Cambridgeshire and Peterborough Integrated Care System

3. Miss T complains the ICS ignored its own policy and denied her treatment, even though she met the criteria.

4. She also complains none of the complaint responses address the main point of her complaint, that the policy describes ‘a couple’ but she is being denied because of the medical history of her partner.

5. Miss T says she went through eight months of tests, scans, and vaccines in preparation for IVF treatment. She also says the complaints process has taken ten months, meaning she is ten months older and her egg quality is reducing. Miss T wants financial compensation.

6. Miss T’s partner had one round of IVF treatment ten years ago, when with a different partner. The treatment was unsuccessful.

7. Miss T and her partner began the process for requesting funding for IVF treatment in January 2021. This included a range of scans and tests. Miss T was told by a doctor at the Trust that she met all the health requirements to get treatment.

8. In August 2021 the Trust reinstated funding for ‘Assisted Contraception’ and published its policy on its website. It states, ‘Couples will be eligible to receive IVF where they meet the specified criteria’.

9. In December 2021 Miss T was told she and her partner do not qualify for funded IVF treatment as her partner had one round of treatment before with a former partner.

12. The law says we cannot investigate a complaint where a person has the option to take legal action, unless we consider this is unreasonable in the circumstances. We have discussed this with Miss T to understand the circumstances and the outcomes she wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

13. Miss T argues the ICS’s policy does not exclude her and her partner from funding. Miss T’s wants compensation. She told us she wanted enough to be able to get private IVF treatment. Miss T did not give us a specific figure, we know that private IVF treatment can be several thousand pounds. We could potentially achieve financial compensation if we found failings, but our recommendations are often modest compared to what can be achieved through legal action. For this reason, we think Miss T should take legal action.

14. Miss T told us she would not be able to pay for legal action herself. We have given Miss T information to help her find an appropriate solicitor who may work on a ‘no win, no fee’ basis.

15. Miss T also told us she wants the ICS to change its policy to consider circumstances like hers. Miss T may be able to achieve this as a result of legal action.

16. Miss T has now got a solicitor who is working on a ‘no win, no fee’ basis.

17. It seems likely that Miss T has a legal route available and so we cannot investigate the complaint. Miss T can get back in contact with us if legal action is unsuccessful or a court has not looked at all the outcomes she wants. If Miss T wants to bring her complaint back to us she should do this quickly because complaints need to be made to us within 12 months of when someone knew something was wrong.

18. We understand this has been an emotional and difficult time for Miss T and her partner. We thank Miss T for bringing this complaint to us.

1. The Parliamentary and Health Service Ombudsman has carefully considered Miss T’s complaint about Cambridgeshire and Peterborough Integrated Care System (the ICS, formerly Cambridgeshire and Peterborough Clinical Commissioning Group). We think it is reasonable for Miss T to take legal action to resolve the complaint.

2. We are very sorry to hear about the difficulties Miss T and her partner experienced as they tried to get funding for IVF fertility treatment. We appreciate the impact this had on them.