Hansard

I thank Mary Scanlon for giving us the opportunity to speak about infertility services and to review the guidance of the expert advisory group on infertility services in Scotland on criteria for access to NHS-funded assisted conception treatment. From talking to officials, I know that Mary Scanlon has a great passion for the issue and I have probably heard her speak about it in the past.

The Scottish Executive has long recognised that management of infertility represents a health need. Susan Deacon worked on the issue in her former life as a minister; we should acknowledge the importance of that. The Executive prides itself on putting families and children at the centre of our policies. We also acknowledge the heartache and pain that not being able to have a child or complete a family unit causes many couples.

As many members have said, infertility is much more than just a physical health need; successful and unsuccessful treatments can have long-lasting emotional impacts. For that reason, we are keen to ensure that access to NHS-funded assisted conception treatment is available fairly and equally throughout Scotland. Like many other MSPs, I have heard heart-rending stories at surgeries in my constituency.

NHS-funded infertility treatment has been available in Scotland for many years, although provision and access is variable around the country; I will touch on that more in a moment. In order to redress that, an expert advisory group on infertility services in Scotland—EAGISS—was convened to examine the services that are available and make recommendations for future management of assisted conception treatment. The group reported in 1999. The report covered a range of issues, including the evidence base for effective treatment and the service model for different levels of infertility treatment. One of the report's most important recommendations related to the criteria for access to treatments requiring Human Fertilisation and Embryology Authority licensing, such as IVF or ICSI. Following production of the EAGISS report, the Scottish Executive asked NHS boards to adopt the criteria.

The criteria covered clinical aspects, such as underlying health problems, previous treatments and age, and the number of treatment cycles that a couple should have. The criteria were based on the best clinical evidence of effectiveness that was available at the time. The criteria also stated that couples who already had a child living with them in their home should not be able to access NHS-funded treatment. That social criterion was reached by consensus. Again, Mary Scanlon referred to issues around that, which I will touch on later.

The EAGISS report was well received, I understand, by clinicians and service users because of its focus on ensuring equity of access across the country and its emphasis on basing the criteria on evidence of effectiveness. The chief medical officer asked NHS boards to implement all the recommendations and the service model that was set out in the report, but no timescale was specified.

To ensure that boards were working towards implementation, a review of access criteria was conducted in 2000, which found that NHS boards were working towards implementation of the criteria and that significant progress had been made. However, the review also found that there remained variability in the criteria that boards were using, particularly around the female upper age limit for treatment. Because of that continuing variability and the availability of more up-to-date information on the effectiveness of treatment, the Scottish programme for clinical effectiveness in reproductive health conducted a consensus conference in 2003, at which the very latest evidence was presented and each of the criteria was revisited. The conclusions of the conference were submitted to the chief medical officer for consideration.

Concurrent with those developments in Scotland, Westminster ministers asked the National Institute for Clinical Excellence to review fertility services in England and Wales. NICE published in 2004 recommendations for clinical management of fertility services in England and Wales, which included criteria for access to treatment.

We then asked NHS Quality Improvement Scotland to revisit the conclusions of the consensus conference, review NICE's recommendations and provide us with a coherent evidence base for provision of infertility treatment. I now have the results of that review by NHS QIS, which suggest—based on evidence of effectiveness of treatment—that there should be changes to the age limit of up to 40 years and to the number of cycles that are available to eligible couples, which is currently five cycles.

However, as I have already remarked, not all NHS boards have adopted the present EAGISS criteria. Many people have drawn attention to that. Therefore, prior to making any further changes, we need to ensure that we can deliver on the criteria and that we are not simply creating even longer waiting lists for treatment.

Mary Scanlon asked whether the Executive intends to introduce waiting-time targets. We do not routinely collect information on waiting times for fertility treatment because of sensitivities around patient confidentiality. The HFEA is responsible for maintaining all information on infertility services throughout the United Kingdom. Indeed, it releases information only to licensed centres in order to ensure that patient confidentiality is protected. However, we are very much aware of the kind of differences that exist. Margaret Ewing drew our attention to the longest waiting time—five years—which is in Grampian.

We need to think carefully about what is happening in terms of current implementation and its variability. We also need to think about whether we are going to change the criteria and whether we can deliver the criteria—that is critical. We are going to conduct a consultation in the coming months, in which we will take on board comments from service users, which is important, and clinicians. We will concurrently conduct an economic appraisal of the suggested changes to the status quo.

We need to be clear about the resource consequences of widening the access criteria before possible implementation of revised guidance. It is important that NHS services be provided equitably and fairly and that service users do not feel that they are subject to exclusion or inclusion on the basis of where they live. However, that does not mean that all infertility services can be available in every board area. David Davidson touched on that. Some areas of provision are highly specialised and can be delivered only by appropriately trained, resourced and licensed centres. That means that there will still be a need for couples to travel to a tertiary centre for specialist care such as IVF. However, we want to ensure that the pathway of referral on to those centres is clear and equitable, regardless of where the patient originally presents.

There has been much discussion about infertility. Elaine Smith, Susan Deacon and other members have talked about that. There is no doubt that we need to look in broader terms at issues to do with infertility. Indeed, the Scottish Executive is seeking to make a difference and to tackle issues such as smoking with legislation that it is introducing. It is also seeking to tackle over-consumption of alcohol and is taking steps to address obesity.

A lot with which I agree has been said about chlamydia and sexual health. Chlamydia is potentially damaging to fertility. Members may be aware that that is one of the areas that the national sexual health demonstration project, Healthy Respect, has been looking at, and it intends to demonstrate best practice in improving sexual health, including prevention and diagnosis of chlamydia. I recognise the importance of that. I respond to Susan Deacon by saying that we have to make it clear that tackling chlamydia is one of the central aims of our sexual health strategy. Although a national chlamydia testing scheme may not be feasible just now, I am certainly not ruling that out. I want to be absolutely sure that we are doing something effective about the appalling rates of chlamydia in Scotland. Let there be no doubt about that.

Through the consultation and appraisal that I described, we believe that we can develop a protocol for infertility services that not only provides equitable provision for patients but is deliverable within available resources. Through the consultation, we want to address issues such as the use of social criteria, the relative priority of infertility treatment—given the many demands on the NHS—and the balance between attempting to ensure that as many infertile couples as possible have at least a limited number of treatment cycles and ensuring that we maximise the effectiveness of treatment.