Hitting the ground running: The first 100 days
Hitting the ground running: The first 100 days

Posts Tagged ‘Women’s Health’

IVF – what to expect when you’re expecting returns

A recent World Health Organisation report finds that about one in six people worldwide experiences infertility. Unsurprising, then, that this year would-be parents around the world will spend an estimated £12.8bn on fertility treatments, a figure growing at an annual rate of 10.3%. The UK IVF market – valued at around £420 million in 2018 – is expected to reach £760 million by 2026.

WHO officials highlight that IVF remains “underfunded and inaccessible to many due to high costs, social stigma and limited availability”. In the UK, IVF is provided through a mix of NHS and private services, and regulated through the Human Fertilisation and Embryology Act, passed in 1990. The Act has been updated only once, in 2008, despite the sector having witnessed scientific breakthroughs and an accompanying shift in public perception in the time since. Both factors have contributed to a significant growth in demand. As attitudes and access to IVF have evolved, sector stakeholders have started to highlight issues: regional variations in NHS funding, poor regulation of treatment ‘add-ons’ and perceived profiteering.

Although the National Institute for Health and Care Excellence (NICE) recommends three cycles of IVF for women under 40, some Integrated Care Boards offer only one cycle, or only offer NHS-funded IVF in exceptional circumstances. In the absence of national standardisation, and at a time of squeezed public sector budgets, the recent years have seen a steady decline in the number of IVF cycles funded by the NHS. Data shows that NHS-funded cycles in England fell from 40% in 2014 to 32% in 2019. In Wales, they fell from 42% to 39% over the same period, and in Northern Ireland they fell from 50% to 34%. Scotland is the only devolved nation to have seen an increase in the proportion of IVF cycles funded by the NHS, up from 58% to 62%.

Reflecting these developments, IVF has attracted media and political interest, with MPs from across the political spectrum becoming more vocal about the issues in the sector.

Launched in Summer 2022, the Government’s Women’s Health Strategy acknowledged the need for action and announced NICE would be updating its guidelines on fertility, with changes expected to be published in November 2024. The strategy removed the requirements for same-sex female couples to self-fund fertility treatment before becoming eligible for NHS-funded care and committed to exploring the possibility of publishing data nationally on IVF provision and availability. Several Labour MPs, including senior Shadow Cabinet members, have criticised the strategy for failing to get to the heart of the problem, claiming that increased transparency around available funding doesn’t do anything in improving provision or tackling the postcode lottery for fertility services.

According to HFEA, in 2019 the average birth rate per embryo transferred (IVF attempt success rate) was 24%. It comes as no shock that would-be parents have increasingly been opting for add-on treatments in hopes of improving their chances of conception. Add-on procedures are optional extras that are offered by clinics on top of normal fertility treatments. There is currently little direct evidence that add-ons, which can add up to £2,500 to the cost of each attempt, improve the chances of success. In the absence of available evidence, and the growth in demand for add-ons, in June 2021 the Competition and Markets Authority issued guidance for fertility clinics to ensure they don’t mis-sell add on treatments. Still, HFEA’s 2022 National Patient Survey found only 46% of people who used add-on treatments felt their clinic has clearly explained how likely the add-on was to increase their chance of conceiving. This debate is part of the reason why HFEA has been calling for reforms to the Human Fertilisation and Embryology Act for years.

It was only earlier this year that the Government asked the independent fertility regulator to submit reform recommendations for consideration. Now HFEA is seeking additional powers to enforce standards, including the ability to introduce economic sanctions on non-compliant providers. The lack of control over fertility treatment add-ons by HFEA have enhanced the criticism of the poor regulation and fuelled the ‘profiteering’ debate.

Given the mounting scrutiny, increasing size of the sector and the fact that the Women’s Health Strategy had already set out that government would consider changes to regulatory powers to cover fertility treatment ‘add-ons’, it is likely HFEA’s recommendations will be accepted. Even if parliamentary time is squeezed, and the Government doesn’t make progress ahead of a General Election expected in late 2024, women’s health will be high on Labour’s agenda should it form the next government.

Labour MPs have been vocal on a number of women’s health issues, with menopause awareness in the workplace being the most recent example. And with the Shadow Secretary of State for Women and Equalities, Anneliese Dodds, calling for a “national conversation” on women’s health and wellbeing, it is safe to assume Labour would take a more interventionist approach in government.

With 3.5 million people struggling to conceive in the UK, and the proportion of IVF cycles provided by the NHS steadily declining, private provision of IVF remains a growth industry. Considering the WHO’s recent findings and calls for better policies and public financing, the regulatory landscape is likely to tighten, so those looking to invest in the sector will need to keep an eye on both regulatory reform and updates to NICE fertility guidelines. The policy agenda of a potential Labour government, which is more likely to scrutinise profit-making delivery models in the health space, should also be a key consideration.

However, tighter regulation needn’t be discouraging, especially if it is followed up with better public financing. As we have seen in other sectors, if done well it is likely to build confidence and present growth opportunities for high quality providers committed to doing their best for patients. And that should motivate investors to drive the innovation that will deliver better outcomes for patients – and reward all expecting stakeholders in the long run.

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Boris Johnson is Safe… For Now

On the surface Boris Johnson commands the support of nearly all his MPs. He will derive some comfort from this public display of loyalty. In terms of his future, the relationship with the Conservative parliamentary party is all that matters. Quite a lot of voters may tell pollsters that they regard Johnson as a ‘liar’. Normally calm constitutional historians and Archbishops may fume. Parts of the media and Twitter can be in uproar. But, as long as Johnson keeps his MPs on board he can carry on. The power to remove him lies with Tory MPs alone. During his post-Easter statement to the Commons, the first since he received his penalty notice for the birthday party in Number Ten, only one backbencher called on him to go.

But the surface does not tell the whole story. Over the bank holiday I phoned several Tory MPs including a few who are uneasy about  their Prime Minister becoming a ‘law breaker’. They told me they would not contemplate for a single second speaking out in public against Johnson before the local elections. Their party members are spending their spare time campaigning energetically and they would not undermine such effort by condemning their party leader. They would never be forgiven by activists if they did so. In other words the May local elections are a big protective shield for Johnson and also a threat. In advance of the vote, quite a lot of Tory MPs feel they have no choice but to suspend judgement. Any critical quotes would help Labour. That does not mean their support is guaranteed if the Conservatives perform poorly in the elections.

As has been the case since ‘partygate’ erupted, the mood of the Tory doubters in the parliamentary party fluctuates on a near daily basis. There have been times when they were ready to make a move against Johnson. On other occasions they are resolved not to do so. Ukraine is another factor fuelling the changing judgements, although from my conversations this is becoming less potent compared with the fact that that important elections loom. Political parties are at their most tribal during a campaign. There is another reason why the mood constantly changes. Many of the MPs, especially those from the ‘red wall’, are new to national politics. Suddenly they face the most daunting of decisions, whether or not to remove a Prime Minister. They do not quite know what to think or what to do.

In reality the parliamentary party divides into three sections. There are the Johnson loyalists who will stick with him even if he receives more penalty notices and the Sue Gray report is damning. There is a tiny minority for now calling for him to go. In the middle there is a significant section waiting to see what happens next. That includes some ministers who are unsure how this is going to play out. All are loyal for the time being except for the significant resignation last week of Lord Woolfson, a Justice Minister. It’s easier for peers to resign when local elections are being contested. They are above the electoral fray. In some cases Johnson cannot assume that loyalty will endure across the government after the May elections.

The strategy in Number Ten, a more nimble operation after recent changes, is clear. They call for “perspective” as Johnson focuses on Ukraine, the cost of living crisis and his plans for dealing with the migrant crisis. Johnson’s every move is made with his own survival in mind. He and his new inner circle know he is not safe yet. Johnson seeks to be the indispensable ‘man of action’, visiting Kiev earlier this month and off to India this week. After his act of contrition in the Commons he delivered a different more upbeat performance to his own MPs at a private meeting, linking his plan to send migrants to Rwanda with an attack on the BBC and the Archbishop of Canterbury, suggesting they were soft on Putin. This is a classic Johnson tactic, seeking to tick several boxes in a single assertion. He knows most of his MPs approve of the Rwanda scheme, admire his approach to Putin and are angry about the BBC and the Archbishop. After the May elections Johnson plans to unveil a Queen’s Speech that will again be aimed at pleasing his MPs with bills on ‘levelling up’ and other legislative items that he will claim represents the ‘people’s priorities’.

But Johnson and his advisers are not wholly in control of events. The metropolitan police investigation continues without any indication of which party is being scrutinised and when the next penalty notices will be handed out. No one in Number Ten knows when the investigation will end. When it does the Gray report will be published and, on the basis of her interim findings published earlier this year, it will be damning. In his Commons’ statement Johnson focused only on the Number Ten birthday party. If charged for other events he will have to find new explanations. Johnson has a distinct capacity for climbing out of deep holes. But he is not entirely lacking in self-awareness. Indeed he can be introspective and melancholic at times. Mostly I hear from his allies how he is robustly determined to keep going  but one did note that this crisis is getting Johnson down. With his ‘Churchillian’ sense of destiny, being the first prime ministerial law breaker was not meant to be part of the narrative.

The context is as much a key to his fate as the scale of the law-breaking. If the Conservatives do badly in the local elections and Labour soar, Tory MPs will begin to worry about whether they will lose their seats. The elections next month might not be as clear cut as that. They rarely are. But then there is the Wakefield by-election probably to be held later in the summer, a big test for both Johnson and Keir Starmer.

There are some other big themes that will dominate the coming months. The IMF has forecast that the UK economy will suffer the weakest growth out of the G7 countries. Rising inflation is destabilising for even the strongest of governments and the Johnson administration is fragile. The collapse in the standing of Rishi Sunak might have removed a leadership rival but any government needs a Chancellor with authority when the economy is weak. The dynamic between Johnson and Sunak will be pivotal. At the moment both are vulnerable. Usually one has been in a stronger position than the other. Sunak’s spring statement was framed when the Chancellor was at his most assertive as Johnson fought for his political life. In the past Johnson’s deeper interventionist  instincts have tended to win out because he was in a strong enough position to prevail over his Chancellor. For now at least they dance together after Sunak decided to stay on rather than resign after receiving his penalty notice and with Johnson currently too weak to sack him. If Johnson emerges safely from ‘partygate’ he might be tempted to appoint another chancellor, but none of the options are straightforward. The likes of Liz Truss and Sajid Javid share Sunak’s fiscal conservatism. Javid’s tax affairs are also attracting media interest.

For whoever is Prime Minister and Chancellor this autumn, the budget will be a moment of great significance for the economy and the future of this government. There could well be a further economic statement from Sunak this summer although he is keen to avoid one, wanting to focus on his budget and not give the impression of ‘panic’ reactions before then. Sunak has spent some time studying what happened in the 1970s when inflation raged more wildly than now. He noted that there were endless emergency budgets that tended to fuel further panic.

Even so the autumn is a long way off. There will be many twists and turns before then.

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Are women finally being heard?

Women in the UK are becoming increasingly vocal about the challenges they face in their healthcare and the unjust variation in access to services. When the Government opened their consultation to inform a Women’s Health Strategy in Spring 2021, over 110,000 respondents took the opportunity to make it known that the system does not work for them. Following years of campaigning, it comes as no surprise to women and those in the women’s health community that an overwhelming 84% of people felt their voices are simply not being heard when they seek health care.

By demonstrating an interest in women’s voices and their experiences, recognising failures in the system, and committing to developing a Women’s Health strategy, the Government has taken a positive initial step, albeit an ambitious one. There is no disease-specific focus and no target patient population, unlike other policy areas. This challenge affects 51% of our population and includes natural, life course events that women have, for many years, been told to just live with. With publication of the strategy imminent, the Government now need to demonstrate that they are willing to not only listen to women’s voices but to implement action based on what they are saying.

Women continue to face challenges when it comes to choices about their own bodies. Ongoing variation in access to abortion care, a full range of contraceptive choice, and a holistic range of menopause treatment options, all impact on women’s freedom to choose the treatments that work best for them. The Government’s commitment to prioritising the menopause in the upcoming strategy and cutting prescription costs for Hormone Replacement Therapies (HRT) in response to the Menopause Revolution campaign is hopeful. However, the Government’s initial attempt to reverse progress made in at-home abortion during the pandemic despite women citing a clear preference for this to continue, suggests more need to be done to prioritise women’s voices, choices and rights in practice.

In addition to not being heard, a fragmented system and the pandemic backlog have resulted in services that are increasingly difficult to navigate, leading to the most vulnerable falling through the cracks. Upcoming system reforms focusing on the integration of care offer opportunities to take a patient centered approach and reduce inequalities in outcomes. The Government is also expected to advocate for the establishment of ‘women’s health hubs’, which aim to enable access to all required care in a one-stop shop, in line with calls from advocates including the Primary Care Women’s Health Forum and Royal College of Obstetricians and Gynaecologists. Despite the promise of better integration locally, fragmentation is continuing at a national level. Abortion has been removed from the Women’s Health Strategy and is expected to feature in the upcoming Sexual Health Strategy. With a wider interest in health inequalities, the Government must recognise the connection between these elements of healthcare and align planning nationally to support local areas to integrate care.

Committing to a women’s health strategy is a promising step in the right direction for this Government and has offered women long overdue hope. Action in response to prominent campaigns, such as the Menopause Revolution, to change the way women can interact with the system allow us to believe that the challenges women have faced for far too long could be overcome within their lifetime.

The Government have a real opportunity to ensure women have their voices heard. To do this, they must recognise the challenges they face, capitalise on system reforms to integrate care, collaborate with the women’s health community, and most importantly, commit to funding appropriate and immediate action. In a health system and economy designed by and for men, the time for meaningful, impactful change, is now.

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