Fair treatment in access to Assisted Conception
Assisted Conception is one issue for which the Armed Forces Covenant has literally had a life changing impact! It seems every week there is another news story about rationing of treatments on the NHS such as In-Vitro Fertilisation (IVF) but for RAF couples struggling to conceive there is good news.
IVF is one of a group of treatments called “Assisted Conception” to help couples who are unable to conceive through sexual intercourse. The National Institute for Health and Care Excellence (NICE) guidelines recommend that couples should be offered three cycles of treatment but many Clinical Commissioning Groups (CCGs) have reduced their offer to less than three or even none in some areas, leading to many geographical variations. Consequently, this could have created disadvantage for service personnel who move on assignment as their entitlement to treatment is affected by their assignment rather than their clinical need. The NHS is a strong supporter of the principles of the Armed Forces Covenant to provide fair treatment to the Armed Forces and their families. To overcome this disadvantage there is a commitment that service personnel who meet the clinical criteria for treatment as set out in the NHS England Armed Forces Assisted Conception Policy will be offered the same number of IVF cycles, regardless of wherever they are assigned.
The current NHS Armed Forces Commissioning Policy on Assisted Conception upholds the NICE guidelines of three cycles of treatment for couples who meet the eligibility criteria. Whilst Assisted Conception is classed by Defence Medical Services as non-essential elective procedures and, as such, are not required to return military personnel to operational ﬁtness, where possible and practicable, they will facilitate testing of Service personnel for fertility issues to ensure they have equal access to this treatment as for any civilian.
On top of this commitment, the Ministry of Defence and the NHS England have worked together further to set out good practice in a Defence Instruction and Notice (DIN 2016DIN01-052 Assisted Conception and Fertility Policy). The MOD recognises that the investigation and diagnosis of fertility issues and any subsequent treatment takes time and, as Armed Forces personnel are more mobile than the majority of the UK population, this can impact on continuity of care and increase the stress associated with the process. Therefore again, where possible and practicable, the Ministry of Defence will provide up to three years of geographic stability, in the UK, for military couples accessing assisted conception. This will be assessed on a case by case basis by the single Services and the DIN sets out the process by which the individual can request geographical stability which must be discussed with their Commanding Ofﬁcer Conﬁrmation that the couple have read and understood the DIN is now included in the required supporting documentation for NHS England Armed Forces Assisted Conception funding applications.
To qualify for treatment under the NHS Armed Forces Commissioning policy at least one member of the couple must be in the regular armed forces with more than six months left to serve. It may be either the regular Servicewoman seeking assistance for themselves or their spouse/partner or Serviceman whose spouse/partner are seeking assistance and includes unmarried or same sex partners. However, couples should be aware there are several other clinical criteria which must be met before funding can be approved for NHS treatment and their doctor can advise further on these.
We have many examples at the RAF Families Federation of couples who were unaware of the NHS Armed Forces Commissioning policy and have been told by the non-serving partner’s GP that their local CCG did not offer IVF or were offered less than the three recommended cycles. In some cases couples have spent their savings funding private treatment without knowing that they could have been entitled to NHS treatment. What can be particularly tragic for couples is to ﬁnd out that any previous full IVF cycle, whether self or state- funded will count towards the total of three full cycles that can be offered by the NHS.
In simple terms, if a couple have privately-funded one cycle they will only be entitled to two further cycles funded by the NHS, if they have privately funded two, they will be entitled to one more and if they have privately funded three or more they will not be entitled to any NHS funded treatment. NHS England are not able to reimburse the costs of any privately funded treatments, regardless of whether the clinical criteria set out in the policy would have been met.
If any couples are experiencing difﬁculties conceiving they should discuss their clinical need with their GP or doctor who can advise and consider seeking a referral under the NHS Armed Forces Commissioning Assisted Conception policy to ensure they get access to the three NHS funded cycles regardless of where they live.
All applications for funding should come through NHS England Armed Forces where either partner is serving – no applications should be made to the local CCG via civilian GP referrals. For further information please contact the RAF Families Federation who can help.
See also Health