----------
Colleagues

Two comments on the current debate

The NHS was set up with the laudable objective of making available the best possible health care to all members of UK society,  If you restrict IVF to private access only then you restrict access to a significant medical intervention to the small section of society who can afford private access and deny access to many at the lower end of the socio-economic spectrum.   Access would be decided by ability to pay rather than ability to be a good parent or any other criteria.

You will note I term IVF a medical intervention rather than a treatment to avoid the emotional baggage the word treatment brings with it (illness, disease etc).  Remember even the WHO recognizes that medicine is about more than treating or even preventing disease, it has a broader aim, "the promotion of well-being", physical, mental, and I would argue sociological.  I fully support the comments of our colleague who alluded to the undoubted, but very difficult to quantify, adverse effects of infertility on the well-being of many of our patients and the converse beneficial effect of parenthood on those same patients.

Therefore I argue that IVF has every right to be assessed on its merits in the same manner as any other medical intervention.  The problem then arises however as to how to quantify or measure the benefit / problems of different interventions and decide on their availability in a health care system with limited resources.  This decision making has to be transparent to all interested parties (i.e. everyone involved can understand how and why the decision was made) and responsive to the wishes of society ( i.e. society has a right to contribute to the decision making).   

Therefore in a resource limited health system as we now (and in reality always have had), we should determine the health care priorities and the resources we are willing to devote to them.  In effect I am arguing for an "Oregon" Type process to determine health care priorities.  If this decides that the society is willing to devote more resources to IVF than fractured hips,  so be it.

We have always had rationing in our  multi-layered health care system.  In the past and now access to treatment / medical intervention was / is determined by money, who you know, how interested your doctor was in your plight, whether you are a member of  the right golf club etc,   Lets start to be professionals and determine access in an honest, egalitarian, and transparent way.

Jim

James Kennedy
#GP and SL in General Practice




%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%