Should we be spending more?

This is most prevalent in respect of cancer, but I have also been made aware of similar arising over both cardiac and pulmonary conditions.

This divergence of policy between the UK and Guernsey is a newish development, although I’m told by HSC that it actually started some years ago. Understandably it is causing huge upset among those directly affected and their families, although human nature is such that it hasn’t really registered on the political radar of the rest of the population.

No one knows better than I the challenges facing a health department trying to stay within a fixed budget when the demands on that budget are almost infinite, especially when nearly all of those demands could validly be described as falling within the ‘need’ rather than ‘want’ category. So the purpose of this column is certainly not to throw stones at HSC, but I do think that something so profound is going on in terms of Guernsey’s health care policy that the whole island needs to understand and debate it.

Put simply, some years ago if a drug was approved by Nice [National Institute for Health and Care Excellence] for funding by the NHS then it was automatically put on Guernsey’s white list and funded here too. On top of that, the local clinical committee would consider occasional applications to funds extra drugs which were not Nice-approved.

The logic was that Nice had huge teams of clinicians, academics and health economists working for them and could carry out such assessments far more rigorously than anybody in Guernsey. Not only that but because they appeared to be quite niggardly, often approving new drugs years later than other countries, they were deemed to be a pretty effective gatekeeper.

Now we have moved to the other side of that equation. Instead of white listing all Nice-approved drugs and a few more, we are instead funding a smaller list of drugs than the UK.

In terms of the availability/funding of drugs (and I must stress only in this respect) Guernsey has gone from NHS-plus to NHS-minus.

This gives rise to three obvious questions.

1. Is Nice, and therefore the NHS, being too open-handed in their funding of drugs?

2. Is Guernsey being too restrictive?

3. Even if it is the UK which is getting it wrong, how sustainable is it for the local drug funding policy to diverge further and further from theirs when our patients are referred to tertiary hospitals on the mainland, lie in wards next to UK patients with identical conditions and are treated by the same specialists?

Let me try to answer those three questions one at a time, but always bearing in mind that I am a complete layman with no clinical expertise at all, albeit that over recent months I have received views on this issue from leading clinicians both here and in the UK.

Firstly, is the UK being too generous in funding drugs?

Having spoken to one of HSC’s local advisors in this area I have no doubt that that is the committee’s stance. They could be right.

Personally I find that very hard to reconcile with the very parsimonious approach I remember Nice taking a decade or two back, but I suppose it is just conceivable that a leopard could change its spots.

It is also hard to square with the fact that many of those Nice-approved drugs which are refused funding over here were approved in other countries even sooner than the UK.

Certainly the NHS itself would not lean towards largesse given its well-publicised funding problems, but my understanding is that they have no choice but to fund drugs once they are Nice-approved.

So it could be argued that a drug policy which is too open-handed is skewing the NHS budget and starving other areas of UK health care of funds.

Is Guernsey being too tight on drug expenditure?

This is really the other side of the same coin. One thing is certain, though – we can only defend our current policy on the basis that Nice is getting it all hopelessly wrong and being too willing to approve drugs.

However tight our local health budget might be, we can hardly argue that it is in a worse condition than that of the NHS. If it is that, it really needs to be highlighted and addressed pronto.

Perhaps the third question is the most important. Even if we accept (for the sake of argument) that Nice is being too generous, and Guernsey’s policy is spot on, how much divergence is acceptable?

If we were a country of five million souls with a completely separate health care system, maybe. But it becomes far more problematic when we send many of those with serious condition to be treated in NHS hospitals.

Is it sustainable for consultants in Southampton, London or wherever to treat their Guernsey patients differently to their UK ones? To prescribe the patient from Bournemouth a drug which they consider to be in that patient’s best interest, knowing it will be funded by the NHS, but to deny the Guernsey patient in the next bed the same drug treatment because they know it won’t be funded by the States?

Maybe it can be defended as a harsh but entirely logical policy which protects other areas of health spending in Guernsey from unnecessary cuts. Maybe it is sustainable in the long term, but frankly I really, really doubt it.

One thing I am certain of, though, is that the policy will have such a profound effect on some of the most vulnerable islanders with serious health conditions that it really needs to be debated both by the States and the wider community.