'For some, fertility issues are heart-breaking - not marginal NHS issues but utterly central to their lives'
Oh dear, what's this? At the end of a baleful financial year for the NHS we get April rain to spoil the Easter sunshine. Which shall we write about, the woes of dentistry or of maternity? Both are important and both roads lead to health minister Rosie Winterton.
Maternity has been making more headlines, this week at least. The Human Fertilisation and Embryology Agency has been drawing up what was promptly dubbed 'rationing' of IVF treatment available for infertile women, a 'single egg transfer' rule.
It is intended to prevent multiple births that put the health of both mothers and often very small babies at risk, although less so for the babies, I imagine, than not being born at all. Only one in 80 natural pregnancies produce multiple births, one in four the IVF road.
Fair point? In a week when the Daily Mail reported on a Swansea mum who had two single births, followed by twins, then triplets, all naturally and all under eight, it is hard to cover all eventualities.
Contrary to HFEA claims, some experts suggest the new rule will more than halve the success rate, this in a week when health ministers have announced that pregnant women will be guaranteed the right of home births from 2009 - despite shortages in qualified midwives which may leave maternity support workers in charge on some wards.
Enter stage centre-right Grant Shapps, Tory MP for Welwyn Hatfield, the ultra-marginal he took from former health minister Melanie Johnson. Mr Shapps knows about IVF because he and his wife, Belinda, have had three children that way.
In the Commons the other evening he staged an adjournment debate based on his own research into anomalies in primary care trust policy towards IVF since the National Institute for Health and Clinical Excellence's 2004 guidelines were accepted by then health secretary John Reid. He allowed for at least one cycle of IVF treatment on the NHS. NICE suggested three for women in the 23-39 age range.
You know what's coming next: PCTs interpret the NICE report differently. Mr Shapps is a dab hand at Freedom of Information Act requests and quizzed them all to produce a report - available on his website -called The Messy Business of Conception, a picture of a postcode lottery he calls 'baby boundaries'.
Swindon only treats the 36-39 age range, parts of Somerset only those over 35 (when success is harder) and Essex's five PCTs are all over the place on whether having a child from a previous relationship counts. Staffordshire's three PCTs were worst of all, the MP reported.
Naturally, other MPs told similar tales. For some of their constituents, fertility issues are heartbreaking - not marginal NHS issues but utterly central to their lives. We all know cases, don't we?
Fresh from battling with the dentists, it fell to Rosie Winterton to reply to the Shapps assault. NICE guidelines allow for variation and for local priorities, the minister explained, but things are much better than they were. The DoH is working with PCTs and the Infertility Network UK to make them better still.
Thus Cheshire and Merseyside PCTs had staged a major public consultation on NHS fertility services in 2005. Result: a decision to fund two cycles of IVF.
The phrase I circled in Mr Shapps' speech was that 'it is wrong falsely to raise the expectations of couples'. Well, yes, expectations: but it is not just governments that do it. Although Ms Winterton was not so rash as to blame the voters for lax sexual habits, she did mention the link between chlamydia and infertility. That is being tackled, too.
When I rang Mr Shapps, the MP acknowledged it is never easy. The NHS's first priority is life-saving, indeed it had saved him from cancer (hence the IVF). Yes, there will always be variations in local priorities, he conceded.
'But if you are going to have Whitehall setting priorities it's going to raise expectations,' he said. 'For 18 months after such a statement, PCTs are probably going to provide the service. Then another secretary of state comes along offering new priorities, usually at the rate of one a week.'
One way of looking at this week's maternity issues is priorities, another is that they are forms of rationing. Brace yourself for more.