As a patient group that was involved in the consultation process, Health Equality for All (HEAL), feel it important to add some non-political public perspective on the Policy & Resources letter of comment to the Health and Social Care policy letter, “Review of Funding of Drugs, Treatments & Devices,” ahead of the States debate this week.
It is reassuring that P&R accept HSC’s analysis that the disparity with England has become too great to be justifiable, and agree with HSC that a phased introduction of the most cost effective drugs, treatments and devices, reviewed after two years, is a pragmatic Guernsey compromise.
Disappointingly P&R also say, “Whilst achieving parity of provision with the UK and Jersey is undoubtedly attractive, it must be considered whether this decision is appropriate for Guernsey”. The presumption appears to be that it is not in our best interest, for our health service, to provide the same base level of drug and treatment provision as the NHS, Jersey or indeed as we once did. You may draw a different conclusion but for us this seems far from equitable, morally questionable and appears to contradict the very essence of the P&R vision for Guernsey of becoming the happiest and healthiest place in the World.
P&R glibly highlight the fact that many of these drugs are not life-saving treatments. Fortunately HSC paint the full picture in their comprehensive evidence based policy letter, telling us they may not all be life saving but many are life extending. In addition, many of these newer treatments also have the effect of reducing uncomfortable and unpleasant side effects enabling patients to maintain a greater quality of life, in the time they have left. In the case of the latest Cystic Fibrosis drugs that potentially means adding decades of quality life to our young adults, young adults who can then go on to contribute economically to our Island and our community.
It should not be forgotten that currently we have some 4000 local residents who have been identified as not getting the drugs or treatments Jersey or the NHS would recommend as the optimum treatment for their condition. If HSC’s policy letter is approved the unseen social, economic, mental health and wellbeing benefits to patients and their carers will be significant and is not considered or accounted for in the headline costs.
The headline costs are material and come with consequences, as P&R rightly point out, however let’s add some perspective.
In year 1 the cost to the tax payer will be £5.6m, benefitting 3129 patients, over 80% of the total number possible. As of June 2019 we had 31544 employed/self-employed tax payers. Some basic maths tells us that the cost to each tax payer is 49 pence a day, yet we think nothing of spending £2.50 on a Costa coffee every day.
In year 2 including the next tier of cost effective drugs and treatments means the cost rises to £8.3m, now benefitting a total of 3751 patients, over 90% of those currently on a sub-optimal treatment. The cost to the 31544 tax payers is now 72 pence a day. The chance of one of those 3751 patients being one of those tax payers immediate family is very significant indeed. Who wouldn’t be prepared to pay an extra 72 pence per day for the piece of mind that brings, or indeed £1.05, the extra per day it would cost to include the final 8% of patients, many of them children, who will suffer from the rarest and usually most expensive conditions to treat. Is achieving parity of provision with England and Jersey so out of reach that we should dismiss it so casually?
Finally it is worth emphasising two important points within HSC’s policy letter.
1. The ability to include non-NICE Technology Appraisal (TA) drugs within drug funding policy will be retained to ensure best value for money. Unlike the NHS, this allows HSC to identify and source cheaper generic drugs where appropriate to achieve the same health outcomes.
2. In a strategic context this policy letter aligns with key aims within HSC’s vision for health care ‘Partnership of Purpose’, primarily, Fair Access to Care: ensuring that low income is not a barrier to health. The CfHSC rightly draw our attention to the current inequality within our system where ability to pay has a material effect on your quality of health and indeed your final health outcome, for any given condition. This has to change.
HEAL fully support the HSC policy letter and would urge deputies to speak up during debate and commit to a policy of full drug and treatment parity with England and Jersey by the end of 2024.
Health Equality for All
Health Representative for the GDA