Not a Nice place to be without health insurance

Nice, with its expertise, defines services and offers evidence-based recommendations for the UK. Surely Guernsey can reach the low level of funding of the NHS. This island’s GDP per capita in 2016 was 57 per cent greater than in the UK and 14 per cent greater than Jersey GVA per capita. (Source: States of Guernsey Annual GVA and GDP Bulletin 2016, published December 2017). Remember that the UK spends less of its GDP on health than our neighbours do, such as France or Germany. Guernsey is an affluent jurisdiction, so why are we not spending more on health care?

Yes, budgets are tight but in March 2018, a report in the Guernsey Press stated that Health & Social Care underspent its budget by approximately £2.5m. despite earlier returning £2m. to general revenue as a recurring saving. What are the values that underpin such decisions? It seems that the medical practitioners are being hampered in their excellent work by the policies of the States.

HSC says providing Nice-approved drugs will distort provision and that early detection provides better outcomes. At times the HSC has presented this as an either/or choice. My experience and the reality has been neither/nor. Timely diagnosis denied because the test was not ‘in the contract’ with the MSG for those without private health insurance. So months lost before the tests became unavoidable, followed by a cancer diagnosis. Valuable time lost.

Now the oncologist advises that for the next stage of treatment that there are two drugs, and a further one anticipated, on the Nice list to treat this type of cancer, but not one of these is available in Guernsey through the States. This is not a good place to be without private health insurance.

Having read the HSC drugs and treatment policy (Policy G1033) it is clear that treatments recommended by the Nice technology appraisal programme will not automatically be funded. Furthermore, treatments whose cost-effectiveness is estimated to be above £30,000 per quality adjusted life year will not be funded, unless exceptional circumstances apply. My understanding is that the UK and Jersey both use a value of £50,000 per quality adjusted life year. A further limitation on accessing treatments in Guernsey is the very restrictive reapplication period. In the UK, repeated reapplication is permissible.

Budgets are important. Nevertheless, it is disingenuous for the HSC to say that the current budget has evolved over seven years since zero-10 through the FTP and the realities of the budget deficit since 2011. The £30,000 figure per quality adjusted life year, set in 2011, needs to be increased immediately. HSC must challenge the total budget available in this affluent jurisdiction with a GDP/GVA per capita that is higher than that of the UK or Jersey.

The public debate should have taken place before the abandonment of the Nice guidelines, which most of us would not have known about without the question raised, by Deputy Roffey, in the States in February 2018.

A review of health priorities is promised, but when will it be finished? In Deputy Heidi Soulsby’s answer to Deputy Peter Roffey at the States meeting 28 February 2018, she said that it was anticipated to be completed this term. This vagueness is not satisfactory. Surely, in a mature democracy, this low funding level should be a topic for urgent public debate. Are we prepared to pay more or make savings in other areas to have health outcomes in line with the P&R aspiration of the healthiest place in the world?

It is not acceptable for this review to be left until the next States term. That is a lifetime for some people if denied drugs and procedures they need. A clear commitment to consultation and a publication date for the report is urgently required.

Health provision is important us all. What is concerning is that the HSC appears not to be fighting on our behalf, nor does it seem to aspire to obtain the necessary budget to address need. Instead, they are conforming to budget cuts and constraints without informing the public of the impact of the reduction in provision since Nice guidelines were abandoned.

The public needs to support HSC in calling for an immediate debate on ‘how much more are we willing to pay?’ in order to obtain the budget to provide the health service that islanders deserve.

SUE RYDE,

Address withheld.

Editor’s note: The HSC response to this letter will follow at a later date.