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Out of hours charges for cancer care "a huge backwards step"

Out of hours charges for cancer care

Monday 21 November 2022

Out of hours charges for cancer care "a huge backwards step"

Monday 21 November 2022

A senior politician and health campaigners are condemning the introduction of charges for cancer patients who need out of hours treatment at the Princess Elizabeth Hospital.

Patients requiring cancer treatment overnight or at weekends - when Bulstrode Oncology Unit is closed - were previously treated free of charge at the Accident and Emergency Department.

The President of the Committee for Health & Social Care, Deputy Al Brouard, said that cancer patients are now charged for treatment "so that all patients with life-limiting and chronic illnesses are treated the same".

But Deputy Peter Roffey and community groups Health Equality for All (HEAL) and Guernsey Cancer Alliance said the recent introduction of charges amounted to cutting a vital out of hours oncology service.

"This is a cut in service to a vulnerable group of patients dressed up as a move towards equity," said Mike Read, Chair of HEAL, in a statement supported by the Cancer Alliance.

"I am very disappointed by the decision to start charging cancer patients, who are under the care of the Bulstrode Unit, for treatment related to their condition out of hours. I think it is a huge backwards step in providing care for very sick and vulnerable islanders," said Deputy Roffey.


Pictured: Deputy Peter Roffey and community health groups believe that charging cancer patients for out of hours treatment should be seen as a cut in service and not, as the Committee for Health & Social Care has suggested, a move to treat all patients equitably.  

Deputy Roffey wrote to the Committee in September to enquire about charges for cancer patients who require unexpected care out of hours at Accident and Emergency. 

Deputy Brouard recently replied, confirming the introduction of charges, which he said were "fully supported, agreed and ratified by [the Committee's] corporate management team and the Committee prior to their implementation in May of this year".

"In August 2021, when discussing a tariff increase, it was agreed that we needed to ensure that the charging schedules were fair and equitable to all service users in our community," said Deputy Brouard.

"Therefore, the decision was made that in order for all life-limiting and chronic illnesses to be treated the same, attendance charges at the Emergency Department based on the time of day would be waived, but patients would be charged a treatment fee.

"It should be noted that, prior to 1 May 2022, patients with illnesses such as heart disease, kidney failure and respiratory illnesses, such as chronic obstructive pulmonary disease, were fully charged an attendance and a treatment charge, contrasting to oncology patients who were not charged at all."

Deputy Roffey said yesterday that "this policy change is a mistake" and that he intends "to write to the Committee to ask it to reconsider its decision" and "if necessary, request a meeting to discuss the issue".

Deputy Peter Roffey

Pictured: Deputy Peter Roffey hopes to persuade the Committee for Health & Social Care to reverse its decision and scrap out of hours charges recently introduced for cancer patients.

Bulstrode Oncology Unit, which is also in the grounds of the Princess Elizabeth Hospital, continues to provide cancer treatment free at the point of use during normal office hours on weekdays. 

"Secondary care is meant to be free. Where you access medical support at the Princess Elizabeth Hospital as a direct result of that treatment is just geography," said Mr Read of HEAL, supported by the Cancer Alliance.

"The nature of the contracts, and hence charging for these different locations, is not of interest to the patient. They just need access to treatment 24/7 for a limited period of time."

He said "the crux" of the issue was whether a patient had a "need to attend the Emergency Department as a direct result of current secondary care treatment" and added: "If so, there should be no Emergency Department charges regardless of the health condition the patient has...that is truly equitable."


Pictured: Cancer patients still receive treatment at Bulstrode Oncoloy Unit free at the point of use during normal office hours but they must now pay if their treatment requires a visit out of hours to the Accident and Emergency Department.

"Oncology treatment, such as the various forms of chemotherapy, can have quite profound impacts on some patients," said Deputy Roffey. 

"If they react adversely during the working week, they can return to the Bulstrode Unit and receive free care and attention. Hitherto, if this has happened at night, I know it has been a great comfort to be able to access the equivalent service at the Emergency Department.

"The removal of that facility will cause significant issues. For many people, a period of extended cancer treatment is also a time of their lives when their finances take a real hit. The patient may have to give up work. Partners spend cash on accompanying loved ones on appointments in Southampton. It is a challenging and costly time.

"I would hate to think that in future any cancer patient alarmed by the way they are feeling in the evening will have to debate whether or not they can afford to access necessary treatment via the Emergency Department. This has to represent a significant worsening of service provision to cancer patients, however you look at it."

Deputy Roffey was President of Health & Social Care himself in the 2000s and said he realised "that the Committee's budget is under extreme strain" and added: "I’m not seeking to score points off the Committee. I know how difficult their job is. I have been there and bear the scars."

In his written reply to Deputy Roffey, Deputy Brouard suggested that his Committee had to use its limited budget as equitably and efficiently as possible.

"Whilst we recognise that many would support a National Health Service free at the point of delivery and access for all, this would require a fundamental shift in funding mechanisms, which is not how we are structured at this point in time," said Deputy Brouard.

Health & Social Care Committee

Pictured: The Committee for Health & Social Care said that out of hours charges for cancer patients were introduced to bring them into line with out of hours charges for patients with other conditions.

Express recently reported on other pressures on the island's health and social care services.

Community care is being reduced for 55 adults and withdrawn completely from seven.

The Committee said that domiciliary care services were under intense pressure from a combination of staff shortages, increasing demand and greater complexity of care required by the island's ageing population.

Meanwhile, around four out of every 10 gastroenterology patients are waiting longer than six months for a procedure or appointment they need with a specialist.

Only one in five patients is being seen within eight weeks – the waiting time expected under the States' secondary health insurance scheme. Hundreds of patients are affected: 75 patients have been waiting longer than six months for an appointment, 159 have been waiting longer than six months for a procedure or operation, and more than 300 others have been waiting between eight weeks and six months.

The Committee said waiting times were down to increased demand, lack of specialist staff and disruption caused by the covid-19 pandemic.


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Posted by Steve Simon on
The committee should hold their heads in shame and resign, people going through cancer should be cared for not having to worry how they can afford treatment
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