AGENDA ITEM 5. GOVERNING BODY MEETING IN VITRO FERTILISATION (IVF) AND ASSISTED CONCEPTION CONSULTATION Date of the meeting 1 st February 2018 Author Sponsoring Governing Body Member Purpose of Report Recommendation Reason for inclusion in Part II Stakeholder Engagement Previous GB/Committee Dates Matt Rangué, Chief Nurse, NHS Southend CCG Matt Rangué, Chief Nurse, NHS Southend CCG To summarise the feedback received during the In Vitro Fertilisation (IVF) and Assisted Conception Consultation undertaken by Southend CCG between the 26 th July and 9 th October 2017, to enable the Southend CCG Governing Body to make a decision regarding the future commissioning of IVF services. The Governing Body is asked to consider the key findings of the consultation note the outcome of the debate at the Clinical Executive as outlined within this report and confirm their decision as to whether NHS Southend CCG should reduce the offer of IVF or suspend routine funding of IVF. N/A Monitoring and Assurance Summary This report links to the following Assurance Domains Stakeholders have been engaged with via the formal consultation which ran from the 26 th July 2017 to 9 th October 2017. NHS Southend CCG Governing Body meeting on the 1 st December 2016 discussed the commissioning of IVF and Assisted Conception services and agreed to progress to consultation regarding future funding. The Clinical Executive Committee considered the outcome of the public consultation at their meeting on 11 th January 2018. Quality Equality and Diversity Engagement Outcomes Governance Partnership-Working Leadership I confirm that I have considered the implications of this report on each of the Yes [e.g. ] Any action required? Yes (Detail in No
matters below, as indicated: report) All three Domains of Quality (Safety, Quality, Patient Experience) Board Assurance Framework / Risk Register Budgetary Impact Legal / Regulatory People / Staff Financial / Value for Money / Sustainability Information Management &Technology Equality Impact Assessment Freedom of Information 2
1. Introduction In July 2017, Southend CCG published documentation relating to a public consultation on In Vitro Fertilisation (IVF) in Southend-on-Sea (Appendix 1), following a Governing Body decision (1 st December 2016) to consult on no longer routinely funding IVF and other assisted conception treatments which include: 1. Intrauterine insemination (IUI) where sperm is placed into the womb through a fine plastic tube 2. In-vitro fertilisation (IVF) where the fertilisation of the egg occurs outside the body 3. Egg and sperm donation where the patient receives eggs or sperm from a donor to help conception. Treatment with donor eggs is usually carried out using IVF. The consultation, does propose two specified exceptions which are outlined below: Fertility preservation will be 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; and Sperm washing will be provided 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. In both the above circumstances, the use of specialist fertility services to subsequently conceive a child using the preserved eggs or sperm, or the washed sperm, would not routinely be funded. The consultation ran from the 26 th July 2017 to the 9 th October 2017. People, patients, stakeholders and clinicians were invited to give their views on the proposal as above by: Completing the consultation questionnaire, either online or by completing a paper version and returning via a Freepost address. Attending one of three workshops held during the consultation period. Writing direct to the CCG. The consultation and associated questionnaires/workshops were promoted via the CCGs website, Twitter account and Facebook account. The consultation documents were also distributed direct to: All Governing Body members 3
Communication lead at all Essex CCGs and the STP All GP practices (GPs and practice staff) Healthwatch Southend NHS England Local MPs Southend-on-Sea Borough Council (Chair of the HOSC and council members more generally) Members of the Community Engagement Advisory Group Local media The consultation was originally due to run from the 26 th July to the 26 th October 2017, but was extended by a further two weeks at the request of Southend s People Scrutiny Committee held in September 2017. The extension was to allow additional promotion of the consultation by the committee. The extension has proved sensible, as the number of responses received following the committee meeting increased by 70%. Governing Body members are asked to consider the key findings of the consultation as outlined within section 2 of this report and conclude their decision with regards to no longer routinely funding IVF and other assisted conception treatments. If Governing Body members conclude that the CCG should no longer routinely fund IVF, it is proposed that patients who have already been referred from secondary care (hospital services) to tertiary care (specialist fertility services) under the existing policy would complete their treatment. If Governing Body members agree to the proposed new policy, it would apply to new referrals from secondary care to tertiary care made from the date of the Governing Body decision. The CCG will continue to support local gynaecological services and access to these will not be restricted regardless of the commissioning decision made. There is a range of services available to people who need help with fertility issues, both in primary care and in our local hospitals. Services provided by the gynaecology clinics in the local hospitals include: the standard investigation of causes of infertility; non-specialist treatments such as physical and hormonal therapy; management of ovulation disorders; management of tubal and uterine abnormalities; medical and surgical management of endometriosis; medical and surgical management of male infertility; and management of ejaculatory failure. 4
Once a patient had completed these investigations, the proposed policy would no longer fund patients requiring specialist fertility treatments apart from the exceptions set out above, if agreed. 2. Consultation Findings The key findings of the consultation are summarised within the IVF Public Consultation Feedback document included as Appendix 2. In summary: 2.1 Survey Responses The consultation questionnaire received 396 responses. It should be noted that of the 396 responses: 21.52% of the respondents do not live in Southend 46.72% of respondents responding advised that they would not be directly impacted by the changes In response to the question: What are your views regarding IVF and other assisted conception treatments? 90.91% of respondents to the survey (360 of the 396 respondents) selected the answer that IVF and other assisted conception treatments should continue to be funded 8.33% of respondents to the survey (33 of the 396 respondents) selected the answer that IVF and other assisted conception treatments should no longer be routinely funded and should require an Individual Funding Request (IFR) to demonstrate an exceptional circumstance 0.76% of respondents to the survey (3 of the 396 respondents) selected the answer Don t Know. The percentages above do not change when the responses from those living only in Southend are reviewed. Key themes from verbatim feedback and comments received in respect to whether IVF and other assisted conception treatments should be funded centred on: A high number of respondents (approximately 1 in 5 who left comments) referenced the impact on mental health services; i.e. increased rates of depression, psychological intervention required and the increased need for counselling. Many respondents suggested that the potential cost implications on mental health services required to support impacted couples requires consideration. 5
A number of respondents felt that the potential saving per year to the CCG appears small in comparison to the significant impact the change will have on couples. Many of the respondents argued that infertility is a medical condition / illness and not a lifestyle choice and like all other illnesses should be treated. A number of respondents suggested that conditions caused by individuals lifestyle choices; i.e. smoking addiction, alcoholism and obesity should be considered for review instead of IVF. A number of respondents suggested that services to support the option of adoption or fostering should be provided if IVF funding ceases. A number of respondents reflected that the glimmer of hope for couples should not be removed completely, and perhaps the provision of one cycle should be considered. 2.2 IVF Workshops In addition to the questionnaire, three workshops were also held. 11 people attended the workshops in total. The key discussion points are summarised within Appendix 2, of the IVF Consultation Feedback document (Appendix 2). A common theme discussed at the workshops (as highlighted via the questionnaire) is the need to focus on mental health and the impact that ceasing funding of IVF would have on current services. 2.3 Written Feedback NHS Southend CCG received a letter direct from the Chief Executive of the Fertility Network UK. The letter is included within Appendix 3, of the IVF Consultation Feedback document (Appendix 2). The letter requests that Southend CCG considers carefully the evidence for consultation and considers carefully the long-term costs associated with decommissioning fertility services. 3. Clinical Executive Response to Consultation. Follow the public consultation and in consideration of the public comments the CCG included three options for consideration: 1. Continue to fund IVF and assisted conception services with current eligibility criteria (Current cost 2016/17, 199,442) 2. To further restrict access to IVF treatment in Southend, excluding those aged 40 and above, reducing the number of cycles to 1 for women aged 23 to 39 (Reduction in cost of approximately 62,000) 3. Suspend routine fund IVF and assisted conception services 6
Option 2 was developed with Public Health colleagues based on the evidence that 72% of 1 st IVF cycles are successful and subsequent cycles have less chance of success, very few cycles are offered to women over 39 and again are less likely to be successful. The Governing Body members should note that the Clinical Executive Committee discussed the IVF consultation on 11 th January. Members of the committee were split evenly on whether to keep IVF funding or reduce the offer of IVF or whether to suspend IVF at the current time in order to meet the current financial savings required. The Clinical Executive agreed that the recommendation to the Board would be to either reduce the offer of routine IVF or suspend routine IVF. 4. Conclusion The Governing Body are requested to consider the summarised information as contained within this summary report and the more detailed report entitled IVF Public Consultation Feedback Document included as Appendix 2, in order to conclude whether NHS Southend CCG should no longer routinely fund IVF and other assisted conception treatments. An updated Equality Impact Assessment and Quality Impact Assessment has been completed for the proposed change with consideration of consultation findings, as requested by the Governing Body in December 2016. The updated Equality Impact Assessment is included within Appendix 3. The updated Quality Impact Assessment is included within Appendix 4. 5. Recommendation Members of the Governing Body are asked to consider the key findings of the consultation as outlined within this report and in recognition of the feedback received consider the following options for the future routine funding of IVF and assisted conception treatments: 1. To restrict access to IVF treatment in Southend, excluding those aged 40 and above, reducing the number of cycles to 1 for women aged 23 to 39 2. Suspend routine fund IVF and assisted conception services If members decide to change the current commissioning arrangements for IVF provision, agree a date from which the changes will come into effect. 5. Appendices Appendix 1 IVF Public Consultation Document 7
Appendix 2 IVF Public Consultation Feedback Document Appendix 3 Equality Impact Assessment Appendix 4 Quality Impact Assessment Author s Name and Title: Matt Rangué, Chief Nurse, NHS Southend CCG Date: Revised 24 th January 2018 8