Thursday, 21 February 2013

NHS Mission Creep


Where does one draw the line?

I was dismayed at the news this morning that there is a recommendation form the National Institute for Clinical Excellence (NICE) that the age range for IVF treatment for infertile women free on the NHS be extended upward from 39 to 42.  Is this justified, at a time when we are trying unsuccessfully to contain the demands on the public purse? Our precious NHS is being dismantled by realists simply because it has failed to find a way of curbing the ever-upward growth in overall cost. Perhaps these revised recommendation are ill-timed; perhaps even ill-considered.

For that was not the only change, as I read in the Independent; NICE also recommend that IVF treatment be offered free to women in same-sex marriages, and after 2 years (instead of 3 years) of 'trying' for a child by other means ('normal' or intrauterine). These changes will surely increase the cost to the NHS if adopted. One other recommendation reported in the Independent seems fiscally neutral and based entirely on medical considerations; namely it is suggested that the practice of inserting multiple embryos is dropped, as there are increased risks to mothers carrying twins.

This brings sharply into focus the question of the role of NICE — is this body concerned entirely with the question of "best clinical practice", or does it have a role in determining "value for money"? Is it telling us that a 41 year old woman can carry an embryo essentially as well as a 39 year old — a clinical question? Or is it trying to tell us what we can afford, or what we should afford if we can afford other treatments. I can see that a bunch of clinicians can (and perhaps should) tell us that there is as much human distress at childlessness as there is at dying aged 70 from a preventable cancer. But is that what they are saying?

Then there is the data to consider. Currently it is recommended that the prospective mother be offered 3 cycles of IVF treatment, each costing £3,000, though not every health authority can afford that. If success rates are rising, perhaps 2 cycles would sufficiently test the ability of the parent to carry to term.  I.e., is the 3rd cycle success rate the same as those of the 1st and 2nd cycles? If its success is lower, it is a waste of money.

If a couple desperately want a child, perhaps they should go about it in the proper way; i.e. 'try' for two years before the age of 35. If that does not work, we could perhaps offer free IVF for 1 year. After that they can continue IVF but should perhaps pay. If they postpone 'trying' till 36 or 40, they should be deemed not that serious, and expect to pay. But that would be unfair unless made clear to couples in good time.

L. Cawstein

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