South West London Integrated Care Board

3. Miss I complains about the ICB’s decision not to provide funding for IVF.

4. As a result of the above, Miss I says she experienced intense low mood and feelings of failure. She says this has had a significant impact on both her and her partner’s mental health.

5. As an outcome to her complaint, Miss I would like a formal apology, explanation for the lack of transparency throughout the past four years and a review of the communication and eligibility process. She is also requesting a reconsideration of eligibility for IVF funding or the ICB provide a contribution or grant towards private fertility treatment

8. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

9. Funding decisions for health services in England are made by ICBs and are based on the clinical needs of their local population. We expect these organisations to commission fertility services in line with NICE guidance on the assessment and treatment of fertility problems, ensuring equal access to fertility treatment across England. NHS funding for ACT is available but varies by local ICB and depends on strict eligibility criteria.

10. In its response to Miss I’s complaint, the ICB detailed the eligibility requirements for ACT. The requirements included the following: • the prospective mother to have a body mass index (BMI) between 19 and 30 • the couple has no living child from their current relationship; and • at least one of the prospective parents does not have a child from a previous relationship.

11. In its response, the ICB clarified that prior approval must be submitted by the treating clinician responsible for carrying out the treatment, as evidence that the patient meets all the access criteria for ACT. The ICB further confirmed that no such prior approval has been received from Miss I’s treating clinician.

12. We reviewed the ICB’s Evidence Based Interventions Policy. We consider the ICB’s response is in line with section 21 Access criteria for Assisted Conception Treatments’ and Prior Approval Procedures (PAP). The criteria states the following: ‘Prior to the procedure being undertaken authorisation must be obtained by the treating clinician.’

13. When reviewing this complaint, it appears that Miss I’s treating clinician has not submitted the required approval documentation to demonstrate Miss I meets the access criteria for ACT. As a result, the ICB has been unable to consider Miss I for NHS funding of ACT, as this prerequisite step has not been completed.

14. We have contacted Miss I and advised her that her treating clinician has not submitted the required “prior approval” documentation to demonstrate she meets the access criteria for ACT. We also advised that this step is a prerequisite before the ICB can consider her for NHS funding of ACT. Miss I confirmed that she would contact the fertility team immediately.

1. We have carefully considered Miss I’s complaint about the ICB’s decision to decline Miss I’s request for NHS funded in vitro fertilisation (IVF), also known as assisted conception treatment (ACT). We have seen no indication of a failing by the ICB here.

2. We can see Miss I feels strongly about their complaint. We would like to take this opportunity to thank Miss I for bringing her complaint to us. We will explain our decision in more detail below. We hope our explanation provides her with reassurance that we considered her complaint carefully before reaching our decision.