NHS Richmond Clinical Commissioning Group (CCG) is seeking your views on our proposals to change our policy on commissioning two elements of assisted conception services; In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI).
While we know that the number of people affected by a change in policy would be low we are also aware that infertility is an area of significant concern to some who are affected by it.
We want to know what local people think about these proposals in light of the financial pressure the local NHS is facing. Richmond CCG needs to make savings of at least £13m in the next financial year.
This is a significant financial challenge for an annual budget of £261m. The CCG is required to live within our means and focus our resources on the greatest health needs of our population to secure the best possible health possible outcomes for local people. That is why we need to reduce our spending in some areas of our health budget.
We would like to hear from local people on the following proposed changes:
- Option 1 No further change to the existing service. This option would mean that women aged 39 years or younger, who meet the clinical criteria, will continue to be offered one fresh and one frozen cycle of IVF.
- Option 2 Access to IVF would be limited to patients with exceptional clinical circumstances. These might include infertility following cancer treatment, or prevention of the transmission of chronic viral infections, such as HIV (among others). As part of the consultation we are asking the Richmond community if there are other specific circumstances we should consider.
Find out more about the proposals by reading the IVF and ICSI consultation document. Please note the consultation is now closed.
Read an overview of the responses received by reading the IVF and ICSI consultation report.
Changes to the access criteria for in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) – governing body meeting decision
A decision was taken at Richmond CCG’s public governing body meeting on 18 July to change the access criteria to in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI). These changes have been informed by feedback received during a public engagement exercise ‘Choosing Wisely for Richmond and a public consultation.
The ‘Choosing Wisely’ engagement exercise showed that 51% of respondents strongly agreed or agreed and 37% disagreed or strongly disagreed that the local NHS should reduce the number of IVF cycles offered from one to on an exception only basis.
The CCG recognised that this is a sensitive issue and a difficult decision to make. Therefore at the January 2017 meeting of the governing body the decision was taken to hold a public consultation on the option to remove funding for IVF in all but exceptional cases.
The formal public consultation which ran from 4 February to 4 April 2017 presented two options for people to comment on:
Option 1 – No further change to the existing service
This option would mean women who meet the criteria as outlined (below) will continue to be offered one fresh cycle and one frozen cycle of IVF on the NHS:
- women 39 years of age or below; and
- neither partner must have any living children from this or previous relationships (including adopted children) and
- who are in a current long term relationship (at least one year)
Option 2 – Change the access criteria for IVF so that it is funded in limited circumstances only
Access to IVF would be limited to patients who meet the criteria in option 1 and who can demonstrate exceptional clinical circumstances; these might include infertility following cancer treatment, or prevention of the transmission of chronic viral infections, such as HIV (among others). As part of the consultation people were asked whether there are other specific circumstances that we should consider.
Richmond CCG received a total of 276 written responses, and a summary of the consultation feedback has been published on the CCG’s website.
As part of the consultation process respondents suggested that the CCG consider other options, or further restrict the current eligibility criteria in order to maintain a level of IVF services in the borough. This option was also supported in discussions with the
Assisted Conception Unit at Kingston Hospital who suggested that access should be based on clinical evidence associated with successful outcomes of fertility.
A decision was taken at Richmond CCG’s public governing body meeting to support a third option by adding the following eligibility criteria to the current policy:
- No previous self-funded cycles of IVF
- Reduce the IVF age to <39 (the evidence shows that successful outcomes reduce with age)
- Reduce access to people with an AMH level of <5.4pmol/l (this is an indicator of fertility and below this level there is less likelihood of success).
It was agreed that the CCG’s policy would be updated with a start date of 1 August 2017.
The case for change
Richmond CCG has a legal responsability to ensure that it lives within its means in future and everyone in Richmond has equal access to operations; and that only treatments which offer value to our population are commissioned. Read more about our future plans.
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