NHSSheffieldCCGEqualityImpact Assessment2013

Title of policyor service / Access toinfertilitytreatment
Name and role of officerscompleting the assessment / ElaineBarnes, E&D Manager,Will Cleary-Gray, Head of Collaborative
Commissioning& Planning.
Date assessmentstarted/completed / 18thOctober 2013 / 6thNovember 2013
1. Outline
Give abrief summaryofyour policyor service
Aims Objectives
Links toother policies,including partners,nationalor regional / This is the commissioningpolicy for tertiaryfertilityservice for adultsregistered with aClinicalCommissioningGroup(CCG)intheYorkshireandHumberregionand hasbeendevelopedinpartnershipwiththeYorkshireandTheHumberExpert FertilityPanel.
InFebruary2013NICEpublishedrevisedguidancewhichupdatespreviousNICE guidancepublishedin2004.OnApril1st2013ClinicalCommissioningGroups (GGCs)acrosstheYorkshireandtheHumberregionsadoptedtheexisting Yorkshire and the Humber Fertilitypolicy
CCGsacrosstheYorkshireandtheHumberagreedtoworkcollaborativelyto updatetheexistingpolicyin light ofthenewNICE guidance.
The aims ofthis policy is to ensure that those most in need and ableto benefitfrom NHS funded treatmentare given equitable access to tertiaryfertility services across

theYorkshire and Humber Area.

2. Gathering of Information
This is the core oftheanalysis; what informationdo you have that indicatesthepolicyor service mightimpact onprotected groups,with consideration of the GeneralEquality Duty.
What keyimpact haveyou identified? / What
action do you need totake to address these issues? / What differencewill this make?
Positive
Impact / Neutral
impact / Negative
impact
Human rights / TheCCGhasadutiesundertheEqualityAct
2010 to:
(a)eliminatediscrimination,harassment, victimisationandanyotherconductthatis prohibited byor underthis Act;
(b)advanceequalityofopportunitybetween personswhosharearelevantprotected characteristic andpersons who donot share it;
(c)fostergoodrelationsbetweenpersonswho sharearelevantprotectedcharacteristicand personswhodonotshareit.Italsohas responsibilitiesunderthePublicSectorEquality Dutytohavedueregardtotheneedtoadvance equalityof opportunity.
Overallthepolicywillhaveapositiveimpact upon allthe 9protected characteristics.
Thiscommissioningpolicyasawholeaimsto provideequalaccessandtosupportall heterosexualandsame-sexcouples,cohabiting,
Age / x
Carers
Disability / x
Sex / x
Race
Religion or belief / x
Sexual orientation / x
Gender reassignment
Pregnancyand maternity / x
Marriageand civil
partnership(only eliminating discrimination) / x
Other relevantgroup
marriedorincivilpartnershipswhomeetthe eligibilitycriteriatoachieveconceptionwho have infertility.
AsstatedinNICE2013guidanceallcouples withoutknownreproductivepathologyare requiredtotesttheirfertilityandmeeta thresholddefinitionofunexplainedinfertility beforetheywill beeligibleforfundedtertiary treatment.
Forcouplesthatdonothaveidentifiedfertility pathologypreventingthemfrom conceiving therearetwooptionsavailabletoenablethem totest theirfertilityto access tertiaryservices:
Forcoupleswhereconventionalmethodsof conceptionisanoptionapathwayof unprotectedsexforaperiodof2yearsis followed.
Forcoupleswhereconventionalmethodsof conceptionisnotanoption(apathwayof unprotectedsexisnotanoption);inorderto supportthesecouplestobeabletoaccess tertiaryfertilityservicesthepolicyenables couplesto:
demonstrateinfertility(intheabsenceof pathologyorconventionalunprotected sexforaperiodof2years)byfailingto conceiveafter12roundsofinsemination ofwhich 6 shouldbe IUI andself-funded
The requirement to self-fund will have an
adversefinancialimpactonsame-sexcouples andheterosexualcoupleswhocannothave conventionalintercoursebutcanreasonablybe expectedtoattemptconception.Itislikelythat thenumberofsame-sexcouplesaffectedis likelytobeproportionatelyhigher.Itisalso recognisedthatforsame-sexcouplesthereare innatebiologicalissueswhichaffectthecouples’ own resources toaccess thepolicy.
Thispolicyrelatestoaccesstoinfertility treatment,i.e.tertiaryservicesforthosewho haveidentifiedfertilityproblems(whetherknown reproductivepathology,physicaldisabilityor unexplainedfertilityasdefineintheNICE2013 guidance.TheCCGsconsiderthatNHS financialresourcesinthis areashouldbe directedtomeetingthemedicalneedsofthose withidentifiedfertilityproblems.Ifthe CCG weretofundIUIforcoupleswhodidnothave identifiedfertilityproblems,significantNHS resourceswouldbe beingspentontreatment for individualswhodonothave(andproportionality arenotlikelytohave)anidentifiedfertility problemwhichwouldrequiretertiarytreatment onthegroundsofinfertility.TheCCGshave alsoconsidereddiscriminatingagainst heterosexual couples in this regard.
TheCCGconsidersthatappropriatefocussingofscarceNHSresourcesisalegitimateaim, andthatnotprovidingfundingofIUItreatmentin these circumstances is a proportionatemeans of achievingthataimhavingregardtotherestof
thepolicyandbroadaccessforallcoupleswith identifiedfertilityproblems.Theinnatebarriers toconceptionareknowninsame-sexcouples andarethereforesomethingthatcanbe plannedforinadvance.Alternativerestrictions wouldinvolvereducingfundingtoindividuals withidentifiedfertilityproblems(inheterosexual, same-sexfemaleandsame-sexmalecouples) orotherclinicalareasandtheCCGsdonot considerthatfundingthistreatmentoutweighs
otherdemands on NHS resources.
CCGswillalwaysconsiderexceptionalcaseson anindividualbasisviatheirIndividualFunding Request Process.
Ageasacriterionforaccesstofertility treatmentsisappliedinlinewiththeNICE ClinicalGuidelineonFertilitywhichisbasedon acomprehensivereviewoftherelationship betweenageandtheclinical effectivenessof fertilitytreatment.
Informationonfertilityserviceswillbeprovided inwiderangeofformattomeetthediverse needs of couples.
Facetoface discussions with couples Written information and advice Culturallysensitive
Besensitivetothosewithadditionalneeds
e.g.physicalorcognitive,orsensitive disabilities,orthosewhodonotspeak English.

Pleaseprovide detailson theactionsyou need totakebelow.

3.Action plan
Issues identified / Actions required / Howwill you measure
impact/progress / Timescale / Officer
responsible
AllCCGs are requiredtoensure
that resourcesareallocated equitablyto address the health needs of the population. / Onan annual basis,each
CCG are required to do an audit ofthefertilityservice to ensurethat it isaccessible to allthose who require it andin line with the commissioning policy. / Service are equitable to all
who require it. / Annually / Each CCG
4. Monitoring, Review and Publication
Whenwill the proposal be reviewedand bywhom?
Lead Officer / Review
date:

Once completepleaseforward to your Equality& Diversitylead Elaine Barnes via for QualityAssurance