God’s lottery

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Grant Shapps is frequently cited as one of the Tories’ brightest of bright young hopes, but if this is anything to go by, I wouldn’t get too breathless just yet.

Access to IVF on the NHS is a lottery, with different areas adopting different rules, an MP says.

Mr Shapps, whose own three children were conceived through IVF, said that PCTs were, to some extent, “playing God” – deciding who had the right to a child and who did not, based largely on the state of the PCTs’ annual budgets and deficits.

He explained: “Couples are effectively being told that they cannot have a baby while their friends on the other side of the street, who might have a similar set of circumstances, are able to obtain three cycles of IVF provided for them by the NHS.”

All of this may well be so, but how exactly does this square with Gideon Osborne’s plea yesterday about being “disciplined and responsible with public money.” It might not be a nice thing for people wanting IVF to hear, but the cost of offering fertility treatment universally on demand would be exhorbitant. In a debate about spending priorities, it is always going to lose out.

The solution is not offering universal health care, but accountability over local health budgets: replacing a postcode lottery with postcode choice. I thought the Tories were headed in that direction, but Shapps has clearly undermined this if it is the case. These sorts of headlines put pressure on governments to tighten the reins, not loosen them.

And as for going on about ‘playing God’ – IVF – healthcare for that matter – IS playing God! IVF has created a world whereby infertility is literally a death sentence in poor countries (no children means no-one to look after you in old age), and largely avoidable in the West. Invoking theology is lazy, kneejerk populism that dismisses the no doubt very real ethical dilemmas that healthcare managers have to face on a daily basis.

In short, Shapps has added nothing to the public forum apart from his own name. It looks like crusading politics, but I doubt he would ever want a government to rise to his challenge.

2 thoughts on “God’s lottery

  1. Couldn’t help but notice your comment, courtesy of a Google Alert from my office.

    I’ve consistently said that it would be better for the government not to make the IVF pledge if it’s undeliverable and have never called for anything to happen other than what John Reid pledged in Feb 2004.

    I happen to think that the pledge would be fundable if it weren’t for the waste and mismanagement of the NHS, but to tell couples to expect a cycle of IVF and then take it away from them is wrong and even cruel. I know this because I’ve been through IVF.

    So if you interepreted a snipet you heard as a call for funding I’m sorry to hear that. The full report available on my website next week makes it clear that this is not what I’m getting at. Sorry the coverage you heard obviously fell short of making that as clear as it should have been.

    I don’t start from the view point that everyone has a “right” to IVF. Only that everyone has a right to believe what a Minister says at the despatch box about IVF.

    Always an enjoyable blog. Congrats.

    Grant Shapps MP

  2. Grant,

    My issue is that I don’t think that national government ought to be making such pledges at all, especially as it then leaves it to local PCTs to do the actual implementation. The idea of a centrally managed, push-button NHS has always been a myth; far better if the accountability lay at a local level as well as the operation.

    That’s why I don’t like talk about ‘postcode lotteries’ – because it presupposes that the problem is the local decision making, not the centralised target setting. The implicit ‘solution’ to postcode lotteries is greater central control, yet it is the centralised control itself that often leads to the random factor. That’s why more devolved health services – such as Denmark’s – tend to have more equal provision. Instead of jumping to the often contradictory tune of central government, healthcare managers would be both more accountable to the end users and more under pressure to keep up with best practice.

    Much of the rhetoric of the Conservatives these days seems to go along with that argument, which is why I was surprised with the rhetoric you used in the piece. I will certainly read your report (in fact I looked for it before posting) – I’m sort of under an obligation now.

    We do agree on one thing though – Ministers should never make promises they can’t keep.

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