The NHS postcode lottery

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I have just been listening to the radio and there is a discussion of the very different rules that apply to ivf depending on individual PCT rules. The same applies to other medical procedures - e.g gastric bands. This has always seemed to me grossly unfair because the money comes from our taxes and it seems to me that the same rules should apply to everyone. Otherwise, for example, you could have two women in exactly the same circumstances - but one gets £10,000 worth of treatment for free and the other doesn't.

What I didn't realise is that in Wales and Scotland the rules are set centrally and so the system is a lot more fair. Don't most people agree that the English PCT system is grossly unfair?

YANBU.

That's "localism" for you...

Exactly - it seems to me that the only thing that flows from "localism" are all sorts of very unfair results.

Yes, it is unfair. It's been that way for a long time.

But, I can understand that different areas may have different priorities in the healthcare of their local population, so I don't think it's unreasonable that where an area is struggling to provide quality care for illnesses that they choose to not fund IVF.

I agree that it should be the same policy and access to treatment wherever you live, but sadly our NHS funding is so shocking and policies so crap that it's just not realistic to be able to offer this.

DH and I are a case in point - if we lived a couple of miles up the road we'd be eligible for funding for 2 rounds of the IVF we absolutely need if we're to start a family. As it happens, we've had to pay for every step of our treatment ourselves (we're hoping the next round of FET will be successful as we're spending nearly all the money we were planning on using to bring up our new family on actually getting one!).

I feel pretty irritated and frustrated by this but I can only imagine how fucked-off I'd be if I needed a cancer (or other potentially life-saving) treatment only to be told my hospital couldn't afford it because they're allocating £10k per couple to everyone who needs IVF.

I guess one way to establish a fairer system might be to lower the number of cycles to those awarded NHS funding to just one, therefore allowing more to benefit as the costs are 'spread' (if that makes sense?!).

Scotland and Wales have far smaller populations with overall less diversity. That makes commissioning and funding priorities a bit easier. It doesn'take for better health outcomes though.

The NHS previously was about local ownership and financial responsibility so it doesn't follow to then apply national mandatory treatments which might not be appropriate to each individual population. It's a conundrum which Andrew Lansley has made worse.
And IVF is an easy target - its always in the same sentence as "cuts in cancer services" when actually the way they're funded is entirely different. And if Trusts were better organised, had better managers with real financial teeth (and that means pay more for them, not less) and better purchasers, they'd save millions in weeks.

And IVF commissioning is a joke. Instead of sending people for the same treatments at the same crappy piss-arse clinics with shit results, there should be a small number of clinics with excellent replicable results where everyone is sent to. The most expensive cycle is one that doesn't work. It's hardly sodding brain surgery to reallocate where patients are sent to. Yes, some local clinics would go bust but then hard look, they should have got better results.

You have a point Bluegingham - had our NHS Trust continued with their funding we'd have to have had our treatment at our closest / local hospital, which is a bloody bleak, depressing place with a poor-to-mediocre reputation in IVF and results to match (not surprised they didn't think it was value for money on the funding front, tbh). As we were paying for our own treatment we selected a good clinic with a strong track record and a far nicer place undergo what is a tough process.

IVF is not available to anyone at all under the NHS where I live. If I lived 2 miles down the road and was in a position where I needed it, I could. Its morally indefensible IMHO. The NHS is supposed to be so everyone has access to the treatment you need and that is far from the case.

Worst still is they pick and choose what healthcare issues postcode boundaries exist. When it comes to giving birth I could choose to go to my local hospital in the NHS Trust I live in, or I could go to one in a neighbouring Trust.

NICE guidelines are being ignored left right and centre - guidelines that very often are written and consider costs when making recommendations of treatments. You have to question at times whether there is actually any point to them at all with such widespread difference in practise. Instead of making the system every to understand and navigate through all these local differences only work against patients.

YABU

Various parts of the country have different needs. There are pockets of particular diseases. If an area has a lot of people with diabetes then they have to spend more on diabetes.

There are other demographics, some areas have more older people, or younger.

Parts of the UK have TB other don't. Would it be right to vaccinate everyone? Or better to not vaccinate anyone? At the moment you are offered the vaccine if you live in an area where you will encounter TB.

If there is a need for something you treat it. You don't deprive others of something else in order to do that, sashh.

Yes, of course different areas have different health needs - but if one area is really deprived and lots of people have diabetes, etc then that area should have more money allocated to it.

What I am saying is that the NHS is funded through our taxes - so everyone should be entitled tom the same services. It would be like saying that in some areas where there are lots of children then local authority could choose to provide schooling for only four hours per day, because it does not have enough money to fund schooling for all children for a whole day...

There actually are guidelines on what IVF should be available and to whom. Many trusts ignore it and see if you will leave alone. Be brave and tell them so and they should give in. - anythin to avoid a case and publicity as then many other couples wud come forward who haven't known this.

My PCT has no paedatric neurologist and no occupational therapy for children with hypermobility / dyspraxia etc. No physio either!

YANBU.

Slightly off topic, but if we accepted that as a nation, we cannot afford to maintain our position 'on the world stage' and slashed our overseas aid budget, then we could afford to offer IVF etc to everyone who needs it and stop taking DLA away from the poor buggers who fall on the boundaries of eligibility.

Charity begins at home.