The coalition’s radical reshaping of the health service has been a “step backwards” for the commissioning of fertility services in the NHS, the chair of the national fertility watchdog has said.
In an exclusive interview with HSJ, Sally Cheshire, chair of the Human Fertilisation and Embryology Authority, said the organisation had arrived at a “relatively good place” by educating primary care trusts on how to get the best out of IVF services.
Expertise on fertility services was lost, she added, when PCTs were scrapped and replaced by clinical commissioning groups by the Health and Social Care Act 2012.
“Because of the changes in commissioning and because of the new landscape we’ve almost had to start again,” Ms Cheshire said.
Despite this she said progress was now being made, with some form of IVF treatment being offered everywhere in the UK for the first time ever.
Ms Cheshire said there was still “variability” in access to IVF and the performance of clinics.
She was also concerned about how CCGs were implementing new national guidance recommending that patients aged 40-42 be offered one cycle of treatment.
“In some [CCGs’] eyes [this] means redistributing the money between different age groups as opposed to increasing the amount of money available,” she said.
The HFEA aimed to address national variability by helping CCGs to take more “intelligent” commissioning decisions, and by encouraging the sharing of information between clinics.
“Rather than be very reactionary with the clinics that aren’t performing… what we’d like to do is think much more about benchmarking,” Ms Cheshire said.
“All the different parts of fertility are sometimes done differently in clinics and what we are trying to publicise is real best practice.”
Ms Cheshire said the NHS had to improve patients’ “fertility journey”, including supporting those people for whom treatment was an unsuccessful “emotional rollercoaster”.
“Two-thirds of our patients… go home without a baby and we need to think about their wider patient experience,” Ms Cheshire said.
“Some of our most recent patient focus groups do say the level of care they receive in clinics is mostly good, excellent even, and they’re very happy with that performance.
“They’re not as impressed with the number of years they’ve been seeking treatment and where they get their information in primary care.”
When the coalition government came to power, it originally wanted to merge the authority with the Care Quality Commission, but following a consultation it decided to retain it as an independent regulator.
Despite this, fertility expert and Labour peer Lord Robert Winston recently criticised HFEA for failing to regulate the private fertility market strongly enough, claiming the organisation had “had its day”.
Responding to Lord Robert’s comments, Ms Cheshire said he “occasionally” made relevant points, particularly in relation to private clinics sometimes springing costly and unexpected fees on patients.
She said the HFEA was combating this by mandating that clinics should give all patients a “costed treatment plan” so they knew their likely total bill at the outset.
Ms Cheshire added: “[Lord Robert] was one of the very few people back at the consultation stage on our future who didn’t think we should be around, and he doesn’t speak for the sector anymore, if he ever did.
“The vast majority of people… wanted the HFEA to remain as a small expert and very successful regulator.
“A new generation of IVF clinicians don’t share his views.”