A sixth of hospitals in England have expanded private patient options this year, the BMJ finds
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4524 (Published 17 July 2013) Cite this as: BMJ 2013;347:f4524All rapid responses
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Competing interests: No competing interests
It's important to maintain the principle that NHS treatment, except where the law provides otherwise, is free. That is what defines NHS treatment. The Advertising Standards Authority required Homerton Hospital to change their advertising of self funded treatment in order to make that clear.
Competing interests: No competing interests
Re: A sixth of hospitals in England have expanded private patient options this year, the BMJ finds
Dear Sirs
Yet again vulnerable fertility couples are being used as a soft target as NHS managers are on the act bolstering the coffers of financially failing Trusts by promoting “self funding, private or self paying” IVF”. It is not surprising that IVF is considered an easy and safe way to boost NHS Trusts finances as serious complications from fertility treatment are extremely rare thus it falls below the radar of those monitoring quality of care based on mortality rates only.
Since the first publication of the NICE Fertility Guidelines in 2004, the large majority of PCTs openly ignored the experts’ advice on IVF clinical effectiveness to provide 3 NHS funded IVF treatment to those patients meeting criteria. Similarly, the new clinical commissioning groups are disregarding the 2013th Update of the NICE recommendations leaving couples to dig deep in their pockets to pay thousands of pounds for a treatment that in many cases NICE recommend should be free.
The findings of this BMJ investigation further concern us since the concept of “self funding” or “top up care” is offered to needy fertility couples even from hospital Trusts who are not fully licensed by the human Fertilization & Embryology Authority (HFEA). Some of the centre mentioned in this article work as satellite centre with not validated outcome results, Yet they advice couples desperate for treatment to pay large sums of money for further treatment in the same Trusts, sometimes after the same centers have failed them once or more.
The NHS Trusts and the HFEA do not scrutinise fertility centers for quality of care with the main outcome being 'live births'. The HFEA published results show very large variation with consistently few high performance centers. Sadly many of the low performance centers are NHS ones but not exclusively. The HFEA as the 'watchdog' for care fails to name and shame these centers as it present the outcome results of live birth (LB) in 95% CI, claiming that the results of very badly performing centers are within the National Average (32% LB is the bench mark for women below the age of 35 years; the largest treated group). Some centers have repeatedly shown LB outcomes of 25-33% lower than the national average. The latest HFEA results for the year 2011 and the last 3 years show that the highest rate for LB in the age group below 35 years of age was 55% per cycle of treatment in private centers, compared to 21% in the lowest NHS centre (which also pride itself of providing a self funding treatment option for its patients). This is surely an unacceptable variation. We do not accept the argument that an NHS self funding option is offered at a reduced price or so called standard NHS price. We have looked at the price of an IVF cycle (as advertised in fertility centers web sites) and found not much of a difference between the high performance private and the low performance centers and surely those fees are not cost prices for both the NHS and private IVF providers. The difference in cost does not justify accepting a significantly lower quality of care. Moreover, the so called National tariff for IVF has never been introduced in the attempt to remove inequality in the provisions as well as the quality of treatment offered nationwide.
Fertility couples need to have access to full details of the centers results and given a trustworthy advice to enable a free and informed choice on where to have their full entitlement of NHS treatment or private care (the so-called self paid or self funded).
The HFEA has many attributes to be praised but it has failed significantly in improving the quality of care and outcome of treatment to infertile couples in those centers (NHS or private) that falls short of the acceptable outcome rate. The New HFEA must not fall in the same trap of compromising on safety (singleton pregnancy) and quality and must set up a much higher standard of care.
References:
1. Iacobucc G. A sixth of hospitals in England have expanded private patient options this year. BMJ 2013;347:f4524
2. NICE. Updated NICE guidelines revise treatment recommendations for people with fertility problems. http://www.nice.org.uk/newsroom/pressreleases/UpdatedGuidelinesReviseFer... (accessed 27th July 201
Competing interests: Competing Interests: Mr TS have one session in private practice in London. Mr LS have 2 sessions in private practice in London