The question we should ask is: ‘How much money do we want to provide for health and social care?’

In his interesting article he asked three questions in relation to the expenditure on drugs and treatments. The first two, ‘Is the UK being too generous in funding drugs?’ and ‘Is Guernsey being too tight on drug expenditure?’ are, as he acknowledged, the flip sides of the same coin. Who’s got the policy right?

In terms of the UK, the National Institute for Health and Care Excellence, delightfully known as Nice, is the body that determines what drugs can be prescribed in the UK and the NHS has to follow its recommendations. The crucial point here is that the former doesn’t have a health budget to manage, but the NHS does. The consequence, over recent years, has been that money which may have been better spent elsewhere, such as primary care and mental health services, has been diverted towards a growing drugs bill. Indeed, the huge financial pressures that the NHS has been under recently have resulted in changes in policy to enable the NHS to manage the introduction of new drugs to minimise the impact on its budget.

As far as Guernsey is concerned, the current drugs and treatments policy (known as Policy G1033: Priority Setting in Health and Social Care) has basically evolved over the seven years since Zero-10, through the FTP and the realities of a budget deficit since 2011. It is pretty comprehensive and the latest version can be found online at https://www.gov.gg/fundingprioritisation. It attempts to treat everyone equally, so someone with a particular condition is not treated any more favourably than anyone else. In other words, it seeks to ensure a fair allocation of spending, acknowledging there will always be finite resources.

And this leads me to Deputy Roffey’s third and last question: ‘How much divergence is acceptable?’ This is a perfectly valid point to make, although does assume that the UK policy won’t change and, with all the uncertainties surrounding Brexit and the access to drugs once the UK leaves the EU, that might be considered a rather optimistic view. It also implies that everyone, wherever they live in the UK, will be able to access all Nice-approved drugs, which is certainly not the case. A postcode lottery really does exist and was most recently highlighted by an All Party Parliamentary Group on Breast Cancer in February this year which showed that women can be more than twice as likely to die prematurely from breast cancer than others depending on where they live.

However, putting that aside, whether or not the gap is something we are happy with is a question that the current committee has been asking and to which it wants to give proper consideration. And while not referenced in the article, I should make clear here that we have already agreed to undertake a review. That’s not just me saying it either. We have it in black and white in our policy letter, ‘A Partnership of Purpose: Transforming Bailiwick Health and Care’, which received unanimous support from the Assembly in December last year.

As part of this process, we have begun to review the access to drugs for people being treated in the UK and who require ongoing drugs when they return, as well as to model the potential financial impact were we to follow Nice guidelines. We also intend to beef up this proposition when we debate the Policy & Resource Plan in June.

But of course, that is all very well and good. It is almost inevitable that, were we to follow Nice guidance automatically, the budget for drugs and treatments would need to increase and that leads me to the fundamental question that was not raised, but which we should be asking ourselves – ‘How much more money do we want to provide for health and care?’

I think it is important to clarify at this point how drugs and treatments are currently funded and who is responsible. It will probably surprise many to know that, while Health & Social Care spend around £3m. each year from General Revenue, this is only for those drugs used at the PEH. The majority of the expenditure, approximately £17m., represents drugs prescribed in the community and is controlled by the Committee for Employment & Social Security and paid for from the Guernsey Health Service Fund. We are currently working with that committee to transfer the responsibility to Health & Social Care, but the important point to note here is that, contrary to what has been implied elsewhere, recent general revenue savings achieved by Health & Social Care have not been made by restricting access to drugs.

However, that aside, whatever pot is used, the funds will need to be found somewhere. The Committee for Health & Social Care has spent the last two years achieving system grip and putting in place a process of continual service improvement. However, modelling done for our policy letter suggests that public spending on health and care will increase in real terms from £193m. to £214m. by 2027 if nothing changes in the way that health and care is provided. Even with fundamental transformation, there is still likely to be a funding gap of between £3m. to £12m. per annum as a result of an ageing population, medical inflation and high expectations.

We are already seeing it happen – winter pressures this year have been unprecedented and impacted not just the hospital, but also our community services. In the first three months of 2018, St John’s Ambulance and Rescue Service has seen a 10% increase in demand compared to the same time last year, with the highest number of call-outs related to patients between 79 and 82. Other partner services have also reported growing demand. This is the reality of the situation we face.

The Committee for Health & Social Care is determined to provide fairer access to primary care. It is a key principle of the Partnership of Purpose and a priority piece of work we have set ourselves for the rest of this term. This too is something I know Deputy Roffey believes in passionately. We don’t want people put off going to the doctor because of the cost and the truth is that cancer survival is much more improved through early diagnosis than drugs. It too will come at a cost, but long term should help enhance sustainability and outcomes.

So, should we be putting money into making primary care free at the point of delivery, or increasing the number of drugs available? Or both? This is the debate we now need to be having and asking ourselves, not ‘should we spend more?’ but, if we want to continue to have a health and care service that enables average life expectancy to remain in the top 10 in the world, ‘how much more are we willing to pay?’

DEPUTY HEIDI SOULSBY,

President,

Committee for Health & Social Care.