Could new NHS plan see an end to Norfolk's 'cruel and desperately unfair' IVF postcode lottery?
PUBLISHED: 17:12 07 January 2019 | UPDATED: 11:19 08 January 2019
A "cruel and desperately unfair" postcode lottery which locks some Norfolk families out of accessing fertility treatment on the NHS could come to an end after announcements made as part of a long term plan for the health service.
Theresa May yesterday hailed the launch of a 10-year plan for the NHS in England as a “truly historic moment”.
Health chiefs say that up to 500,000 lives could be saved under the plan, which involves greater use of high-tech treatments and diagnostic testing and could prevent 150,000 heart attacks, strokes and dementia cases.
But it could also mean joy for women who are struggling to conceive, as differences in access to IVF could end.
Currently there are five clinical commissioning groups (CCGs) across Norfolk and Waveney, each able to decide how many rounds of IVF can be offered to women in their areas on the NHS.
In most places two cycles are offered, even though The National Institute for Health and Care Excellence (NICE) recommends three.
But in south Norfolk no NHS-funded treatment is offered, except in very specialist circumstances, which Dr Mike Macnamee, chief executive of Bourn Hall Clinic previously said was “absolutely devastating”.
A spokesman for the CCGs said there were no plans to merge the five organisations. But the long term plan said areas such as Norfolk and Waveney must operate under a new system, known as an integrated care system (ICS). And the document said this would “typically involve a single [clinical commissioning group] for each ICS area”.
There were hopes this could mean IVF access would be equal across the region.
Dr Macnamee said: “While it is difficult to predict the outcome of such a merger of the Norfolk CCGs we would hope that this would be a positive move for fertility treatment.
“A joined up service from GP through to resolution would improve patient outcomes. Some areas of Norfolk have among the best fertility care in the UK, it would be wonderful if this was made available to all patients and those that need it - and who meet the strict NHS criteria - can gain access to IVF.”
While Aileen Feeney, chief executive of charity Fertility Network, said although there was little detail so far “reducing the number of clinical commissioning groups in England has the potential to be positive for fertility patients facing the current postcode lottery for access to NHS IVF.”
She added: “What we do not want to see is CCGs moving towards the lowest provision of care. This is an opportunity for CCGs to end the cruel and desperately unfair IVF postcode lottery.”
A number of other priorities set out in Mrs May’s new plan for the health service are pertinent for the region, especially as they are reflected in the plan already put forward by local bosses.
Reduce pressure on hospitals
The aim is to reduce the reliance on hospitals, which may be welcome news for the three in Norfolk who last week were seeing the pressure of winter stack up at the front door.
For those who do need emergency care, one of the major short-term priorities is understood to be a new target to “ensure every hospital with a major A&E department has ‘same day emergency care’ in place” - largely understood to ambulatory care units.
In these units, which are available in varying guises in all Norfolk’s hospitals, patients are assessed, diagnosed, treated, and then able to go home the same day - keeping them out of hospital and freeing up beds for those who really need it.
The James Paget University Hospital (JPUH), in Gorleston, opened their ambulatory care unit in November. Joanne Segasby, associate chief operating officer, last week attributed some of the success the JPUH has had with keeping ambulance handover delays the lowest in the county to the unit.
Improved mental health care
The long-term plan also said there would be more support for mental health in schools, and 24 hour access to mental health crisis care via the NHS 111 service.
The latter is unlikely to soothe the fears of patients in Norfolk who already struggle to get crisis support, as revealed in the most recent inspection into Norfolk and Suffolk Foundation Trust.
And the proposal has been criticised as not being a substitute for properly funded and professional care.
Labour MP Luciana Berger said: “There’s no use directing people in #mentalhealth crisis to a helpline to signpost care that either doesn’t exist, or they will struggle to access quickly.”
Last year an inquest found NHS 111 hung up on mentally ill Norwich man John Worthington when he was in crisis on June 6. He took his own life.
The plan will also look at mental health care for new and expectant mothers - something bosses will keep a close eye on considering the Kingfisher Unit, provided by NSFT at Hellesdon Hospital in Norwich, is due to open soon.
It will mean new mothers with serious mental health problems will soon be able to receive specialist inpatient treatment closer to home.
Focus on heart attacks, stroke, and dementia
But ahead of full publication the NHS said the plan would prevent “150,000 heart attacks, strokes and dementia cases”, plus ensure an extra 350,000 children and young people get mental health help.
More money to prevent heart attacks will be welcome in the county, as one of the areas of focus in the Norfolk and Waveney Sustainability and Transformation Partnership (STP) - the region’s health plan - is to improve cardiology.
In Norfolk and Waveney demand for cardiology services is high and there is a shortage of cardiologists.
Improvements in stroke will also be relevant for the county, as it was announced in September that a pioneering treatment which “brings patients back to life2 from stroke to be launched at the NNUH.
And with an aging population and a high prevalence of dementia, extra help for those services will be welcomed.
New testing centres for cancer patients
Early prevention of cancer is also high up on the agenda - with a hope more people can be cured if it is caught earlier.
Earlier detection of the disease was one of the ambitions of the NNUH when they launched a bid to become a cancer centre of excellence in 2017.
At the time NNUH cancer manager Matt Keeling said: “We want diagnoses as early as possible so that their outcome is better. The cancer strategy is about how we are going to meet that challenge.”
Consultant urological surgeon and cancer clinical lead Vivekanandan Kumar said they were aiming to “reach the top of what we can deliver nationally within the NHS”.
There will also be DNA testing for children with cancer and those with rare genetic disorders to help select the best treatment.
Dr Chris Bushby, chief executive at Norfolk and Waveney’s cancer charity the Big C, said: “We enthusiastically welcome an NHS England strategy which invests in early detection and prevention as these factors are crucial for improved outcomes for cancer patients. These are also areas which are central to Big C’s vision here in Norfolk as we look to the future.
“For Norfolk in particular, with an ageing population and many people settling in the county for retirement, it is vital that there is continuing investment in cancer diagnosis and cancer services.
“Everyday we see the impact of cancer on individuals and their families and the earlier a cancer is diagnosed, often the less invasive treatment, more successful outcome and better quality of life for those affected. We were also delighted to see and endorse the target to include health and wellbeing support and information within every individual’s cancer care plan by 2021.
“This is a fundamental aspect of the services that Big C has established over the past 38 years within our region and we are fully committed to continuing to develop outstanding cancer support and information services across our communities in Norfolk and Waveney.”
When West Suffolk MP Matt Hancock became health secretary last year, it was expected he might use some of his experience as minister for digital and culture to try and revolutionise the NHS’ technology.
His support for bringing more up-to-date technology into the NHS was clear from his support of GP app GP at Hand and his announcement to scrap fax machines in the health service.
So the announcement that everyone in the country will have digital access to their GP, including being able to make appointments, manage prescriptions and view their health records online.
The independent chair of the Norfolk and Waveney STP, Patricia Hewitt, said: “I warmly welcome the NHS Long Term Plan and, particularly, the commitment to increase the share of funding going to primary, community and mental health services. This is essential if we are to support people to remain healthier for longer.
“In Norfolk and Waveney, where work is well underway to create an integrated care system, the NHS is already working closely with Norfolk and Suffolk county councils and other partners on improving services and delivering better value for money.”