July 21, 2021
NICE TAs have tried to have the breaks put on by the Government Work Plan (GWP) but an amendment by Deputies Peter Roffey and Lester Queripel has been carried by the States over a late amendment by Policy and Resources. This means that the project to bring Guernsey into line with the NHS and Jersey for these drugs and medicines will continue as originally planed.
Mike Reed, the Chair of HEAL and the GDAs health representative, has led a strong campaign to ensure that these drugs and medicines will be available in future and now needs GDA members support to help keep this project on track.
Read how this went through the States and Mike’s request below.
Request to GDA Members
28th July 2021
In January last year, after a public consultation and detailed review, the States acknowledged that the disparity in the availability of drugs and treatments (NICE TAs) between ourselves and the NHS was now too great to be justified. They voted to begin the process of closing this treatment gap by phasing in new drugs with a certain cost effectiveness value in year 1 and a higher value in year 2, followed by a review.
Last week the States debated the GWP. A significant period was spent discussing Policy & Resources proposals to make the promised 2 year rollout of NICE TAs subject to a new review at the end of year 1 rather than at the end of the second year. As a minimum this would introduce a delay to the introduction of the next level of treatments (mostly cancer drugs) but more likely stop implementation of year 2 indefinitely.
An amendment was laid by Deputy Roffey and Deputy Queripel committing the States to maintaining the original proposals, at least for the moment. Despite a counter amendment by Deputies Soulsby and Ferbrache the Roffey/Queripel amendment was successful. This was an unexpected but encouraging decision.
On the 22nd July the Guernsey Press printed a headline that said, “HEALTH will be at the centre of our economic growth.” Deputy Soulsby was reported as saying, “Now this is about prevention, early intervention and those wider determinants of health which will make islanders’ lives better.” This is also an encouraging but longer term commitment to solve important systemic problems that have not been addressed by government so far. However, the wider determinants of health involve committing resources to housing, mental health and education, putting pressure once again on immediate health concerns, particularly the cost of new drugs and treatments.
The NICE TA review also highlighted the deep inequality within our health system, where thousands of ordinary islanders are being offered a more limited set of cheaper treatment pathways for numerous serious life changing health conditions. It also made clear, but is still not widely appreciated, that your ability to pay makes available a completely different set of treatment pathways, often leading to much better outcomes and quality of life. Treatment pathways that are routinely available to everyone in Jersey and to all NHS patients. In other words wealth equals better health outcomes in Guernsey.
So far we have been able to argue that the additional £3 million per annum it will cost to implement the NICE TA policy in full is worth spending and that expanding treatment provision to match more closely that of neighbouring jurisdictions is a worthy aim. However, pressure is increasing and the cost of providing for your health is already being blamed for the tax rises threatened so recently. It is interesting to note that it will cost £10 million alone to service the interest on the debt that was approved within the GWP for future capital projects. A debt the States has yet to make a decision on how it will raise the necessary revenues over the next 40 years to repay.
Without your support, without your personal health stories and the evidence they provide it is difficult to continue to hold States members to account for their words and the commitments made by the States as a whole. In the absence of an obvious and effective public patient voice, we are determined that those using our health and social care services are represented and heard throughout this term.
GDA Health Rep
Chair Health Equality for All
Representation from HEAL on NICE TAs
HEAL Chairperson and GDA Health representative Mike Read has written to all States Members in support of amendment 1 laid by Deputy Roffey and seconded by Deputy Queripel on the NICE TAs see his email:
I am writing to you today with what I hope is a more cogent less emotive email, expressing other concerns around Amendment 12 that have not as yet been answered by Heidi or in the debate so far. I am hoping members of HSC yet to speak will raise some of them. I hope you can support Amendment 1.
– It is our understanding that only Amendment 1 retains Proposition One of the ‘Review of the Funding of Drugs, Treatments & Devices’, which as you may recall says;
- To agree, in principle, that the States of Guernsey should adopt, on a non statutory basis, a policy of funding drugs and treatments in receipt of a Technology Appraisal from the National Institute for Health and Care Excellence, including those drugs approved for funding from the Cancer Drug Fund.
Our interpretation of this is that it speaks to a desire or aspiration by the States to go beyond the £40k ICER level, if and when circumstances allow, and offer the same provision as the NHS. Amendment 12 limits that aspiration to NICE TAs with an ICER up to £40,000 and even then only after a review. Giving up on the aspiration within Proposition One risks putting us back in the same position we found ourselves in at the time of the Roffey Requete in 5 -10 years time.
– It is also our understanding that the propositions were phased over 2 years to allow the necessary investment in the work around the PEH pharmacy, Bulstrode and laboratory services, increasing capacity to administer more infusions, including new scheduling and pharmacy management software and staff recruitment to take place, allowing HSC to seamlessly move into year 2 and NICE TAs with an ICER up to £40,000.
If we accept Amendment 12 why would that investment, that ground work, in anticipation of year 2 take place? It would be far from certain it would be required. At best, if the new review (which will take time) confirmed the need to move beyond NICE TAs with an ICER up to £30,000 then we are introducing significant delays in being able to provide the next tranche of drugs and treatments.
– By implication if investment in year 1 is limited or held back due to the uncertainty surrounding the outcome of the new review and the uncertainty of whether the States will actually approve any recommendations coming from it, then the estimated costs for year 1 will be wrong.
– At 9.22 on page 27 of the NICE TA Review HSC said, “these investments will have wider benefits to improve patient care and efficiency of service delivery that extend beyond those receiving new treatments.” This also includes but is not limited to benefits for palliative care and respiratory services.
– Health inflation. Again our understanding is that by limiting us to only a £30,000 ICER, the value of that cap will be materially eroded, even over the term of this States.
– Finally, as Deputy St Pier suggested, what has actually changed since the decision was made in January 2020? The outcome of the Taxation Review was always required to determine longer term funding and the level of provision for ALL public services. Tough decision still have to be made and NICE TAs may be a casualty at that time.
As we heard in an earlier debate, the GWP is a living document and will come back to the States in June 2022. If the CfHSC can not deliver tranche 2, if the economy has not recovered as hoped, if the States can not raise additional revenues through taxation, if the actual costs of tranche 1 are materially different from expected, then you can change the plan, in fact it is expected that the plan will have to adapt.
Voting for Amendment 1 leaves the States and the CfHSC with all its options open, to react when necessary.
With kind regards
An amendment has been laid to the GWP by Deputy Roffey seconded by Deputy Queripel to stick to the original States’ resolutions on funding the NICE TAs and to ensure that the review of the future funding ceiling only after drugs with an incremental cost-effectiveness ratio (ICER) of £40,000 per year had been funded. For this amendment click here.
As well as the above amendment a late amendment has been proposed by Deputy Soulsby, the author of the GWP, and Deputy Ferbrache. This amendment proposes that a review is undertaken before drugs with an ICER of £40,000 meaning the implementation of these drugs will be delayed and potentially not providing for sufficient infrastructure. For this amendment click here.
How the States Voted
Amendment 1 laid by Deputy Roffey seconded by Deputy Queripel:
CARRIED: Pour: 21 Contre: 17 Ne vote pas: 0 Absent: 1
For more detail of who voted which way press the button below.
Amendment 12 proposed by Deputy Soulsby and seconded by Deputy Ferbrache:
LOST: Pour: 17 Contre: 20 Ne vote pas: 1 Absent: 1
For more detail of who voted which way press the button below.
What the Media Said
The Bailiwick Express has reported on the NICE TAs decision and the article can be read by clicking the following button:
The Guernsey Press has also provided articles both before and after the debate. Click on the following button to go to the article published after the debate:
Oscar Pearson of BBC Radio Guernsey also interviewed Mike Read Chair of HEAL on 23rd July 2021 at just after 7:30 am. This is available for 29 days if you want to listen go to the BBC website at Oscar Pearson – 23/07 – The Olympics & entrepreneurship – BBC Sounds