Infertility Services (Hansard, 8 June 1993)

§ Ms Dawn Primarolo (Bristol, South)

I beg to move, That leave be given to bring in a Bill to place a duty on district heath authorities to secure the provision of infertility services within the National Health Service; and for connected purposes. The causes of infertility may be complex and in some cases cannot be explained. Whatever the cause, however, the emotional and psychological impact of the failure to conceive should not be underestimated.

There are many, often highly successful, treatments available for infertility. However, on a national basis the level of service provision and availability of infertility treatment has never been established. Recent changes in the structure and funding of the national health service have resulted in increased competition for resources and highlighted the emphasis placed on value for money for individual treatments.

Given that infertility treatment has often been seen as outside the main stream of national health service care, owing in part to poor understanding of the condition and of the treatment available, it is possible in the current climate that levels of provision may remain static or, unfortunately, decrease.

When we talk of infertility, we talk of thousands and thousands of men and women living in our constituencies. Let me give an example of the type of problem that is faced by couples.

Mary is 37 years old. She has been to see her GP with her husband Jack, who is in the Navy. They have been married for 14 years and have never managed to have a child. In the early 1980s, they put it down to the fact that Jack was always away. It has always been difficult to sort out the problem—[Interruption.]— this is a serious point — because they have never lived anywhere for any length of time.

Four years ago, they saw a gynaecologist, who diagnosed polycystic ovary disease in Mary and oligospermia in Jack. The typical features of the syndrome for women include disturbance of the menstrual pattern and infertility. Fortunately, many women can be treated for this syndrome. Men like Jack, if they are unable to be treated for infertility, will end up with a choice of agreeing to artificial insemination of his own sperm or that of a donor.

In this country, there are 12 million women of childbearing age. Some couples will choose not to have children, but the vast majority will do otherwise; 600,000 men and 600,000 women will want, but be unable, to have children. For them, infertility can be an absolute tragedy. Each of us, as a Member of Parliament, will have an average of 1,000 couples in our constituency who are unable to conceive, and require help. Some of this help is very simple: for instance, advice on the fertile time of the month, and general health advice about smoking and diet. Men who smoke produce fewer sperm and have more damaged sperm, and those who drink heavily also experience difficulties.

This advice can come from primary health care teams. The GP can do many of the investigations for infertility, and egg-stimulation treatment can be given in a partnership between the GP and local infertility units. A 149 course of egg-stimulation treatment, including ultrasound monitoring of egg production, can cost as little as £200 or £300 to solve the problem of infertility.

Some will need more complex treatment, of course, such as in vitro fertilisation or GIFT—gamete intrafallopian transfer—often known as test tube babies. Only 6,004 women had this treatment, which has been successful, between 1985 and 1990. Twenty times that number of women are waiting for the treatment but cannot get it.

For some, no treatment or help will be available, and adoption is paraded as the option. But there is often a long waiting list, and some areas may be reluctant to allow couples over the age of 35 to adopt babies.

Some people argue that infertility is not a health problem. That is to argue that the national health service should be re-titled the national sickness service. The "Health of the Nation" initiative has recognised a broad concept of health based on quality of life. For many infertile couples on whose lives infertility has such a profound effect, it is important to have access to treatment. For many couples, infertility is comparable to bereavement and major loss.

This Bill is not about test tube babies. I have given an example of the numerous forms of simple treatment which are available and which can be undertaken but which, in many parts of the country, are not available free through the national health service. The Bill will place a duty on health authorities to ensure that all areas of the country provide a comprehensive service. After all, the national health service is supposed to be based on the principle of need and not of ability to pay.

What sort of infertility services do we want the NHS to provide? The Independent College of Health has just surveyed 174 purchasing authorities in Britain. Its survey reveals that only one in four pay for advanced treatment. Two thirds of infertility treatments sought by women have to be paid for in the private sector because they are simply not available under the national health service.

150 We must develop a rational universal service with equality of access. Too often in the NHS, we veer from boom to bust. A proper planned service with the benefit of the intervention of organisations such as the Audit Commission is essential to ensure a comprehensive and efficient service. A clear first step would be the definition by the Department of Health of the clinical services required to be provided by local and central specialist units.

My Bill is not just about infertility. It goes to the heart of the fundamental principle of the national health service —that it treats people on the basis of their need. We want an NHS that asks not, "How can I help you?" but, "What can I do for you? What is it that you want?" Too often in recent years, the champions in our society have been the takers, not the givers. The strong have become stronger and the weak weaker.

The 600,000 men and women suffering from infertility problems have very real needs. Health care should be provided on the basis of an understanding of the facts. Health care policy should be developed for the benefit of many, not based on knee-jerk reactions to unusual cases.

I hope that the House will allow the Bill to proceed this afternoon so that we can make a clear statement to infertile couples in this country that we care about their needs and will fight for their rights.