11.53 am

Dr. Lynne Jones (Birmingham, Selly Oak): I am pleased that the hon. Member for Meriden (Mrs. Spelman) succeeded in obtaining this debate. Despite the fact that one in six couples will require some form of assistance to have a child, there seems to be little public sympathy for such people. One wonders why that is so, and one hopes that the debate will help to redress the balance.

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Recently, Fay Weldon described women without children as:

"These barren twigs on the tree of life, this stunted growth."

Why are the public so unsympathetic? A survey carried out by my local health authority revealed that there was little public support for funding for fertility treatment. Perhaps some of the publicity given to certain women who have received fertility treatment is partly to blame, but the fact remains that the majority of people who seek this form of medical intervention are from stable backgrounds--couples who have been together for some time and who want to start a family.

The other aspect of the lack of sympathy may be that there is such a stigma attached to the inability of a woman to conceive or of a man to father a child that the subject is not talked about much. Perhaps this debate will help to get people talking. It is excellent that two women Members of Parliament have spoken publicly about their own experiences; the more people are able to discuss the issues, the more public support will be generated. Whether or not there is public support, it is wrong that the availability of treatment varies according to the area in which one lives or whether one can afford to pay. I hope that, in her reply, my hon. Friend the Minister will give some hope that we will start to develop national guidelines for a comprehensive service in future.

In Birmingham today, a meeting is taking place between the health authority and the clinical directors of the relevant trusts to consider how to improve the service in Birmingham. At present, only £50,000 a year is allocated, which is about one tenth of what is needed. That leads to grave difficulty in deciding who should receive treatment and to enormous waiting lists. That is clearly unsatisfactory, so the health authority is looking at other services it provides. Many general gynaecological services relate to infertility and, if clearer protocols were drawn up in respect of access to such services, we might be able to release money for the provision of infertility services. There is also the question of where services are provided and the need to set up tertiary centres which, when funding becomes available, will be able to offer good prospects of success with staff who have the necessary experience to provide treatment.

I join other hon. Members in calling on the Government to look seriously at the problems relating to infertility treatment. If we are to have a genuinely national health service, as opposed to a national illness service, we should be providing national guidelines for a comprehensive sub-fertility service in this country.

11.59 am

Fiona Mactaggart (Slough): I reflected for some time before contributing to the debate, partly for some of the reasons mentioned by my hon. Friend the Member for

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This is an important issue because of the effect that sub-fertility can have on people's lives. It creates a feeling of powerlessness and confusion. It is connected to the Darwinian requirement to reproduce, which means that fertility is closely connected to one's identity. That is the main reason why, in so many people, sub-fertility leads to depressive illness and, consequently, high expense for the NHS.

It is wise and sensible for us to provide for that health obligation. It is clear that, at present, the health service is not doing that; it is failing in a number of ways. In many parts of the country, fertility treatment is absolutely inaccessible. Some time before I was elected, I attended a Berkshire health authority meeting considering the range of treatments not normally approved of by the health authority. I vividly remember speaking to a clinician who said that, in many cases, he felt that the health authority's decisions were wise because the treatments being excluded from funding were ineffectual. However, he felt strongly that it was wrong to exclude fertility treatment from funding, particularly IVF, because it is an increasingly effective clinical measure, as the hon. Member for Meriden (Mrs. Spelman) pointed out.

Another important issue is the provision of information. Many women feel that attempting to find out about treatment makes their situation and their confusion greater. Doctors are often not well informed, and women often have to undergo long, tortuous and confusing investigations, some of which are not particularly necessary and some of which are inefficient. After all that, they may find, as I did, that they have reached the end of road and that the NHS will no longer provide treatment. They then go through what can only be compared to trying to read the form of race horses by trying to work out which private clinic--if they can afford it--is the most appropriate.

My hon. Friend the Member for Northampton, North (Ms Keeble) described a much more efficient sounding approach than that which I experienced, but it is confusing and difficult. It is necessary to look under the statistics such as those quoted by the hon. Member for Meriden. Some centres where the statistics are not so good may take older women. It is difficult for the ordinary person seeking treatment to know what to do. There are failures in the quality of information across public and private provision. The health service should look at that.

The health service needs to provide better support for families to help them deal with the experience of treatment, which can be devastating for those involved. They need help to gain access to the most effective treatment. That is the responsibility of the Government. The Government should be centring treatment on the places where it works rather than adopting a scattergun approach, allowing people to carry out the treatment even if they are not excellent at it. It is a relatively expensive

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The Government need to deal with the issue of who should have access to treatment. It is not appropriate to leave it to individual doctors. However, sometimes the confusion created by individual doctors helps us to get through the moral decisions that we like to avoid taking. That is one of the reasons why Governments, health authorities and so on duck aspects of such decisions. We must take responsibility for that--it is our job. There should be a public debate about who should be eligible.

It is my view that there are cases where people who are not in standard relationships or stable marriages should be eligible for such treatment. Whatever view we reach, it should be debated publicly so that people know at the beginning of the heartache whether they have any chance of obtaining treatment or whether--to add to the horse racing analogy--they are betting on a blind horse and will not obtain treatment because of their age or their relationship.

There are other things the Government can do to help those who are sub-fertile. One of the things we are already doing, and which I welcome, is improving access to child care and introducing family-friendly employment policies, which make it more likely that women will try to have children at a younger age. I believe that one of the reasons for the fertility crisis is that women are having children later, and that is partly because of the structure of the labour market. If we can make it possible for women to start their families earlier, some of these problems may not arise.

My hon. Friend the Member for Norwich, North (Dr. Gibson) referred to the importance of tackling environmental policies which have an impact on fertility. The Government should be aware of that. I believe that improved sex education and sexual health among young people can help them to avoid conditions that can affect their fertility. In all those ways, there is a responsibility--it is a difficult responsibility to deal with well--for the Government to seek to improve the quality of fertility provision. We are failing women and men around the country and, as a community, we are paying the price of that failure in their depressive illnesses.

As the technology and quality of care improve, we have an opportunity to make a difference to such people's lives. We can give more couples access to treatment and improve the quality of it. We can ensure that people are informed about and supported through treatment when they can get it.