• A coalition of charities, patient organisations and professional bodies are today calling on the Health Secretary to issue guidance to CCGs, to prevent fertility patients becoming ineligible for NHS-funded IVF due to the delays caused by the pandemic.
• Across England, IVF is commissioned by CCGs, which each impose their own upper age limit on fertility funding, ranging from 34 to 42 years old for female patients.
• The closure of services during the pandemic and the continued delays to services mean that some patients will cross over the age threshold for funded treatment.
• In Scotland, Wales and Northern Ireland, there have been commitments to extend patient age limits and ensure patients will remain eligible for NHS-funded care despite the delays caused by the pandemic.
• The coalition are calling on the Health Secretary to follow the example set by the devolved administrations and issue guidance to CCGs to “stop the clock” and preserve patients’ eligibility for care.
A coalition of charities, patient organisations and professional bodies is today calling on Matt Hancock to issue guidance to prevent patients missing out on NHS-funded fertility treatment due to the delays caused by the pandemic. The coalition, which includes representatives from the British Pregnancy Advisory Service (BPAS), the Royal College of Obstetricians and Gynaecologists, the Fertility Network UK, the Fertility Foundation, the Progress Educational Trust and the Association of Reproductive and Clinical Scientists, has written an open letter to the Health Secretary, calling on him to “stop the clock” for fertility patients, who risk becoming ineligible for care due to the strict age limits for NHS-funded IVF and the delays caused by COVID-19.
Fertility clinics were closed for several weeks during the height of the pandemic. Despite being permitted to apply to reopen from May, many clinics are still operating a reduced service and patients can face long delays. In England, individual CCGs impose their own upper age limits on fertility funding, which, according to a recent report from BPAS, range from 34 to 42 for female patients. Due to the delays in access to treatment, experts are warning that there is a risk that some fertility patients will cross these age thresholds and risk becoming ineligible for NHS-funded fertility care.
In all other parts of the UK, guidance has been issued by the devolved administrations to advise fertility clinics to “stop the clock” for fertility patients, affording them several extra months of eligibility to account for the pandemic-related delays. In England, however, this decision is being made at the level of CCGs. Freedom of Information requests submitted in September by BPAS have revealed that CCGs are adopting different approaches, with some offering extensions and others stating that no exceptions to the age limit will be made, putting at risk patients' chance of receiving treatment. Policies include:
CCG in the South East of England:
“We extended the 12 month rule (that being the time of validity of an approval before which treatment must commence). However, we have not extended the age range. For those few couples which will then reach 40 for the female partner we would like to see that via exceptions as the age limit is not an arbitrary figure, it is based upon chances of conceiving."
CCG in the North East:
“There has been no change in policy due to COVID-19 and each case would be considered individually in accordance with the Individual Funding Request/Value Based Commissioning policy.”
CCG in the Midlands:
“There have been no changes to the CCG’s eligibility criteria for IVF funding. Patients are treated according to age on date of referral into the service.”
CCG in the North West:
“Where a patient has been unable to commence treatment in line with the above criteria due to COVID-19 restrictions, Oldham CCG will still consider them eligible for funding.”
The coalition is calling on the Health Secretary to follow the example set by officials in Northern Ireland, Scotland, and Wales, and issue guidance to CCGs stating that patients who have crossed an age threshold during the pandemic should still be considered eligible for treatment.
The delay in accessing treatment, and uncertainty about their ability to qualify for treatment, are causing significant harm to some patients’ emotional and mental wellbeing. A recent survey of fertility patients conducted by the British Pregnancy Advisory Service (BPAS) found that patients reported feeling worried (78%) and upset (78%) during the time that clinics were closed, with more than 50% reporting bad or very bad sleep during that period. Comments from patients included:
“I am frightened I may miss my opportunity. I am getting older and time is not on my side.”
“I’m very concerned about the age limit. I have a cyst on my ovary, this is causing me extreme pain as well as impacting my fertility. […] I need surgery before I try IVF. I’m not sure when my surgery will take place and they will make me wait at least a year trying naturally before referring me for IVF. I feel extremely let down.”
“It affected my work as a nurse massively as it exacerbated my anxiety. I felt like I was living my life on pause whilst the media were joking about a ‘baby boom’. Even when clinics resumed the uncertainty around when our treatment would start was exhausting.”
Commenting on the call for Matt Hancock to “stop the clock” and reassure fertility patients that they will not run out of time to access NHS-funded care due to the pandemic:
Marta Jansa Perez, Director of Embryology at the British Pregnancy Advisory Service, BPAS, said:
“A lot of patients have had treatment suspended due to the COVID-19 pandemic, and many clinics are still operating a reduced service. As a result, fertility patients continue to face long delays, causing significant distress and uncertainty.
"Without action, there is a danger that some patients will miss out on treatment altogether. In England, Clinical Commissioning Groups (CCGs) have their own upper age limits on fertility funding, which range from 34 to 42 for female patients. Due to delays caused by the pandemic, some patients now risk crossing these age thresholds and becoming ineligible for NHS-funded fertility care. We are therefore calling on the Health Secretary to issue guidance to CCGs that patients who have crossed an age threshold during the pandemic should still be considered eligible for treatment. This will provide much needed reassurance and ensure that no patients are disproportionately affected by the pandemic.
"NHS funding criteria for fertility treatment are inconsistent across the country, including age limits for women. It is time to review this postcode lottery system and provide fair NHS funding in line with the NICE Guidelines recommendations for all patients going forward.”
Gwenda Burns, Chief Executive, National Charity Fertility Network:
“During a time which is challenging, distressing and extremely stressful for patients it is completely unacceptable that patients could be disadvantaged due to the COVID 19 pandemic. Through working with the devolved nations from an early stage it was confirmed that patients in Scotland, Wales and Northern Ireland would not be disadvantaged: “The clock was stopped when treatment was paused and will restart when the centres open up. Hence entitlement should still be the same subject to the usual appropriate clinical assessments”
"Patients in England are already subjected to an unfair postcode lottery. It would be welcomed and extremely helpful at this time if the Westminster Government could give assurances that patients in England will not be disadvantaged as a result of treatment being paused or delayed due to the pandemic. There has been a huge surge of patients seeking vital support during this period, concerns have been varied including concerns for the future, being unable to access treatment, impact on mental health and wellbeing and concerns specifically from people aged 36 and over.
"Fertility Network will continue to offer a wide range of support services to everyone. We believe that no question is too trivial and no worry is too small #YouAreNotAlone. You can find more details on our website, www.fertilitynetworkuk.org”
Dr Emily Scott, founder of IVF Fairness, said:
“While COVID-19 laws and restrictions prohibit many of us from spending time with members of our family, for others it is threatening the possibility of being able to start a family at all. People approaching arbitrary age-based thresholds to qualify for treatment for infertility are understandably anxious as COVID-19 compounds existing barriers to accessing IVF and related treatments on the NHS.
“IVF Fairness stands with BPAS and other co-signatories of this letter in calling for the Secretary of State to respond compassionately and proactively to mitigate the anxieties of patients approaching arbitrary age thresholds which would prohibit them from accessing NHS treatments due to COVID-19. Now is the time to ‘stop the clock’ on behalf of those who are experiencing delays in accessing treatment for infertility (categorised as a disease by the WHO) on the NHS.”
Katy Lindemann, founder of the Uber Barrens Club, said:
“Couples suffering from fertility problems already face an unethical and unfair postcode lottery to access NHS IVF, denied medically recommended fertility treatment based on arbitrary criteria rather than clinical need. All NHS treatment has been affected by pandemic-related delays, but all we're asking for is simply an administrative change. Scotland, Wales and NI have acted to 'stop the clock' - don't patients in England deserve the same?”
Tone Jarvis-Mack, Chief Executive of the Fertility Foundation, said:
“Due to the lockdown, patients have been left devastated by their treatment being either delayed or cancelled. Telling them they no longer qualify for NHS funded treatment due to them crossing the age threshold is another smack in the face to would-be parents. In these uncertain times, treatment decisions across the four nations in the UK should be aligned so that nobody is disadvantaged.”
Sarah Norcross, Director of the fertility charity Progress Educational Trust, said:
“Fertility patients should not be penalised because of the pandemic. We urge the Government and England’s clinical commissioning groups (CCGs) to show compassion: time is of the essence for fertility patients but they are facing both COVID-related delays caused by clinic closures, and lengthening waiting lists for NHS fertility services because of backlogs in the system. If the Government doesn’t act now and issue guidance to CCGs to ‘stop the clock’ and protect patients’ eligibility for care, many already deeply distressed couples will miss their chance to become parents, through no fault of their own.”
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BPAS is a charity which sees almost 100,000 women a year for reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception, at clinics across the UK. It supports and advocates for reproductive choice. BPAS also runs the Centre for Reproductive Research and Communication, which seeks to develop and deliver a research agenda that furthers women’s access to evidence-based reproductive healthcare, driven by an understanding of women’s perspectives and needs. You can find out more here.
BPAS intends to launch a not-for-profit fertility service in Spring 2021, to provide ethical, evidence based, person-centred care that supports patients. We intend to only charge what it costs to provide a safe, high-quality, and accessible service to patients who may be unable to access NHS funded care.