NHS Fertility Services

Lord Vaizey of Didcot Excerpts

Thursday 19th January 2017 Westminster Hall

[Mr Edward Vaizey (Wantage) (Con)]

I am grateful for the opportunity to speak in this important debate under your chairmanship, Mrs Gillan. I thank the hon. Member for Birmingham, Selly Oak (Steve McCabe) for securing it. I appeared with him in front of the rather intimidating Backbench Business Committee, but thanks to his eloquence and advocacy we now have time to raise this issue in the House. Hon. Members frequently table questions about IVF, but I do not recall when we last had a debate on the subject. It is right that we have the chance to raise the issue, which has frequently crossed my desk since I was lucky enough to be elected to represent the Wantage constituency. Like the hon. Gentleman, I will talk about some of the cases that have come across my desk. They will sound very similar to those that he raised, because couples not being able to have children and not being able to access the treatment that can help them have children has a huge emotional and health impact on them.

As the hon. Gentleman said in his eloquent opening speech, which covered all the issues, it is important to stress that infertility is a disease. Choosing to have children—I hate to put it like this—is not a lifestyle choice; it is a fundamental choice that many people are lucky enough to be able to make. People who are not able to conceive children suffer from a disease, and I think it is therefore incumbent on the national health service to help combat the impact of that disease, as it does for many other diseases. This issue is much more prevalent than people realise: it affects one in seven couples in the UK. I am sure everybody in this House knows people who have been affected directly, and our constituents contact us about it. As the hon. Gentleman pointed out, it is the second most common reason why women visit their GP.

We have also heard how more and more clinical commissioning groups are now disinvesting in NHS fertility services. The signals from NICE, the Government and the CCGs themselves clearly show that fertility services are seen as second-class NHS services that do not rank alongside other, more important services. We in this House know from the many debates we have had, and not least from the huge increase in the profile of and focus on mental health services, that treating something as a second-order issue stores up significant problems. We can reverse that attitude through sustained campaigning. As has been pointed out, in 2016 North East Lincolnshire, Somerset, Wiltshire, Herts Valley, Cambridgeshire and Peterborough, and Bedfordshire CCGs all cut their fertility services and now offer the bare minimum: one funded IVF cycle. Approximately 10% of CCGs are currently considering disinvestment.

The NICE clinical guidance has been around for more than 10 years. It is important to remember that this is not a static issue: the cost of infertility treatment has fallen dramatically and its effectiveness has increased. The second or third cycle tends to be the one that helps a couple to conceive, so I think NICE was visionary and right to say that three full cycles should be offered to women under 40. It is important to remember that CCGs restrict fertility services not only through the front door by making it clear that they will offer only one cycle, but through the back door by restricting the age at which women can access them. In Oxfordshire, for example, the age limit is 35, not 40.

There is also the issue of how a cycle is defined. In Oxfordshire, one fresh cycle is offered to those under 35, and no frozen transfers are allowed. Other definitions of a cycle allow frozen embryos that have been created from the first cycle to be used, so Oxfordshire does not comply with what I understand to be NICE’s definition of a cycle.

Going back to fertility services being seen as second-class services, Oxfordshire CCG’s response to me when I asked it to comply with the NICE guidelines was, “How are you going to fund it? What other services are we going to have to cut to fund fertility treatment?” It was clearly posited as an either/or, and the undercurrent of the message was, “We are funding the important services. Additional fertility services are a luxury. You are asking us to spend £x million on a luxury.”

To defend Oxfordshire CCG, it uses the NICE cost guidelines when it works out what the additional costs would be. It claims that they would be £2.5 million in year 1, four-and-a-bit million pounds in year 2, £5 million in year 3 and just under £5 million in years 4 and 5. What depresses me about that is the fact that it simply took the off-the-shelf guidance from NICE, which gives the game away: it is simply a desktop exercise by a CCG that is not really interested in addressing the issue. It should be possible for it to investigate with a range of different providers how it can potentially reduce the cost. The cost variation in fertility treatment can range from something like £2,000 to up to £8,000 for a cycle, so it is possible to at least engage with providers to investigate how one can provide a cost-effective service.

I also challenged the CCG on how rigorous it is in stopping services that are out of date and past their usefulness. My understanding—I am sure the Minister will confirm this—is that CCGs should be carrying out an ongoing process of reviewing all the services they are currently funding, because there are probably many services that are out of date or falling into misuse but are still being funded.

I pay tribute to Fertility Fairness, which campaigns assiduously on this issue. It made the point that treatment can cost about £2,000 in the north of England, £6,500 in the south and £3,500 across the UK as a whole. One of its asks, which perhaps the Minister can respond to, is this. CCGs can take refuge by charging the highest cost possible, which acts as a barrier to what we want to achieve. If there were a national tariff, more CCGs might be tempted to come to the table and increase what they are doing to support fertility services.

The Minister is not only a fellow Oxfordshire MP but an absolutely brilliant Health Minister. I know that to a certain extent I am knocking at an open door, because she has spoken very strongly about this issue in public. She 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.”

That is very welcome news indeed.

The hon. Member for Birmingham, Selly Oak pointed out that there are knock-on costs to not providing fertility treatment in the UK. We know, for example, that many couples understandably go abroad to fund and access fertility services, but different regulations apply abroad. Often, many more embryos are implanted in treatment abroad, which can lead to multiple pregnancies. Multiple pregnancies can lead to greater complications, so paradoxically that can lead to increased costs for the NHS. We would all much prefer people living in the UK to be able to access more familiar services, instead of having to go abroad and take those risks.

I mentioned that all of us speaking in the debate will have real stories to tell. We are speaking not in a vacuum about some impersonal procedure, but about a disease that affects the lives of our constituents significantly. The reason why I supported the hon. Member for Birmingham, Selly Oak in securing the debate, and the reason why I am present, is the letters I receive as a Member of Parliament from my constituents.

One 33-year-old constituent wrote to ask how the situation was fair given that in Wales, Scotland and Northern Ireland, people are entitled to three full cycles of IVF—I understand that the Scottish Government are moving to three full cycles early this year. For four and a half years she and her husband have been trying to conceive. They have been through every test, but all the results have come back as normal, so they have what is called unexplained fertility. They pinned all their hopes on a single funded cycle of IVF, although that was difficult to accept. She points out that infertility is not a choice made by women; they have no control over it. Her first cycle, in August, failed and she went on to a frozen egg cycle, but unfortunately miscarried. Her emotional status is now such that she sees her GP regularly, has been referred to TalkingSpace, an NHS service, and awaits counselling. She was quoted £6,000 for a private cycle—her parents helped with the cost of the treatment—although it transpired that the overall cost was about £8,000. That second cycle failed, too, and the couple will now remortgage their property to fund a third cycle.

Those who think of infertility as a second-order issue should consider that some people will mortgage their financial future to treat the disease, as people might do for other diseases. The idea that infertility is something that one can simply put to one side is absolutely ludicrous. Another constituent wrote about having to go to Barcelona for treatment, which cost about £12,000. A third constituent, at the age of 36, was again refused IVF treatment, and she is now funding her treatment privately.

Infertility is clearly a disease, and one that affects many couples throughout the UK, and some of the devolved Administrations are moving forward on it. I respect the difficult choices that clinical commissioning groups have to make, but the NICE guidance is crystal clear and fair. The guidance sanctions not unlimited cycles but only three, recognising that the first cycle often fails. The technology continues to advance, prices continue to fall and there is little evidence from my CCG or, I suspect, many others of active engagement on the issue, such as research on the ground in real time into what it might cost to procure fertility services, as opposed to simply using off-the-shelf NICE cost guidance to rebut my constituents’ concerns.

The lack of infertility treatment has hidden costs, as the hon. Gentleman said, in mental health and emotional issues and the ongoing costs when people go abroad for treatment that might have an impact back home. A great step forward would be if the Minister were to bring forward a national tariff, or if research were commissioned into some of the ongoing costs of not providing infertility treatment. I encourage the Minister to continue to hold CCGs to account for not complying with NICE guidance.

Community Pharmacy in 2016-17 and Beyond

Lord Vaizey of Didcot Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[David Mowat]

The right hon. Gentleman makes an extremely good point. They are not yet in place, but they will be by 1 December.

[Mr Edward Vaizey (Wantage) (Con)]

I congratulate the Minister on his statement. It is worth reminding the House that many urban pharmacies are located in clusters and are very close to one another. It is therefore quite right that we should look at how they are subsidised. I am pleased that, as a result of these savings, he will be looking out for rural pharmacies, which are more dispersed. They are the ones that really need the help.

[David Mowat]

The access scheme to which I referred will apply to rural and urban pharmacies. Indeed, there is more urban than rural in it, but it will protect rural pharmacies in the way my right hon. Friend mentions.

Oral Answers to Questions

Lord Vaizey of Didcot Excerpts

Tuesday 11th October 2016 Commons Chamber

[David Mowat]

The STP process is an attempt to upgrade our public health and mental health provision and cancer outcomes. Every STP will be expected to provide an assessment of local public health priorities and the timetable for progress towards that.

[Mr Edward Vaizey (Wantage) (Con)]

Wantage community hospital in my constituency has recently closed because of the threat of Legionnaires’ disease, and it will not reopen until we have finally concluded consultation on the sustainability and transformation plan—if it reopens at all. This consultation has been delayed, and that naturally worries my constituents. Will the Minister join me in urging Oxfordshire to get on with consulting on this very important plan, so that we can have a reasonable discussion?

[David Mowat]

I will join my right hon. Friend in doing that. I am not familiar with the specifics of the Wantage case, but it does not sound right that it is an ongoing thing that is not fixed quickly.

Defending Public Services

Lord Vaizey of Didcot Excerpts

Monday 23rd May 2016 Commons Chamber

[The Minister for Culture and the Digital Economy (Mr Edward Vaizey)]

I am pleased to respond to this debate, and I apologise that I slipped out for a while to attend the Oscars—I refer, of course, to the fantastic Oscar’s book prize, which was started by the journalist James Ashton and his wife, Viveka, in honour of their son, who sadly died at a young age. It is a prize for children’s literature and picture books, and I am pleased that the award went to the fantastic Spanish author, Gemma Merino—are we not pleased that in this country we are able to award a prize to a Spanish author, one of our European brethren?

The winning book was called “The Cow Who Climbed a Tree”. I have not read the book, but I do know that it features a cow that does something unusual—it climbs a tree. That reminded me of this debate, which has been a bit topsy-turvy. A former Trade and Industry Secretary condemned a trade treaty with the United States, my right hon. Friend the Member for Wokingham (John Redwood) called for more investment in public services and not for tax cuts, and the hon. Member for Huddersfield (Mr Sheerman), who is not in the Chamber, recommended that hon. Members read The Sunday Times, a Rupert Murdoch paper, and in particular columns by Max Hastings, to get a real taste for the truth in public policy.

This is a special day, and I want to mark two important occasions. First, it is the Chancellor’s 45th birthday, which was mentioned in the debate. Secondly, I may be the first to congratulate the leader of the Scottish Conservatives, Ruth Davidson, on her engagement. Many others have congratulated her on eclipsing the Scottish Labour party and on the fact that she is breathing down the neck of the Scottish Nationalist party.

The debate has very much been about football. The right hon. Member for Leicester East (Keith Vaz) was not wearing his scarf but still managed to mention his championship-winning team—a team that wins rather than a party that loses, such as the SNP.

[Ian Blackford]

The SNP won the election and increased its share of the vote—it got nigh on 47% of the vote. The Tories got 22% of the vote, which is less than they got when Thatcher was in power. If the Minister calls that breathing down the neck, I do not know what he would think about a real challenge.

[Mr Vaizey]

The hon. Gentleman doth protest too much, and he certainly spoke extensively. As well as Leicester, we heard mention of Sheffield Wednesday, and I wish them the best of luck in the premier league play-off. The hon. Gentleman is a fan of Hibernian, so he obviously had a good weekend. We also had a brief mention of West Ham, who are ably led by the Conservative peer Karren Brady.

Before I mention individual speeches, may I reject the persistent criticism from the Opposition about this being a thin Queen’s Speech? We focus on sugar-free drinks and the sugar tax, but the Queen’s Speech is packed with fantastic nuggets. My Bill will push forward the digital economy. The Department for Transport will focus on autonomous vehicles and on spaceports. We have a commitment to 1 million more homes; the devolution of business rates to give more powers to local councils; rigour for our universities; much needed changes to adoption rules; greater freedom for headteachers and teachers; prison reforms; and a focus on skills and apprenticeships.

We have heard formidable speeches, but I hope hon. Members forgive me if I single out the maiden speech of the hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss). It was a fantastic speech, and particularly poignant for the fact that it came within a year of the maiden speech of her late husband Harry Harpham, who is sadly missed from the House. She talked about skills, housing and libraries. I may not agree with the hon. Member for Huddersfield that we should always read Max Hastings, but I agreed with him when he followed her speech by saying that she will be a formidable Member of the House and a fantastic spokeswoman for her constituents.

Much of the debate focused on the national health service, and my right hon. Friend the Secretary of State gave a robust exposition of his important reforms. He has worked incredibly hard over the past four years to put patients first. The key point is to put patient safety and patient outcomes first.

Many Members spoke in the debate, including my right hon. Friend the Member for Basingstoke (Mrs Miller), my hon. Friends the Members for Harrow East (Bob Blackman), for South West Wiltshire (Dr Murrison) and for Dudley South (Mike Wood), the right hon. Member for Leicester East, and the hon. Members for Ross, Skye and Lochaber (Ian Blackford), for Huddersfield, for North Antrim (Ian Paisley), and for Scunthorpe (Nic Dakin), but I should like to mention the hon. Member for Dulwich and West Norwood (Helen Hayes) and the right hon. Member for North Norfolk (Norman Lamb), who focused on mental health. For a long time, mental health has been the Cinderella, but my right hon. Friend the Secretary of State deserves a great deal of credit for raising its profile and importance, and for investing in it. We need to focus on that incredibly important service as much as possible.

We had mentions of education. The right hon. Member for Leicester East talked about prison reform, which is an extraordinarily important issue, and with my cultural hat on may I say how important culture could be in giving prisoners life chances and aiding their rehabilitation?

I notice from your glance in that direction, Mr Speaker, that I was warned by several of my colleagues not to mention them in my peroration, such is the terror with which you are held, in case they were not in the Chamber to hear their names mentioned, so I had better stop mentioning hon. Members and hon. Friends. I will, however, turn briefly to the BBC, which has been much maligned by those on the Opposition Benches.

The hon. Members for Washington and Sunderland West (Mrs Hodgson), for Manchester, Withington (Jeff Smith), for Sheffield Central (Paul Blomfield) and for Merthyr Tydfil and Rhymney (Gerald Jones) all spent their time talking down the BBC. I found it particularly surprising that the hon. Member for Sheffield Central—he obviously had not heard the hon. Member for Huddersfield extolling the virtues of the Murdoch press—dared to suggest that we were somehow shaping our approach to the BBC at the behest of Rupert Murdoch. I tell you this, Mr Speaker, with utter sincerity and truthfulness that the only organisation that has ever lobbied me to clip the wings of the BBC is The Guardian.

Mr Speaker, I know you well enough to know that you may not know what The Guardian is. It is a left-wing newspaper and website that has been going through some interesting changes recently in terms of its chief executive and the chairman of its trust. It comes to me regularly—quite legitimately, I have to say—to say that it is trying to make a living, as it were, digitally in the digital world. It has been opening websites. It opened an office in Australia and came to complain about the presence of the BBC in Australia taking talent from The Guardian in Australia and paying too much. It also lobbied me about the presence of the BBC in the US, where The Guardian also wants to have a presence.

The serious point is that we have to be aware not just of the fantastic virtues of the BBC, but that it is seen by other media groups, such as The Guardian, as a competitor. We have carried out much needed reform of the BBC. We have put its regulation on a proper footing—it will be regulated by Ofcom, with a unitary board. We have emphasised, in deference to The Guardian, the importance of the BBC being distinctive. We have strengthened its independence by ensuring that it can appoint half the members of the unitary board, and we have put in place a mid-term review so that the BBC can keep pace with technological change. That is only right and proper.

The other important aspect of the Queen’s Speech is the digital economy Bill, which was mentioned by my hon. Friends the Members for Mid Worcestershire (Nigel Huddleston) and for Salisbury (John Glen), my right hon. Friend the Member for Basingstoke, my hon. Friend the Members for Rossendale and Darwen (Jake Berry), my right hon. Friend the Member for for Arundel and South Downs (Nick Herbert), and my hon. Friends the Members for High Peak (Andrew Bingham) and for Harrow East. This is an important point. The hon. Member for Garston and Halewood (Maria Eagle) asked me to talk about the universal service obligation we are bringing in to make it a right to get superfast broadband, and what the extra costs might be for people applying for it. She well knows that if one applies now for a telephone landline under the universal service obligation, one has to make a contribution if the costs exceed a certain level. Of course, that level is many, many thousands of pounds, so it is not as if we will be asking many people, if any, to make a contribution. We will consult after we have legislated for this important right. I hope the hon. Lady will make a contribution to that consultation and perhaps advise us on what level she thinks any threshold should be set at.

I welcome the hon. Lady’s welcome for the cultural protection Bill in relation to The Hague convention. The Bill should have been passed by the previous Labour Government. In fact, I was the Opposition spokesman at that time—as you know, Mr Speaker, I was made Opposition spokesman in about 1874. I was ready and willing to take it on as my first Bill as an Opposition spokesman, but have had to wait eight long years to take it through as a Minister.

This is a Queen’s Speech packed with passion, packed with aspiration and packed with ambition. It is a one nation Queen’s Speech that focuses on the life chances of those who are hardest to reach. This has been a vigorous and important debate. I have to say with utter sincerity that it has been an absolute pleasure to listen to hon. Members on both sides of the House and to hear the passion and the principles that they bring to these issues. Their knowledge, expertise and independence of mind are everything that makes this House of Commons great and everything that makes this country great; a great country and a great member of the European Union. [Interruption.] I am just trying to match the rhetoric.