Queen’s Speech — House of Lords, 2015-06-03
Topic: Health
Robert Maurice Lipson Winston (Labour, Centre-left): My Lords, it is very good to see the noble Lord, Lord Prior of Brampton, on the Front Bench. I am just sorry that he will not be crossing swords with me this evening, but no doubt there will be occasions in the future when we will have an opportunity to argue. I must say that he replaces a wonderful man, the noble Earl, Lord Howe I want to draw the House’s attention to a matter which most people regard as trivial, although it is not trivial to the people concerned. There are around 900,000 pregnancies a year in this country, and something like 20% to 25% of those end in miscarriage or pregnancy loss. One in eight couples in Britain has failure or problems in getting pregnant. What is happening at the moment is absolutely shocking and the National Health Service should be doing much more about it. I would like to describe a model that can be used on a wider basis in the NHS. In his introduction, my noble friend Lord Hunt pointed out that the NHS has, unhelpfully, been used as a political football. I ask noble Lords to forgive me for saying that but it is not directed at the Government as it has happened on all sides. We tend to make all sorts of financial claims which are very difficult to justify. I will say no more than that It is not understood how serious a matter it is for those who are trying to conceive. Initially there is a degree of anxiety and then there is a loss of self-esteem. People who are infertile, or having difficulty with miscarriage, start to have a great deal of pain. It is not a physical pain but a pain which erodes their relationships with their parents, with their partner and with other people—so much so that it is very common for people having difficulty getting pregnant to be unable to socialise with their peers. For example, they do not go to dinner parties or do the usual things because the discussion is about children and schools. They become increasingly isolated One aspect of that isolation is, of course, the effect on their sexual relationship. I must tell your Lordships that in my experience it is extremely common to see men become impotent and women suffer loss of orgasm as a result of this condition. What is worse, of course—it happens frequently to those who are having difficulty getting pregnant—is that they are likely to miscarry, and they are treated abominably when it happens. They go into hospital to have their uteruses scraped out. Normally they have to wait until the end of the list, sometimes overnight, because the staff are too busy to deal with them. Because it is so common, most people do not see what a tragedy it is for the individual. I should say that it is very common for a woman who has miscarried, and sometimes her husband as well, to remember the date of the miscarriage in the following years and, while not celebrating it, recognising it as a date when something significant happened. I have seen people with infertility problems who have miscarried 10 or 15 pregnancies, and that loss is massive. In a way, that is what happens during in vitro fertilisation as well, because once a woman has had an embryo transfer, she will fantasise that she is pregnant. When her period then comes, it is a shocking psychological injury At the moment, as your Lordships know, provision in the National Health Service is inadequate. I think that it is about time we were honest. We should decide which treatments are actually going to be provided and which are not. It is important to recognise that the way we account for so much in the health service, including in vitro fertilisation, does not seem to be justified. For example, in one area IVF treatment costs £1,000 to the health service while in another it costs £6,000. I would like confirmation that this really happens, but it is what I have been told. Several people in senior positions in the health service have said to me that IVF treatments and abortions pay for pregnancy care because the budget is not big enough. There is a curious irony in that The NHS website covering infertility is really quite shocking. In the first sentence, women are advised that they should not worry about getting pregnant until they have had unprotected sex for at least two years or 12 months of artificial insemination and have not yet got pregnant. There is no evidence that artificial insemination is any use at all in the treatment of infertility. In fact, the Dutch figures suggest that people who are having sex naturally are just as likely to get pregnant. Much mention is made of lifestyle, but generally it is not really important. Further, we screen people for conditions like chlamydia. I would like to know how much that screening is costing the National Health Service, because in my experience as someone who has worked with infertile people for 40 years, I have seen no serious evidence that chlamydia definitely causes infertility in its acute stages. It may occasionally be possible for it to leave scarring There is a conflict of interests. People go to an NHS clinic, and they fail. Overall, there is a 25% chance of getting pregnant, so most people will fail. The same practitioners will then be operating in a private clinic where the same patients will then go afterwards for continuity. It is therefore not in everyone’s interests to see success. It is a massive issue and we need to address it. Sadly, however, the regulatory authority—the Human Fertilisation and Embryology Authority—has been extremely bad at regulating the cost of IVF treatment in the private sector, where at the moment the prices are escalating. People are paying as much as £9,000 or £10,000 for a cycle of treatment, particularly if there are added diagnostic procedures, most of which are of unproven value. Examples are biopsy of the embryo and immunological procedures that are not justified, along with a whole range of other issues, which the NHS actually licenses, but in fact they are research procedures for which I do not believe people should be charged It is important for us to consider what the real costs of procedures are throughout the health service. I do not think that we know the figures, and what is happening in in vitro fertilisation is probably happening on a much bigger scale in a whole range of treatments. Because we now have a considerable private practice sector providing treatments within the National Health Service, it is extremely important that the service should understand precisely what the cost of an individual treatment should be. Unless we know that, we will continue to see spiralling costs, as well as the problems of all the people who are not getting treatment. Imagine having one cycle of IVF and finding out that you are no longer eligible for any more, which is the case in many health authorities. The chances of success are 25%. Would we give up a cancer therapy after administering 25% of the drugs, or perhaps 25% of the treatment required for arthritis? We continue with treatments until they are successful. That must be the standard that we need to consider.