This page provides information on how HSC makes decisions concerning the funding of services and treatments.
Prioritising funding for Health and Social Care
- There are challenges ahead in terms of funding care and the HSC aims to further develop its decision making with respect to the patient and public engagement on these issues but this will take time. The first step is to make more transparent the decisions that are being taken.
- What services and treatments are available;
- Who can receive a treatment or a service by limiting access to those who are most likely to benefit the most;
- How much care is provided to patients for example number of physiotherapy sessions;
- The quality of the care that is provided; and
- Limits on the choice of provider.
- The HSC receives an annual budget to carry out these responsibilities. However the need and demand for health and social care exceeds funding available to meet that need. The States of Guernsey is not unique in facing these issues; they are challenges faced by all countries regardless of how care is funded and to what level. As a result, the HSC will need to continue to make difficult choices between competing needs. This necessarily results in a restriction of treatments and services that are made available. This may mean limits are placed on:
- Promoting, protecting and improving personal, environmental and public health;
- Preventing or diagnosing and treating illness, disease and disability;
- Caring for the sick, old, infirm and those with disabilities; and
- Providing a range of social services to all age groups including ensuring the welfare and protection of children, young people and their families and ensuring that the best interests of the child will be a primary consideration.
- Health and Social Care (HSC) is responsible to the States of Guernsey for the health and social well-being of the people of Guernsey and Alderney. These responsibilities include:
Individual Funding Requests
- Health and Social Care has responsibility for funding certain elements of health care. The HSC is not able to meet every health care need and as such has made decisions about what treatment and services to fund and not fund based on available resources and competing demands. The HSC is striving to make available on this website which treatments are funded and which are not.
- What are the options for patients and clinicians if a treatment is not funded?
- HSC recognises that there will always need to be a process for considering and making additional funding available for the individual needs of a patient. The HSC has an Individual Funding Request Process to perform this function.
- The following points set out some of the key guiding principles for our Individual Funding Request Panel:
Key Points Clinical need Your hospital consultant must provide evidence about your clinical need when submitting your application using their clinical judgement Evidence of clinical and cost effectiveness Evidence is required to demonstrate the clinical and cost effectiveness of the treatment, drug, operation or referral. The proposed treatment must be the most cost effective option that meets your clinical needs Exceptionality There must be an exceptional reason as to why you need to be treated over and above other patients with similar conditions, for whom treatment is not available. In the case of experimental treatments, the Panel need to consider whether there are grounds to make a treatment available outside of a clinical study
- Clinical trials
- The Individual Funding Request Panel also considers requests to enter patients into clinical trials when HSC funding is required. However, given the current financial climate the funding of clinical trials is relatively low priority.
- What is the role of the Individual Funding Request Panel?
- The role of Individual Funding Request Panel is to consider applications for funding for treatments, on a case-by-case basis that fall outside existing contracts.
- How can I access the service and have an application considered?
- To access the Individual Funding Request process, your clinician will need to make an application on your behalf. They should only do this if they are of the view that exceptional circumstances do apply in your particular situation. They may therefore decline your request to make an application.
- Applications should be submitted by clinicians to the Individual Funding Request Panel via our generic email address: Individualfundingrequests@hssd.gov.gg
- Can I challenge a decision made by the funding panel?
- The decision of the Individual Funding Request Panel cannot simply be challenged because you or your clinician disagrees with the outcome.
- If you consider the Individual Funding Request Panel did not follow its own policy or processes, you can ask the HSC to review its decision.
- If there are grounds for appeal, then an Individual Funding Request Review Panel will be convened. The Review Panel checks:
- That the funding panel considered all the evidence provided by your clinician correctly
- Whether new evidence has emerged that was not available at the time your request, which might alter the funding decision
- That the funding panel acted in accordance with the applicable HSC policies
Key policy to support the decision making
- G1033: Priority setting in Health and Social Care is the policy which underpins all the decisions of the HSC which commit funding. This includes decisions relating to individual funding requests.
- The first part of this policy sets out the guiding principles, decision rules and policy statements which guide those making funding decisions within HSC.
- The second part deals with the operational aspects of decision making.
- HSC is a constantly evolving environment which means these policies are continually reviewed and challenged to ensure they are up to date.
Transformation of Healthcare Funding
- The States Assembly has approved legal changes which consolidate the funding of health and care services under the mandate of a single Committee, the Committee for Health & Social Care. Far from being a simple accounting exercise, these changes are designed to support the longer-term transformation of funding to allow increasingly patient-centred care.
- The first important step has been taken by rescinding some of the previous legislation which governed how and when care has traditionally been funded. These will be replaced over time with flexible, published policies which will reflect first-class care in the twenty-first century. While this work is ongoing, islanders access to funded care will be unaffected.
- Eligible islanders will continue to have access to:
- Specialist secondary health care;
- Medical benefit grants for consultations within primary care settings
- Travel expenses when using off-island care providers
- Pharmaceutical benefit and medical appliances.