so please send a copy of this letter to I N UK at the following address:


Clare Lewis Jones
NIAC
Infertility Network UK
Charter House
43 St Leonards Road
Bexhill on Sea
East Sussex
TN40 1JA

USE THE SECOND TEMPLATE LETTER

We also recommend that this letter be sent out with a copy of a letter written by Dawn Primarolo MP, the current Government Minister of State for Public Health. In this letter she stresses the position of the Department of Health in promoting and endorsing full implementation of the NICE guideline. She asks PCTs to move towards the provision of three full cycles of IVF for those who need it.

DAWN'S LETTER

If after following all the steps above you are still unsuccessful in getting your treatment funded by the NHS, you may wish to contact your local Member of Parliament (MP) to raise the issue of funding of fertility treatment.

Eeyore has attached the following files:

Eeyore

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Thursday, October 14th 2010, 2:38pm

Contacting you Member of Parliament

Contacting your MP can often be an important step in getting your voice heard. Your MP will be in regular contact with other Government Ministers and civil service officials who may also be able to help. Alternatively, your MP may decide to take up your case with your PCT directly.

MPs must be made aware of the discontent surrounding the provision of fertility services in the NHS.
Inform them of the following:


► How fertility issues have affected you
► The unfairness and challenges that exist in accessing fertility treatment on the NHS
► How services in their constituency compare to those elsewhere in the country
► What treatment you are entitled to under the NICE guideline


1. To find out who your MP is and/or to obtain his/her contact details follow this link
a. You may use the search menu and enter in your postcode, or
b. If you already know who your MP is you may find their contact details by following the link below and clicking on their name.


2. If you prefer, you can find their contact details by calling the information line of your local council. The number can be found in the front section of your local telephone book or Yellow Pages.


3. If you would like to meet your MP face-to-face to present your views directly, you have the option to either attend their constituency ‘surgery’ or you can visit them at their Westminster office.


4. It may however help if your first contact is through a letter explaining your issues. Letters with a constituency postmark are likely to receive priority treatment. You can use the template we have provided to write to your MP explaining the key issues as mentioned above and the difficulties you have personally experienced in trying to access fertility treatment through the NHS. We recommend that this be sent together with copies of the previous two letters you sent to your PCT requesting funding of your fertility treatment.

All MPs have the same address; just send your letter to:
[Insert name] MP
House of Commons
London
SW1A 0AA

If you are happy to do so please also supply a copy of the letter you send to your MP to I N UK.

5. Follow-up with a telephone call. Your MP’s office may receive hundreds of letters each day and so they might not reply right away. A quick phone call can help get your letter noticed.
You can call the Westminster office of every MP by calling the House of Commons switchboard on 020 7219 3000.
a. Ask to speak to the office of your MP
b. When you speak to your MP’s office, explain who you are and that you are following up your letter
c. Arrange for an appointment to meet with your MP


Eeyore has attached the following file:




FERTILITYZONE



MEDHURST – PROUD HOSTS OF FERTILITYZONE