Agenda item

Mr Dominic Cox (Deputy Chief Commissioning Officer) and Mrs Rebecca Fox (Director of Quality and Deputy Chief Nurse) were in attendance of the item:

1)    The Committee received the report outlining the changes to commissioning fertility treatments in Kent and Medway.

a)    NHS Kent and Medway had reviewed its policy on NHS-funded treatment and implemented changes on 1 April, 2026. The Committee was advised that the revised policy was based on clinical evidence and had been subject to public engagement, with feedback considered as part of the process.

b)    It was discussed that that the changes aligned with national trends, with approximately 69% of all Integrated Care Boards having introduced similar amendments.

c)    Mr Cox acknowledged that planned communication with Members prior to the decision had not taken place and confirmed that engagement had been intended but did not occur and expressed regret for the oversight.

d)    The changes to the Policy would deviate further away from the current NICE (National Institute for Health and Care Excellence) guidelines.  Mrs Fox outlined the rationale for the changes, noting that they were made within an established commissioning framework and based on evidence relating to clinical effectiveness, outcomes and equality impact.

e)    Members were advised of the key changes to NHS-funded fertility treatment policy:

i)     reduction in the upper age limit for eligibility from 40 to 38

ii)    reduction in the number of funded treatment cycles

iii)   reduction in the number of embryo transfers.  .

2)    Members raised the following points:

a)    Concerns were raised on the lack of information depth captured in the papers provided.Members expressed alarm regarding the process by which the changes had been implemented, noting that the decision appeared to have been taken following engagement and was contrary to any feedback received from the public.

b)    Members commented on the perceived imbalance between clinically led decision-making and community input, noting that the impact of the changes on residents was substantial and that the revised policy did not align with NICE guidelines, representing a significant departure from recommended standards.

c)    The reduction of both the age threshold and the number of funded cycles /transfers went beyond what would be expected if based solely on clinical evidence. Members suggested that the combined changes could limit access to treatment and create a negative perception that the decision had been driven by cost-saving measures rather than clinical needs.

d)    Members questioned if changes to the IVF treatment impacted individuals on lower incomes disproportionately, potentially increasing inequality and suggested that the combined changes to eligibility and treatment offer should be subjected to greater scrutiny. Additional clarification on adequacy of consultation and the consideration of impacts on affected families was also raised.

e)    Presenters acknowledged the concerns raised and discussed the fertility effectiveness data had indicated that there was a significant decline in IVF success rates due to increasing age, measured by live births per embryo transfer. It was discussed that success rates were approximately 40% at age 35, reducing to around 20% at age 40, and less than 10% at age 42, which was within the age ranges referenced by NICE guidance.

f)     Members challenged the clinical justification for the revised age threshold, noting that the data presented did not clearly demonstrate a significant drop-off in outcomes specifically at age 37. Members raised that available evidence had typically grouped outcomes into broader age cohorts, making it difficult to validate the rationale provided, particularly given the limited supporting detail in the submitted report to the Committee.

g)    Other concerns included that the report, which had been issued shortly after implementation of the decision, did not provide sufficient detail to support effective scrutiny. Members suggested that future reports should more clearly set out the basis for decision-making. Members also queried the extent to which decisions were informed by patient need, clinical evidence, or financial considerations.

h)    It was suggested that the report lacked detail on the financial considerations underpinning the decision and that this had not been clarified in responses. Clarification was sought on the estimated impact and whether this related to specific eligibility changes or the wider policy. The report did not clearly quantify or communicate the anticipated savings and had limited the Committee’s ability to fully scrutinise the basis for the decision.

i)     Members also requested that more comprehensive data be captured, including previous birth figures, projected impacts on future births, and the associated financial implications.

j)     Mrs Fox clarified that an engagement activity with service users was undertaken in advance of the change, rather than a formal public consultation. Mr Cox confirmed that this had been conducted in line with the relevant requirements, but apologised again for not notifying the Committee in advance.

k)    Members of the Committee raised concerns that the decision introduced three substantive reductions in service, relating to age eligibility, number of cycles and number of embryo transfers. They also remained unclear on the impact on low-income families and same sex couples whose eligibility was already significantly challenging in terms of criteria and cost.

l)     Mr Cox confirmed that feedback from the Committee would be reflected upon and emphasised that, while engagement could be strengthened, the decision had been based on available evidence and was not taken with adverse intent, reaffirming a commitment to working constructively with Members going forward

3)    Mr Jeffery proposed, and Mr Hook seconded, the motion that: 

The Committee submit a call-in request to the Secretary of State for Health and Social Care about the decision to change the NHS funded IVF fertility treatment offer for Kent and Medway residents.

The motion was put to the vote and was carried. 

RESOLVED that the Committee submit a call-in request to the Secretary of State for Health and Social Care about the decision to change the NHS funded IVF fertility treatment offer for Kent and Medway residents.