Stuart Jeffery (Deputy Managing Director and Chief Operating Officer, NHS Medway CCG) and Michael Griffiths (Partnership Commissioning Programme Lead – Children and Families, Medway Council and NHS Medway CCG) were in attendance for this item.
(1) The Chair welcomed the guests to the Committee and noted that an additional report has been added to the agenda, via a supplement, as she had agreed that it should be considered at this meeting as a matter of urgency, as permitted under section 100B of the Local Government Act 1972; this was to enable the Committee to consider the East Kent CCGs’ position statement which was not available for despatch as part of the main agenda on 4 October 2018.
(2) Mr Jeffrey began by providing an update about the progress of the review since presenting to the Kent HOSC and Medway HASC in January 2018; he noted that the initial timetable was running significantly behind schedule. He stated that there was currently a single schedule of policies in Kent & Medway relating to Assistive Reproductive Technologies (ART) services which included two cycles of IVF for eligible patients. He reported that NHS Dartford, Gravesham & Swanley CCG and NHS Swale CCG had started pre-consultation engagement on IVF cycles, NHS West Kent CCG was about to begin, and NHS Medway CCG had concluded this stage of work. He highlighted that the East Kent CCGs had decided not to participate in the review relating to the reduction in IVF cycles as they had other priorities in relation to hospital reconfiguration in East Kent. He noted that whilst NHS Medway CCG was the lead commissioner for ART services, each CCG was independent and there was a risk that different policies could be created across Kent & Medway. In relation to donated genetic material (DGM), all Kent & Medway CCGs were supportive of the review to establish the inclusion of DGM in the ART schedule of policies. He explained that a meeting had been held earlier in the week and there were still a few issues to resolve before CCG agreement which was expected within the next couple of months.
(3) Members enquired about the use of a new technology to reduce the costs of ART and pre-conception advice. Mr Jeffery stated that he was not aware of the new technology being referred too but would look into it. He reported that comments about pre-conception advice had been highlighted in the pre-consultation engagement phase and would be taken forward with the Commissioning Support Unit. Mr Griffiths added that the STP Prevention Group was considering a study of 1000 women in relation to pre-conception.
(4) Members expressed concerns about the potential for different levels of provision for couples seeking IVF in Kent & Medway and welcomed the inclusion of the use of DGM. In response to a question relating to achieving a unified CCG position, Mr Jeffery noted that there was currently different level of provision across England. As lead commissioner, he stated that his preference would be for a unified decision. He reported that he was continuing to have conversations with East Kent about the policy review and there was the potential for it to be brought back together.
(5) Members asked about NICE full cycles of IVF and success rates of IVF cycles. Mr Griffiths explained that NICE defined a full cycle of IVF as one fresh cycle and an undefined number of subsequent frozen cycles; the current provision in Kent & Medway was not deemed to be a full cycle as patients were only entitled to one fresh IVF and one frozen embryo transfer per cycle. Mr Jeffery committed to providing the Committee with a briefing note about cycles. Mr Jeffery stated that the average rate of a live birth was 32% after one cycle and 49% after two cycles. He confirmed that measures such as pre-conception skills to improve the success rate of the first cycle were being considered.
(6) The Chair enquired if the review of IVF cycles was worth continuing given the creation of different provision across Kent & Medway, the relatively small financial savings and the impact that the change would have on the mental health of couples seeking IVF cycles. Mr Jeffery noted that savings were required across Kent & Medway and the East Kent CCGs’ decision would be taken into consideration before moving to the next phase. In response to a specific question about re-consulting the remaining CCGs following the East Kent CCGs’ decision, Mr Jeffery confirmed that the CCGs had not been formally notified but would be at their next Governing Body meetings.
(7) The Chair invited Dr Allingham to provide a GP’s perspective. Dr Allingham stated that GPs were not supportive of different levels of provision particularly in areas close to boundaries. He noted that whilst GPs would support individual funding requests if it was in the patient’s best interest, he noted that they were time consuming and were often not successful.
(8) RESOLVED that:
(a) the report on Assistive Reproductive Technology Services policy review be noted;
(b) the Committee expresses grave concerns about the potential for different levels of provision for IVF cycles across Kent & Medway and requests that NHS Dartford, Gravesham & Swanley CCG, NHS Medway CCG, NHS Swale CCG and NHS West Kent CCG, in light of those concerns, reconsider their decision to continue with the review of IVF cycles.