Infertility NICE Guidelines

I congratulate the right hon. Member for Rother Valley (Mr. Barron) on securing the debate. I share his disappointment that others cannot be present to take part in it, but I pay tribute to him for his work as chair of the all-party group on infertility and for giving us the opportunity to explore how far the Secretary of State's undertakings in respect of the NICE guidance have been implemented.

I would like clarification of the two phrases that were used by the Secretary of State and the Prime Minister: what is the difference between long term and substantial progress in the next couple of years? The debate should be about getting some idea of the timelines involved. The right hon. Gentleman posed some important questions that I want to take up; I also have a few questions of my own for the Minister.

The issue is charged with emotion; it is about the fundamental desire that very many of us have to have children. Infertility frustrates that desire, which is further frustrated if a person does not have the financial means necessary for private sector provision and as a result has to go on an NHS waiting list. Prior to the NICE guidelines, about 70 to 80 per cent. of couples paid for private treatment. It is not long since the NICE guidelines were published and the Secretary of State expressed the desire that at least one cycle of IVF be available to couples in each PCT area. Can the Minister say how much she expects that to change? Will there be a reduction in the number of couples who will need to pay privately to have the treatment as a result of the guidance being implemented?

The right hon. Gentleman has already given some of the figures but it is worth repeating one or two of them: approximately one in seven couples in the UK need help in conceiving a child and rely on treatment, either ovarian stimulatory drugs or IVF. Figures available up to 2001, supplied to my hon. Friend the Member for Shrewsbury and Atcham (Mr. Marsden) in June last year, suggested that 28,076 patients had received IVF in that year, which was an improvement on 1997, and that 2,718 had received donor insemination in the UK, which was down from 1997. It puzzles me that more up-to-date figures than those for 2001 are not available. I hope that the Minister can shed further light on the matter and update the figures, so that we can see what progress has been made.

The NICE recommendations have been described in detail by the right hon. Gentleman, who is absolutely right to draw attention to the fact that most press reporting of those guidelines and the Secretary of State's response to them tended to dwell more on the number of cycles of IVF than on other aspects of the guidance. It is right to reflect that the guidelines referred to a host of other issues, not least that of screening, which is an important safeguard. At the time, the chief executive of NICE said:

"Implementation of our guidance will take time. We have therefore suggested to the Department of Health and Welsh Assembly Government that they consider giving advice to NHS organisations on how they should approach putting our recommendations into practise."

The debate is about the Secretary of State's advice and to what extent it should be just that; should it be about social considerations and how they affect the criteria formulated by the PCTs in framing their approach to implementing the NICE guidance? The Secretary of State said on 25 February:

"As a first step, by April next year I want all PCTs, including those who at present provide no IVF treatment, to offer at least one full cycle of treatment to all those eligible."

The Minister later emphasised that that is the starting point.

However, it is not clear from anything that has been published or said to date what the subsequent steps will be. What is the timeline for getting us from where we are now, which is patchy provision of IVF and of NHS fertility services generally, to the ideal that the NICE guidelines set out? What progress has been made in achieving that first step?

It would be wrong of PCTs to interpret the Secretary of State's comments in last year's press release as relieving them of their obligation to set out their plans for implementing the NICE guidelines. I hope that the Healthcare Commission will look carefully and critically at the extent to which PCTs have done that. It should also evaluate whether the April deadline in the arbitrary timetable set out by the Secretary of State is a sufficient response to the NICE guidelines.

I will go one step further and say that it would be useful if the Minister confirmed the status of the Secretary of State's statement. Does it have any formal force in terms of what PCTs should be doing? In particular, what is the status of his comment about giving

"local priority to couples who do not have any children living with them"?

Surely in an NHS where the balance of power is shifted to local providers to make decisions of that sort, the Secretary of State should not give that sort of instruction, or implied instruction, to the NHS.

There are a number of concerns about the Secretary of State's recommendations, some of which the right hon. Member for Rother Valley itemised. First, the NICE guidelines come with a price tag attached, but exactly how much will they cost to implement? No additional resources were provided to allow the services to be developed; it is therefore incumbent on the Government to set out how they will assist PCTs and how they expect PCTs to plan for the implementation-not what they should do, but the mechanisms that they might wish to follow.

As the right hon. Gentleman said, the anecdotal evidence seems to point to a timeline that runs at least six years into the future. It would be useful if the Minister said whether that is a realistic assessment of how long it will take to implement the NICE guidelines fully. In answer to the right hon. Gentleman's question, the Prime Minister said that it would be a couple of years before we saw substantial progress. Yet when one looks at the NHS figures between 1997 and 2001, one sees that although the number of women having access to a cycle of IVF increased, the average number of cycles per woman decreased, and some people are concerned that access to more than one cycle will decrease further. The PCTs that already offered access to more than one cycle will take the opportunity of following the Secretary of State's advice from last year to level down, rather than to maintain their service at its current level. It is therefore important to monitor the situation at local level to ensure that that does not happen. As the right hon. Gentleman said, there is a 25 per cent. success rate from one cycle, but that rises to 70 per cent. with three.

I believe that Lord Winston expressed some concerns about the policy of offering one cycle, describing it as "half-baked" due to the financial and emotional costs of investigating whether a couple is suitable for treatment. There is a huge emotional commitment to going down that road, yet after making that commitment couples could be told, "You've had your one chance", even if they are reaching the age where they will no longer be able to gain access to the treatment. Infertility treatment is a huge investment for a couple, which is more than just financial.

There is also concern about specialised commissioning-tertiary commissioning and tertiary fertility services-and to what extent the roll-out of such commissioning is occurring. There is concern that the still patchy nature across the country of PCTs engaging with specialised commissioning will again slow the process of implementing the NICE guidelines. I would welcome the Minister's comments on that matter.

Can the Minister say whether the Department has assessed of the cost of implementing the NICE guidelines in full? I should be surprised and stunned if the Department had not made some assessment. Does the hon. Lady plan to share the Department's figures with us? I hope that she does. Is the figure of about £50 million, which was the assessment made by the all-party group, a realistic assessment of the true cost of full implementation throughout the country? What discussions have taken place with Scottish Ministers, who are already supporting a three-cycle policy in Scotland?

There are financial pressures in the NHS; we need only read the Health Service Journal from one week to the next to learn about those pressures and their consequences. At present, there is a £500 million deficit in the NHS, which I am sure will disappear magically by 31 March until 1 April of the following financial year.

However, there is a real financial problem that the PCTs must grapple with. They have to find the resources to achieve the targets that are set by Whitehall, and everything else for which there is no target becomes a lesser priority. The NICE infertility treatment guidelines might fall into the second category, and we doubt whether the necessary resources will be delivered.

As we have heard, the anecdotal evidence suggests that progress is patchy. There are concerns that having one IVF cycle as a first step will give a green light to some PCTs to reduce the number of cycles that they provide. I hope that the Minister can tell us today what the plan is beyond the first step, whether that plan is on course, and when it will deliver. Will it be in six years, or in a couple of years? There are thousands of people outside the House who want the answers to those questions because they matter to them and their lives.