Wednesday, 4 November 2015

What sort of NHS do we want?

It is quite a painful thought to realise that some think that by using IVF through the NHS one may have deprived someone of vital life-saving cancer drugs. Yet, that is what I was left thinking after listening to a debate on the radio the other day: it confirmed what many already suspected - access to IVF services is increasingly something of a postcode lottery across the country as the NHS has continually to tighten its belt as it struggles to stay vaguely solvent.

The programme brought memories flooding back from several years ago when my wife and I went through two IVF cycles through the NHS. Oddly enough, I find I struggle to remember many precise details as the whole process lasted so many years and the stress was so tiring, putting it out of my mind has broadly seemed the best thing to do.

Inevitably, we began with the many years of trying and failing to have a baby, then there were the exploratory tests, there was an operation, possibly two, there was a useless GP who lost our notes setting the whole procedure back months, and by doing so reducing our chances of success – and even of being accepted as patients – as we got steadily older and closer to very inflexible deadlines.

Once we finally were accepted, after a doctor was a little generous with my wife’s (lack of) weight, the drugs started, then the evening injections and the final, vital, trigger injection. The latter has to be given with such precision, the first time we did it we had to find a quiet room in the middle of a wedding reception to administer it. Then a specimen has be provided, the specialists do their wizardry. And then there is the waiting to see if it worked.

And, the first time, it didn’t. What next?

Apart from the inevitable huge disappointment, I remember going to our next appointment at the unit not entirely clear what we could do next; it’s possible that is just my recollection. But, suffice it to say, we started the drugs again, and another trigger injection – this time the specified time was in the middle of the night. To my horror, I managed to bend the needle but hoped I had administered the required quantity of the drug. Another specimen, more wizardry, then more waiting.

This time, it worked, bent needle or not. And our daughter has just turned 3.

Some describe this treatment as a ‘luxury’ but it certainly didn’t feel like it at the time. According to NICE guidelines, clinical commissioning groups (CCGs) should offer three cycles of IVF to all women of 39 or under. When we embarked upon this path, the age limit in our area was 35 and only two cycles were offered; it is certainly not the worst. The guidelines are woefully ignored across the country with only 18 per cent of CCGs offering the full service. What treatment one gets is entirely reliant on where one lives. It’s a hopeless situation which the government is studiously ignoring; its budgeting means that such treatments are a secondary concern.

According the OECD, Britain still spends less - in some cases significantly so - on health per capita than many of our European neighbours, such as France, Belgium, Germany, the Netherlands and Denmark. We spend less per capita than Canada and Australia (and the US, though its health service is something of a basketcase).

It is, therefore, hardly surprising that the OECD finds that, as a consequence of pretty mediocre spending, by the standards of developed Western nations, we currently have a mediocre health service. Their new report finds that we lag behind countries in key areas such as the survival from cervical, breast and bowel cancer. We need 75,000 more doctors and nurses to match the standards of our peer nations (a cause hardly likely to be helped by our government's anti-immigration rhetoric).

In these circumstances, and ignoring the fact that infertility is a recognised medical condition, I can understand how someone might think that a trust spending £6,000 trying to assist a couple have a child might reduce funds available for other therapies. We have learned so much about the importance of speed, when treating cancer, for example, that our reaction to demands for swift medical intervention, is urgent and visceral. And politicians, to extent, can make moves to answer such demands. At the same time, however, it is almost impossible to quantify the long term costs accrued due to stress, depression from infertility, and consequent long term savings from successful IVF treatment. In ways similar to aspects of mental health, it is simply easier to ignore.

Ultimately, it is a matter of ambition: It is about what sort of NHS we want - and are willing to pay for. Should the service be one which is constantly scrimping and saving, where one treatment is competing with another and there is a debate about which is apparently more 'justifiable’? Do we want a health service which doesn't aspire to be the best but instead is stuck on a permanent downward spiral? Politicians can talk about delivering the best health service in the world but this needs backing with hard cash. Putting it simply, this should not be a question of either cancer treatment or IVF. We need, and should demand, both. 

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