• Cambridgeshire CCG to axe IVF services due to dire financial position
  • CCG must save £33m to hit £75m deficit 2019-20 control total
  • Then health minister said move was “not acceptable” in June

A heavily indebted CCG is to end funding for almost all IVF treatment, despite being told by a government minister that the move was “not acceptable”.

Cambridgeshire and Peterborough Clinical Commissioning Group took the decision at its 6 August board meeting. The CCG said the move represented confirmation of a decision originally taken in 2017.

The CCG was initially due to take the decision at its July board meeting. The CCG is proposing a wave of service cuts as part of its drive to reduce costs by £32.7m and deliver the £75m deficit it has agreed with NHS England. It will now only fund IVF in “exceptional circumstances” (See box: Exceptional circumstances), a decision it says will save £700,000 every year.

The CCG delayed the decision because it wanted to consider “new information from the Department of Health and Social Care about the commissioning of IVF services”.

A letter was sent to all CCGs on 17 June by then health minister Jackie Doyle-Price. It warned local commissioners that it was “not acceptable” to cut all IVF services – a move taken by only a handful of CCGs to date.

Ms Doyle-Price, who lost her post in last month’s ministerial reshuffle, told CCGs cutting IVF services caused an “unfair” postcode lottery, “psychological distress for patients” and “untold reputational damage” to the NHS.

“I cannot emphasise enough that it is not acceptable for CCGs to offer no routine access to fertility services,” she added.

CCG clinical chair Gary Howsam said: “Clinicians and managers alike acknowledge that this was a difficult decision to make and would have an impact on individuals and their families, but that in the current financial climate, it was not reasonable to reinstate the service.”

Dr Howsam added: “Anyone with fertility problems can still go to their GP who can discuss the treatment options available to them. Couples can still be referred to hospital for further tests to investigate the cause of their infertility, and many of these causes can be successfully treated without the need to go on to have IVF.”

Lead clinician at local fertility clinic Bourn Hall Clinic, Thanos Papathanasiou, said: “This will be devastating for the couples for whom IVF offers the only chance of having a baby and that have been waiting to hear this decision. Infertility is a medical condition that can have a lifelong impact on emotional wellbeing.

“Only a very small percentage of the population needs to have IVF but the emotional impact of infertility on that small group must not be underestimated.”

The CCG has committed to reviewing the decision when it has a financial surplus. But with the CCG’s deficit more than doubling from a £35m in 2018-19 to a targeted £75m this year, this is likely to be years away.

In a major blow to its saving drive, the CCG was forced to radically reduce a package of community service cuts last month following pushback from providers and clinicians.

The new community services package will only save £172,000 in year and £480,000 in 2020-21 which is significantly less than the £6.7m previously envisaged. This means the CCG will have to come up with fresh savings plans to fill the gap.

The new proposed cuts package includes ceasing funding Dial-a-ride, Health and Wellbeing Network, and Stroke Association services.

 

Exceptional circumstances

There are two exceptions to the CCG’s decision to end IVF funding. 

  • Fertility preservation (Cryopreservation): offered to patients undergoing cancer treatment, or who have a disease or a condition requiring medical or surgical treatment, that has a significant likelihood of making them infertile, eg patients who are or will be receiving:
    • Specialist endocrinology services (hormonal imbalances); or
    • Services for a rare mitochondrial disorder (a rare, long term, genetic disorder); or
    • Endocrine treatment or surgery in relation to gender dysphoria (defined by a strong, persistent feeling of identification with another gender and discomfort with one’s own assigned gender and sex)
  • Sperm washing: offered to men who have a chronic viral infection (primarily HIV) and whose female partner does not, where intrauterine insemination is being considered. This is a risk reduction measure to limit the transmission of a serious, pre-existing viral condition, such as HIV, to the woman and therefore potentially her unborn baby