In 2018 Deputy Roffey and Deputy Merrett, supported by the patient group Health Equality for All (HEAL), chaired by Mike Read, urged HSC to review their drug and treatment policy policy. A requete was followed by an extensive review and public consultation, the results of which were published in August 2019. The understated magnitude of the situation was succinctly expressed by HSC in the policy letter. They admitted the current policy, “has created significant disparity with England in terms of the range of treatments available to Islanders which has become too great and which the Committee does not consider can be justified.”
The review found that of the 480 NICE TA drugs routinely available in the NHS only 320 were offered here. Clinicians are able to make an individual funding request, on a case by case basis, for the 160 unavailable treatments, however the review found that of the 43 requests that had been made none had received approval or the required funding.
Shockingly the review also told us that as of the end of 2018 almost 4000 patients were receiving a sub-optimal treatment, with 700 additional patients expected each year. A significant proportion of these patients will not know a better treatment is available. They haven’t been told because they can’t afford to pay, and that knowledge would only be cruel. Those that find out are often left with incredibly tough decisions, including having to leave the Island, debt, charity or all to often, just accepting that their life has less value than others in Guernsey.
Conversely, if you can afford to pay or have the right health insurance you are likely to be offered the additional treatment options and consequently likely to have a more positive outcome, with an extended period of better quality life.
HSC brought their policy letter to the States in January 2020. In an unusually short debate, particularly for such an extensive set of propositions, it was voted through 38/1 unamended. The propositions committed HSC to a phased introduction of 93 of the 160 NICE TAs over a 2 year period. The Guernsey Health Reserve (GHR) was identified as the funding source. The States were advised it had £120m of reserves.
The year one implementation cost is £5.6m and year two £8.3m. A review will follow to examine its impact, future funding options and whether Guernsey should extend treatment to include all NICE TAs. A pragmatic Guernsey compromise. Importantly HSC also tell us that this investment is the catalyst for far wider benefits to improve patient care and efficiency of service delivery, that extend far beyond the 4000 identified in the review.
In September 2019, a year on from the publication of the review and 9 months on from the States approving the change the policy is yet to be implemented.