Your views on
Specialist Fertility Services (IVF)
Consultation on a proposed change in policy
Final date for feedback - 7 September 2015
IVF CONSULTATION DOCUMENT
1. BACKGROUND
North East Essex Clinical Commissioning Group (CCG) is proposing a change to its policy on commissioning specialist fertility services. A change in this policy would affect anyone registered with a GP in the districts of Colchester and Tendring who might be looking to receive specialist fertility services from the NHS. This consultation document describes why we are proposing these changes, details about our plans and the reasons for these. We are allowing for a period of 12 weeks in which to receive feedback from the public. However this consultation is not the only form of engagement that we have conducted over the past year (Please see section on Big Care Debate)
2. INTRODUCING THE CONSULTATION
Between 16 June and 7 September 2015, the North East Essex CCG is seeking the public’s views on:
· Restricting the current IVF policy so that only certain groups of patients would be able to access IVF.
3. WHY WE NEED A CHANGE?
North East Essex CCG has a financial deficit – it has to achieve £14m in savings each year for the next four years. Our health services face demands growing at an unprecedented rate compared to levels of resource which are currently available to us. In addition there is an increasing population with complex care needs. North East Essex CCG therefore must reduce expenditure, find savings and get back into balance in order to move forward with sustainable healthcare services for the future.
4. WHAT ARE WE DOING?
The proposed policy change for specialist fertility services is one part of the
CCG’s proposals for prioritising our expenditure within the available resources. Over the next 12 weeks, we will be conducting further engagement, listening to local people’s views on this issue. However we would also encourage local people to submit their thoughts and opinions through the channels listed on the back of this document.
5. PREVIOUS ENGAGEMENT WITH OUR COMMUNITIES – OUR BIG CARE DEBATE
The possible need for these sorts of decisions was flagged up in our major consultation exercise with the public last year, the Big Care Debate. The local population is quite knowledgeable and understood the dilemma that we faced.
The Big Care Debate included meetings across the district. The feedback we have received from these events showed our local communities want high quality health and social care services delivered in their locality.
The main themes of the Big Care Debate are summarised below:
· Self-care - People overwhelmingly understood the importance of taking personal responsibility for their own health. Diet, exercise and mental wellbeing were recurrent themes.
· GP services – Local people value their GP practice and have told us it is usually their first point of contact for care. Community services therefore need to be closely linked with GP services.
· Access to information and services – Access to information and signposting to services using easy to understand language was viewed as important.
· Prevention – People also wanted clear information about how to stay healthy and how to manage a long term condition so the individual remains in control.
· Integration of services – There was a level of frustration with the lack of joined up services, particularly around discharge from hospital but also with support services.
SPECIALIST FERTILITY SERVICES PATIENT ENGAGEMENT
In 2014, the CCG talked to patients and the public about some proposed changes to fertility services. This involved us talking to several GP Practices’ Patient Participation Groups and to the Maternity Services Liaison Committee. This engagement exercise concerned some very specific changes to fertility services. Although not directly relevant to this consultation, our previous engagement did identify that views on fertility services are mixed, so it is important for us to hear all views on this issue.
6. HEALTH NEEDS IN NORTH EAST ESSEX
The population of north east Essex is growing fast, especially amongst older people. Coupled with significantly higher levels of long term conditions than is average for Essex or England, this will create substantial additional demand for older people’s services over the next 10 years:
· The resident population within the catchment area of North East Essex CCG is expected to rise from 314,293 in 2012 to 357,121 in 2021: an increase of 43,000 (13%);
· The greatest increases are expected to be in the age ranges of 56-75 years (13,300 increase) and the over 75s (9,700 increase).
Deprivation or relative poverty is associated with a higher burden of ill health and worse health outcomes for people. In general, Colchester is less deprived overall than Tendring. However pockets of deprivation exist in both, including rural and urban areas. There is considerable variation in living standards across north east Essex:
· Out of 326 local authority areas in England, Tendring is ranked 86th most deprived; Colchester is ranked 205th;
· The most deprived small area in England is in Tendring.
The most common health problems in north east Essex are high blood pressure, obesity, depression, asthma and diabetes. There are also substantial numbers of people whose health, including their fertility, is affected by their lifestyle (for instance smoking, excessive drinking, and lack of exercise). They tend to use local health and social care services more. There is a strong need for professionals to actively support them to make healthier lifestyle choices and this is something we are investing in.
7. CURRENT PROVISION FOR IVF AND FERTILITY SERVICES
Until February 2015, the CCG funded up to three cycles of IVF for patients up to the age of 40. Since then, we provided two cycles of IVF for women up to the age of 39 and one cycle for women between the ages of 40 and 42 (inclusive up untiltheyreach their 43rd birthday). So we appreciate that these proposals will come as a significant disappointment to many people across the district.
Currently, North East Essex CCG buys the following specialist services to help people with fertility problems to conceive a child.
· In-Vitro Fertilisation (IVF)
· Sperm Recovery and Intra-Cytoplasmic Sperm Injection (ICSI)
· Intra Uterine Insemination (IUI) – Only offered in exceptional clinical circumstances
· Donor Insemination – Only indicated where the male partner has specific clinical conditions
· Egg, sperm and embryo storage – Where future fertility may be affected by clinical treatment
· Egg donation, where no other treatment is available
· Pre-implantation Genetic Diagnosis (PGD)
8. WHAT ARE WE PROPOSING?
Under our plans, we propose that the current IVF service provision would be restricted as it does not provide sufficient benefit to the overall health economy. However, certain groups of patients would still be able to access IVF.
Those individuals and couples who commenced on IVF will have their care continued as advised at the start of their course of treatment.
We are proposing that fertility preservation will be offered to patients undergoing cancer treatments or who have a disease or a condition requiring medical or surgical treatment that has a significant likelihood of making them infertile. Couples who meet current eligibility criteria in which the male partner has a chronic viral infection where there is high risk of viral transmission to the female partner and potentially any unborn child (such as HIV or Hepatitis C), would also be offered ICSI.
Couples experiencing difficulties in conceiving could still seek medical advice through their GP in the first instance.
Treatment or service / What we are proposing?IVF / We are proposing that IVF is only provided in certain clinical circumstances where a couple meet current eligibility criteria
Sperm Recovery and Intra-Cytoplasmic Sperm Injection (ICSI) / We are proposing that ICSI is only provided in certain clinical circumstances such as couple of meet current eligibility criteria
Intra Uterine Insemination (IUI) / This would only be offered in exceptional circumstances – please see section 8
Donor Insemination / This would only be offered in exceptional circumstances where the male partner has specific clinical needs
Egg, sperm and embryo storage / People with material currently in storage would not be affected. However new storage will only be available where fertility is affected by clinical treatment
Egg donation / Exceptional cases only as per IVF
Pre-implantation Genetic Diagnosis (PGD) / Individual funding requests each considered on their own merit.
HOW MUCH IS LIKELY TO BE SAVED AS A RESULT OF IMPLEMENTING THIS NEW POLICY?
We recognise that infertility is a very difficult issue for those affected by it and we have not taken these considerations lightly or without engagement with other clinical professionals.
Between 2013/14, the CCG paid for 107 fertility procedures which amounted to £386k which is the equivalent of:
· 25 drug treatment courses available for breast cancer;
· 15 community nurses;
· 104 hip replacements;
· 108 patients being admitted to an acute stroke unit at Colchester General Hospital (an average cost of £3,567).
9. NICE GUIDANCE RELATING TO IVF
NICE clinical guidelines set standards that all CCGs should aspire to achieve, but is not mandatory. They are a valuable source of good practice, which the CCG takes into account in developing its policy. However, it remains for the CCG and its partners to determine the services it will commission locally, taking into account all clinical, financial and other factors such as equality. Some of the key points of the NICE guidance relating to access for IVF:
· Women up to 40 years of age who have not conceived after two years should be offered three full cycles of IVF;
· Women between 40 and 42 who meet certain criteria should be offered
one full cycle of IVF;
· Both men and women with a body mass index greater than 30 should be
advised to lose weight as this may restore fertility;
· Women who smoke should be offered a smoking cessation programme. However issues such as age, weight and whether someone smokes are all factors that can affect the success of fertility treatment.
To summarise, these proposals would affect:
· New patients who are experiencing difficulty in conceiving naturally and who would currently qualify for IVF funded by the NHS.
It would not affect:
· Patients undergoing cancer treatments or who have a disease or a condition requiring medical or surgical treatment that has a significant likelihood of making them infertile;
· Couples in which the male partner has a chronic viral infection that could be transmitted to the female partner and potentially any unborn child;
· Patients with eggs, sperm or embryos currently in storage. These will continue to be stored under the conditions they were originally stored and in line with HFEA guidance.
10. SCOPE OF THESE PROPOSALS
North East Essex CCG covers the local populations of Colchester Borough and Tendring District councils areas. Our geography varies from urban town centres of Colchester and Clacton through to many villages and rural areas.
· North East Essex CCG is made up of 40 GP practices that provide care for a total of 331,866 patients registered with them (male 162,480; female 169,386).
11. HAVE YOUR SAY
This consultation is your chance to have your say on our plans for this service.
What is important to you? Is there anything else you think we should consider? You can help us to get these decisions right to ensure all of us receive effective healthcare services in the future, against a backdrop of finite resource.
The CCG would like to reiterate that it is not in the business of restricting services and appreciate these proposals will come as a great deal of disappointment to many. However we must consider the health needs of the wider population and firmly believe that these proposals would assist us to achieve this aim.
We are holding engagement events across north east Essex for local people to find out more and to ask questions. They’re taking place during the following days and times:
Date / VenueTuesday 23 June (10am) / Colchester - 12a, Primary Care Centre, Turner Road, Colchester CO4 5JR
Thursday 25 June (3pm) / Harwich – Tower Hotel,Main Road,HarwichCO12 3PJ
Friday 26 June (3pm) / Clacton - Sam’s Hall, CVST, Rosemary Road, Clacton CO15 1NZ
Tuesday 7 July (6pm) / Colchester - 12a, Primary Care Centre, Turner Road, Colchester CO4 5JR
Friday 10 July (2pm) / Clacton - Princes Theatre, Town Hall, Station Road, Clacton CO15 1SE
Thursday 16 July (6.30pm) / Clacton - Princes Theatre, Town Hall, Station Road, Clacton CO15 1SE
WRITE TO US: IVF Consultation, North East Essex CCG, Primary Care Centre, Turner Road, Colchester, Essex CO4 5JR
EMAIL:
FURTHER INFORMATION is available on our website – www.neessexccg.nhs.uk
and on our twitter page - Twitter.com/neeccg
Our closing date for responses is Monday 7 September 2015.