IVF Provision

Abena Oppong-Asare Excerpts

Tuesday 24th October 2023 Westminster Hall

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

It is a pleasure, as always, to serve under your chairship this morning, Mr Robertson. I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this important debate, and thank her for championing such an important issue so eloquently today. She talked about the barriers that LGBTQI+ couples face to having children, particularly being priced out, and the fact that while the guidance is good, more work needs to be done.

I thank Megan and Whitney for sharing their hard-hitting story, along with many others who have done so much work to ensure that we are informed about these challenges. I know that there was an urgent briefing yesterday on IVF provision. I am sure everyone will agree with me that this has been a good debate, and that it is clear that a number of changes need to be made for the sake of equality and fairness.

I also thank the hon. Member for Cities of London and Westminster (Nickie Aiken), who has clearly done a lot of work in this area, for talking about the barriers that individuals may face in the workplace when undergoing IVF treatment. She mentioned businesses signing up to the fertility workplace pledge. The hon. Member for Strangford (Jim Shannon) spoke about how the IVF process was impacting his constituents and, as always, gave a helpful picture of the situation in Northern Ireland. I also thank my hon. Friend the Member for Pontypridd (Alex Davies-Jones) for sharing her personal story and for her work on the private Member’s Bill, the Fertility Treatment (Transparency) Bill.

As we all know, becoming a parent can be a special and rewarding time for many people. It is the start of an exciting journey into parenthood and a time to celebrate new life. However, as we have heard, there are many challenges that women and families face when conceiving and many challenges in the way of those who seek NHS fertility treatments. As my hon. Friend the Member for Jarrow powerfully said, the challenges—both financial and emotional—for LGBTQ+ couples are so much higher. IVF is one of several techniques available to help people become pregnant. This medical procedure has transformed countless lives, providing hope and the possibility of parenthood to those who might otherwise never experience it.

While IVF is a celebrated medical advancement, the lack of accessibility and the inequality of provision in England and across the UK are issues that cannot and should not be ignored. The National Institute for Health and Care Excellence is responsible for making recommendations about who should have access to IVF treatment on the NHS in England. The current guidelines for England recommend that IVF should be offered to women under the age of 43 who have been trying to get pregnant for two years, as has been mentioned. The exact NICE recommendation is three full cycles for women under 40 and one full cycle for women aged 40 to 42. While in some areas women under 40 can access three cycles of IVF, in other areas they are offered one or even none.

For example, in 2020, the British Pregnancy Advisory Service used freedom of information requests to find out that 86 clinical commissioning groups—now ICBs—funded only one cycle of treatment. More concerningly, it found that three CCGs in England did not provide any funding for IVF services at all. In fact, only 23 CCGs funded three cycles as recommended by NICE.

Unsurprisingly, the provision of IVF services across England, as pointed out by my hon. Friend the Member for Jarrow, has been described as a postcode lottery. I am sure we all agree that this is not right, that the policies are unfair and out of date, and that they must be updated as soon as possible.

I want to tackle the important issue raised by my hon. Friend about the need to break down barriers for all couples. As Stonewall has highlighted in its campaign on this issue, LGBTQI+ couples face incredible financial costs to achieve the same outcomes as everyone else. While the women’s health strategy pledged to remove financial barriers for female same-sex couples in England, the statistics prove that little progress has been made. According to Stonewall’s research, only four of the 42 ICBs in England officially provide NHS funding for artificial insemination, and nine in 10 ICBs in England still require same-sex couples to self-fund at least six cycles of intrauterine insemination before they are eligible for IVF treatment on the NHS. As the Minister will know, that means that LGBTQI+ couples are forced to go privately and end up paying large sums of money—thousands or even tens of thousands of pounds— before they can access NHS fertility services.

I agree with the crucial point that the Government must commit to tackling inequality in access to NHS-funded fertility services. ICBs should ensure fair access to treatment for all, and ensure that individuals within the LGBTQI+ community, including lesbians, bi women and trans individuals, are not left behind but have the same access to NHS-funded care. However, sadly, going private is now not the last resort but the norm for all individuals in England. In recent years, fewer and fewer women can access IVF treatments on the NHS, with everyone else having to go private. In fact, the use of privately funded IVF cycles by patients across the UK aged 18 to 34 increased to 63% in 2021 from 52% in 2019. That coincides with a fall across the board in numbers of NHS-funded IVF cycles. It is a damning result, highlighting the lack of support available on the NHS for women in the UK. Women are being forced to go private, and parents and families up and down the country face the added financial burden.

The Government must acknowledge that one of the main reasons for the falling levels of provision has been the extraordinary waiting times that women face prior to starting treatment. As the Royal College of Obstetricians and Gynaecologists has shown, although waiting lists were growing too quickly before the pandemic, the impact of the pandemic has made the situation significantly worse. There is an urgent need to reverse the growth of NHS waiting lists in gynaecology, and to ensure that women can access high-quality, timely care and treatment. I know that the Minister and this Government have committed to tackling those extraordinary waiting times, and I hope that she can update us regarding their progress on this critical issue. We all know that the quicker women are seen, the better the outcome will be.

Another critical factor is non-clinical access criteria, where mothers and parents can be denied access to treatment because of their relationship status—as pointed out by my hon. Friend the Member for Jarrow—their body mass index, or the fact that one partner has a child from a former relationship. The women’s health strategy seeks to remove non-clinical access criteria to fertility treatment, and to address geographical variation in access to NHS-funded fertility services. We on the Labour Benches welcome that ambition, but we know, as do the Government, that it cannot be realised without providing the NHS with the staff and resources it needs. As part of the work, the Minister has said that her Department will work with NHS England to assess fertility provision across ICBs, with a view to removing non-clinical access criteria. Can she confirm the extent of her conversations with NHS England and update Members on the timeline for making the changes?

For far too long, women and their partners have faced unnecessary obstacles to accessing IVF treatment. The Government have had 13 years to address those problems. Instead, I am concerned that they have weakened standards for patients, who are paying more tax but getting worse care. On the important issue of provision of IVF treatment, I welcome the ambitions outlined in the women’s health strategy. I hope that, along with Megan and Whitney’s powerful story, the Minister has been listening to hon. Members, especially my hon. Friend the Member for Jarrow, who has made it clear that the reforms need to happen sooner rather than later.

I urge the Minister to assure us today that there will be full implementation of these aims, and to give us a timeline for when they will occur. I urge her to give us hope that there will be an end to the postcode lottery, and to the inequality in provision faced by so many individuals and partners across England and the UK.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Jarrow (Kate Osborne) for tabling this important debate, and all Members across the Chamber for their contributions. It has been a positive debate—a good example of putting politics aside and debating how to do the right thing. While I am not denying the challenges for the LGBT+ community raised by the hon. Member, I want to highlight that the Government have brought in major changes over the years with the introduction of same-sex marriage, and the transformation of the management of HIV with the roll-out of opt-out testing and PrEP treatment.

I am pleased to announce that, following the advice from the Advisory Committee on the Safety of Blood, Tissues and Organs, the Government will be introducing secondary legislation to allow the donation of gametes by people with HIV who have an undetectable viral load; we will be introducing that as soon as we can. We will also be addressing the current discriminatory definitions of partner donation, which result in additional screening costs for female same-sex couples undergoing reciprocal IVF; again, amendments through statutory instruments will be introduced as soon as possible.

Those are some of the measures that we have been working on, but I absolutely understand from what I have heard today that there are many issues still to be dealt with, and I welcome the hon. Member for Jarrow holding my feet to the fire to deliver change. Hopefully some of these updates will provide reassurance. This is a priority area, which is why IVF, fertility, and particularly same-sex access to IVF, were in the first year of the women’s health strategy, and it is why we are not going to wait for the 10 years of the strategy to introduce the changes.

To be clear, the Government are implementing a policy that no form of self-financed or self-arranged insemination is to be required for same-sex couples to access fertility treatment. I acknowledge that is taking a little while to be rolled out across the country. Hon. Members, especially the hon. Member for Pontypridd (Alex Davies-Jones), have spoken about infertility a lot. We absolutely recognise that it has a serious effect on individuals and couples, which is why it is a priority—particularly for the women’s health strategy.

As the hon. Members for Strangford (Jim Shannon) and for Livingston (Hannah Bardell) pointed out, I can only speak on the provision of IVF in England, but I am very happy to work with colleagues in the devolved nations of Scotland, Wales and Northern Ireland to achieve a consistent approach. Although we are dealing with the inconsistencies in England, if we are a United Kingdom, these matters need to be addressed across all four nations and I am not precious about stealing best practice from other parts of the UK.

In our call for evidence for the women’s health strategy, women told us time and again that fertility was a key issue and that they felt very frustrated about the provision of, and access to, fertility treatment. Colleagues have made a number of important points which I will respond to in turn, but it has been recognised that there has been unequal access to IVF in England since the treatment was introduced; that is why this is such an important issue. There is resistance in some parts of the country to the changes the Government want to make, but I think we will be able to make progress on them.

NICE is reviewing its fertility guidelines, taking account of the latest evidence of clinical effectiveness. These will be published next year and we will be working with NHS England to implement these guidelines in England quickly and fairly. I am told that they will end regional variation and create a compassionate and consistent fertility service across England, but that does not mean that we cannot improve services in the meantime.

As has been set out, integrated care boards are now responsible for delivering IVF services. They were previously determined by CCGs, but from July last year the 42 ICBs across England are now responsible. Since the ICBs were created, we have seen a levelling up of IVF provision in many. Where CCGs have come together, ICBs have often adopted the higher rate of provision, rather than the lowest level. That is to be welcomed, but by no means does it mean that the level of provision is where we want it to be. Some, but by no means all, ICBs, including in north-east London and Sussex—I declare an interest as a Sussex MP—are now fully compliant with the current NICE guidelines and the provision of three cycles. Others are improving their integrated offer, but some ICBs have kept their pre-existing local offer. That is not good enough, and we are aiming to tackle it.

[Abena Oppong-Asare]

What conversations has the Minister been having to make sure that ICBs are currently being updated to be as robust as possible?

[Maria Caulfield]

I will go through that. One of the first things we have done is to be transparent about what is being offered. We have asked every ICB—the whole 42—to detail their provision. We are now publishing that on gov.uk, so if ivf.gov.uk is entered, the table will come up. That illustrates the number of cycles offered by every ICB, the age provision, the previous children rule and what funding is offered for cryo-preservation. That is not just to say, “This is what’s on offer” so that women and couples can see what is available in their area; it is also the start of the process of holding ICBs’ feet to the fire—and for local MPs to be able to say, “Look, they’re offering free cycles in Sussex; why are we not offering that in our local area?”

[Abena Oppong-Asare]

The Minister may be about to get to this point, so I apologise if I have intervened too quickly. In terms of transparency, it is great that the Minister is publishing the data, but what are the Government doing to make sure that more work is being done by ICBs to provide a better—or adequate—service, given that publishing data does not require them to take any action?

[Maria Caulfield]

As the hon. Lady will know, it was only last year that we published the women’s health strategy. IVF was front and centre of that—the first year priority. Getting that information is the first step, and then we are able to look at the ICBs that are not offering the required level of service, have those conversations about why and have a step change to improve the offer. That is just one tool in our box to fulfil our ambition to end the postcode lottery for fertility treatment across England.

Colleagues have also raised the issue of lack of information about IVF, both for the public and healthcare professionals. We are working closely with NHS England to update the NHS website to make IVF more prominent, and also with the royal colleges to improve the awareness of IVF across healthcare professions. One area we are dealing with is that of add-ons, which the hon. Member for Pontypridd (Alex Davies-Jones) and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) addressed. As part of our discussions with the HFEA, it now has the add-on rating system, so that people can see what percentage difference an add-on would make and make an informed choice about whether they want to do that as part of their IVF treatment.

I have also just received the HFEA’s report about modernising the legislation, with particular regard to its regulatory powers. That will cover the provision of add-ons, and I hope to be able to respond to the report as quickly as possible. We are making really big changes to some of the issues that have been holding back IVF for a long time. I know that for many people this is not quick enough, but I reassure hon. Members that progress is being made.

For female same-sex couples and same-sex couples across the board, I know that this is a really important matter. I took the position that it was unacceptable for female same-sex couples to shoulder an additional financial burden to access NHS-funded fertility treatment. On the transparency toolkit now on the gov.uk website, we can easily see which parts of the country are asking for six cycles of self-funded insemination, for instance. In Cambridgeshire and Peterborough it is 12 cycles, in Bristol and north Somerset it is 10. As the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) said, that is exactly the information we need so that we can tackle the issue head-on and directly with the ICBs. Indeed, one of our key commitments in the women’s health strategy was to remove this injustice once and for all. We were hoping to do that completely in the first year; it will in fact take us a little longer, but it will not take us 10 years.