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Human Fertilisation and Embryology Bill [HL]

moved Amendment No. 24: 24: After Clause 10, insert the following new Clause— ““Infertility treatment Duty to commission in vitro fertilisation service After section 10 of the 1990 Act (licensing procedure) insert— ““Infertility treatment 10A Duty to commission in vitro fertilisation service (1) Each specialist service commissioner must commission a service for in vitro fertilisation in respect of the population for which they commission services. (2) An annual report on the performance and outcomes of each in vitro fertilisation service must be made to the relevant strategic health authority by the commissioner. (3) The report made under subsection (2) must be published.”””” The noble Baroness said: This amendment, which is in my name and that of the noble Baroness, Lady Jay of Paddington, affects services for in vitro fertilisation as supplied within the NHS. At present, one in six couples seeks an infertility specialist. Their infertility is a cause of enormous stress and no one should underestimate the extent to which couples who consider and go through IVF find that their lives are completely taken over by the process. NICE has produced guidance to commissioners on how services should be commissioned. It recommends three cycles of stimulated IVF for women between the ages of 23 and 39 who have either a proven cause of infertility or have been infertile for three years or more. How are we doing in the UK? Sadly, not very well. In 1999, 1.4 per cent of births were by assisted reproduction whereas in other parts of Europe, on average the numbers were much higher, and in some parts of Europe they were 3.7 times our figures. And what do we know? A letter from Dawn Primarolo, as Minister, to primary care trusts in July this year, outlined the response to the Infertility Network UK survey, which is part of a project to reduce inequalities in provision of IVF services. In that letter, the Minister outlined the fact that fewer than half of the PCTs responding said that they funded the transfer of frozen embryos created in the course of an IVF cycle; that these embryos are not stored, despite the NICE guidance, in the states that they should be stored in and used before the next stimulated treatment cycle; and that many PCTs have not achieved the full implementation of the NICE recommendation, which I have already outlined. So what happens? Couples desperate for treatment go privately. Under enormous financial pressure, they choose to have more than one embryo implanted, hoping that they will get their two babies in one go. But that is not without its risks and the problem, too, is that the risks and the costs of those risks then fall to the NHS, so it is actually a false economy for the NHS. The problems are that there is a sevenfold to tenfold increase in the risk of neonatal damage with multiple pregnancies, and, to the mother, there is an increased risk of bleeding, all the problems associated with caesarean sections, hypertension during pregnancy, diabetes and all that goes with that. Currently in the UK, about a quarter of births through IVF are multiple births, which is a very high figure. In countries such as Sweden, where they have a health service-related service and only implant one embryo at a time, they have a much better rate, with lower complications, through IVF. Because they implant one embryo, they create a single pregnancy and the women are able to go back later for another pregnancy—or, if that fails, they can go back for another attempt at implantation. It has been said that some women make a financial commitment, which demonstrates their commitment to parenthood. I say ““women””, but this involves couples although it is the woman who undergoes the ovarian stimulation and treatments. Infertility is a disorder. Couples go because they are absolutely desperate, put themselves through very tough financial stringencies and end up making these poor decisions to try to get their babies in one go. There are terrible postcode variations around the country. There are some examples of good practice. I heard, just before coming into the House today, that in Cheshire there is a link between the PCT and the Liverpool service which includes quality markers within the commissioning contracts, as well as several other markers. There are good practices around the country, but unfortunately they are not ubiquitous. Those people who may make excellent parents end up being excluded because of finance—just because they cannot afford the prices. It is also worth remembering that the tragedies that occur from multiple implantations happen right across the board, right across the economic spectrum. People who put themselves through enormous financial stringencies and then have a whole lot of complications may find that the NHS is not attitudinally as receptive as it ought to be when they have hit problems. One other advantage of the NHS having greater involvement and proper commissioning across the board, in accordance with the NICE guidance, will be that it will be much easier to enforce regulation of services more stringently. Contracts could be specific, as in the example that I have already given the Committee. It was with alarm that I read the comments in the report from the Joint Committee on the Bill. In volume 1, Charles Kingsland, an NHS consultant, told the committee that, "““there are an awful lot of treatments that are in theory beneficial but have never stood the rigour of scientific evaluation””." These treatments can be very expensive; whereas they may not do any harm, they may not do any good either. In this area of medicine, we have vulnerable patients who can be influenced by non-evidence-based medicine. Sheila Pike and Kate Grieve claimed that the policy of leaving treatment fees to be decided in relation to market forces has led to unjustifiably high prices for IVF in some centres, and is contributing to the disturbing phenomenon of fertility tourism. The committee made recommendations about fertility treatments, for fully costed treatment plans. I urge the Committee to look at this amendment. It is completely in accordance with the NICE guidance and simply asks the commissioners to finally put their house in order for all couples suffering under infertility. I beg to move.