Helen Farmer, Assistant Director of Integrated Commissioning, Thurrock Clinical Commissioning Group, presented the item that outlined the new policy offer for couples on the NHS which would be two cycles of IVF opposed to the current three IVF cycles. Members were informed that Thurrock remained one of only 23% of Clinical Commissioning Groups that offered two cycles with 62% offering one IVF and recognised the importance and significant impact for those couples who required support with fertility.
The chair thanked officers for the report and questioned why this decision had been made. Helen Farmer clarified this was based on the evidence success rate cycle. That the older a woman got, repeated cycles lowered the success rate and that a small number of woman went on for the third cycle. The review identified a dramatic demand of 45% of the three quarters of last year and the continuation of figures rising which would not be sustainable. The costs in the report were a feature of the review but were not the main focus and in doing so had tried to make it fair, equitable and to improve the service that would be received.
Councillor Ralph stated that lots of mixed messages had been sent out and that the feeling of hope had been taken away and questioned whether there had been an increase of people aged 40 coming into Thurrock. Helen Farmer stated they had not seen an increase in the age range with the average referral age being 32 who would be completely eligible for two cycles. With the criteria becoming tighter, clearer and aligned. That frontline staff at Basildon & Thurrock University Hospital NHS Foundation Trust had been placed in difficult positions when referring couples with children from existing families who can go on to access IVF but have neighbouring ladies coming into the service who may not have any eligibility for IVF.
The chair asked for some clarification on the future age range criteria proposal compared to the current Thurrock criteria. Helen Farmer stated that the current criteria was for women only whereas the future proposal would apply for both woman and partner. This had been changed due to questions being raised on residential and to avoid any complication or misuse of the criteria.
The chair questioned whether women would need to live in the area for at least one year to which Helen Farmer confirmed this as correct.
The chair questioned whether the criteria was for couples to be considered. Helen Farmer confirmed that this criteria was for couples and not for a single woman on their own and whilst undertaking this work had raised some very difficult social questions. There would also be the ability for couples to apply through the exceptional panel where a particular scenario could be considered by the Clinical Commissioning Group if it fell outside the criteria. The chair understood the reasoning behind the decisions but stated that this was sad although the changes had been made socially that modern day living had not been recognised.
The chair asked for some clarification between the Clinical Commissioning Group definition and the NICE definition of a full cycle. Helen Farmer stated that a Clinical Commissioning Group definition was frozen embryo transfer and one live embryo transfer but a NICE guidance was three. This was common across all Clinical Commissioning Group criteria. Helen Farmer stated the NICE guidance was up to the age of 41 therefore all women over the age of 41 would not be eligible for this treatment.
The chair stated the breakdown of statistics was helpful.
Helen Farmer stated that under the policy there was no provision for transgender groups. Currently there was no guidance, with the Clinical Commissioning Group Board looking into how these groups can be supported.
Councillor Ralph questioned the criteria for same sex couples. Helen Farmer stated same female sex would fit the criteria where same male sex would not be included for fertility treatment. The chair stated that this was so sad and that further work was required in this area.
The chair questioned whether any other medical procedures and surgeries such as fallopian tube surgery would be changed or amendments made to the accessibility of those treatments. Helen Farmer confirmed that no other changes would be made.
The chair questioned the plans to implement within four weeks and stated this was short notice especially for those considering a third cycle and questioned when the Board would be meeting and when this date would change. The chair also asked how those affected would be informed of such changes. Helen Farmer stated that policy would remain for those that met the criteria by the end of the March 2020 and would be treated under the existing policy for a period of up to two years. Helen Farmer stated that waiting lists were quite short at Basildon & Thurrock University Hospital NHS Foundation Trust with the impact and disappointment levels expected to be low. That communication would be made through the specialist fertility unit with letters being sent to those affected, a helpline manned by specialist information teams who would be able to answer any questions. The chair stated the response would provide some comfort as some considerable amount of time had been given.
The chair questioned what mental health support was currently available to women and couples going through the fertility treatment. Helen Farmer stated there was limited support and counselling facilities available for those couples facing these challenges but further work would be undertaken with service users to explore peer support networks.
The chair stated that she did not like to see reports that Thurrock Clinical Commissioning Group were being compared with or being asked to fall in line with other Clinical Commissioning Groups. The chair emphasised that Thurrock Clinical Commissioning Groups led not followed. That evidence provided clearly identified a need for mental health support and hoped that this would be provided for such a desperately sad issue.
The chair thanked Helen Farmer for attending this evening and asked for Members agreement with the recommendation to note the report.
Councillor Rigby questioned whether there was any concern that the increase in demand and therefore an increase in cost if the criteria was kept at over 40. Helen Farmer stated the change in demand had been based on the change in criteria rather than the cycle decreasing as they had been less woman taking up the third cycle offer. The age had been around alignment.
That the Health and Wellbeing Overview and Scrutiny Committee noted the report.