1. Tuesday 5 th May 2009 St Martin’s Community Centre Deputy Hunter Adam, Health & Social Services Minister Jim Harley, Director of Finance, Health & Social Services Department

2. Reciprocal Health Agreement The Reciprocal Health Agreement between United Kingdom and Isle of Man on the one hand and the Channel Islands on the other has been in existence since 1976 The original intention of the convention was that, if the healthcare activity between both sides of the agreement were broadly in balance, no money would change hands As tourism to the Guernsey dropped, the number of visitors from the United Kingdom to Guernsey declined, whilst the number of patients referred to the United Kingdom for treatment increased, primarily as a result of the medical specialisms that could not be attended to on island due primarily to diseconomies of scale

3. Reciprocal Health Agreement  These include, but are not exclusively related to, the following services:- Cancer services Cardiac / cardiology services Renal services Paediatric neo-natology services

4. Reciprocal Health Agreement As this imbalance in referral patterns increased, Guernsey entered into direct contractual arrangements with Southampton University Hospitals NHS Trusts and increasingly other NHS Trusts, including Guys and St Thomas’s NHS Foundation Trust, to put the arrangement back into financial balance Indeed the above two hospitals account for approximately 80%, in value terms, of the cash value of contracts that the Health and Social Services Department now has with NHS Trusts in the United Kingdom

5. Reciprocal Health Agreement As a result, in recent times, the Reciprocal Health Agreement has become more focused on those services that the Health and Social Services Department did not have direct cash contracts in place with with various other NHS trusts in the United Kingdom, which were then compared to the costs of treating United Kingdom visitors in Guernsey In 2008, the UK Department of Health announced that it was reviewing all bilateral agreements with various jurisdictions around the world, including the Channel Islands, with a view to phasing these out as, in their opinion, they no longer constituted value for money to the UK tax payer

6. Reciprocal Health Agreement Notice Period In line with the terms of the Reciprocal Health Agreement, the United Kingdom gave Guernsey three months notice of its intention to withdraw from the agreement. This was received in January and the notice period meant that the agreement would cease to exist at the end of March 2009.

7. Need for Medical / Travel insurance As from 1 st April 2009, Bailiwick residents are strongly advised to take out suitable travel / travel insurance for themselves and anyone travelling with them to cover the costs of healthcare interventions arising whilst in the United Kingdom on business or pleasure, as these will now be chargeable services to individuals by the NHS Trusts Insurance policies are available from insurance companies, brokers, banks and travel agents.

8. Need for Medical / Travel insurance Similarly, you are strongly advised to seek a policy that also covers the cost of repatriation from the United Kingdom back to Guernsey, as this too will be a cost that the individual, rather than the Health and Social Services Department or Social Security Department, will be expected to meet and such repatriations, including medical escorts, can be very expensive.

9. Exemptions There are several exceptions to this revised policy, the most notable of which are as follows:- Treatment provided in an Accident and Emergency Department in an NHS Trust or walk in centre, which ceases upon the patient occupying a hospital bed Treatment provided by a GP for immediately necessary treatment. Family planning services Treatment for certain contagious diseases Treatment for sexually transmitted diseases (NB HIV is not included except for initial diagnostic testing and associated counseling) Compulsory psychiatric treatment

10. Exemptions There are also a wider range of more specific exemptions including the following:- Those engaging in employment with an employer who has his principal place of business in the UK or is registered in the UK as a branch of an overseas company, or who are engaging in employment as a self employed person whose principal place of business is in the UK. Those pursuing a full time course of study, which is of at least six months duration.

11. Exemptions Those in receipt of a UK State Pension, providing they lived in the UK for ten continuous years or more at some point in the past. This exemption extends to the spouse, partner (including civil partner) and child (if under 16 or under 19 if in full time education), visiting the UK with the exempt UK State pensioner. Those who have at any time had not less than ten years continuous lawful residence in the UK and are employed or self employed in the Bailiwick for less than five years. It will be for those who are claiming exemption from charge on any of the above grounds to provide evidence that they are entitled to exemption. If they do not, they will be charged.

12. Referrals from Medical Specialist Group It should be stressed, however, that referrals made directly by a Consultant from the Medical Specialist Group to NHS Trusts in the United Kingdom will continue to be funded by the Health and Social Services Department. Similarly, any travel associated with attending for outpatient or inpatient treatment at NHS Trusts in the United Kingdom associated with the above direct Medical Specialist Group referrals will be funded by the Social Security Department.

13. Need for Medical / Travel Insurance Most insurance providers have two main risk areas that prevent the provision of medical / travel insurance and these are: Upper age limit Pre existing medical conditions

14. Need for Medical / Travel Insurance In addition, due the previous existence of the Reciprocal Health Agreement, the vast majority of such insurance policies specifically excluded stays in the United Kingdom, as any treatment required whilst in the United Kingdom to policy holders would have been covered under the Reciprocal Health Agreement This situation has now changed and contact has been made with the Guernsey Financial Services Commission, which regulates insurance brokers on the island, to ensure that brokers and others involved in providing medical / travel insurance revise their policies accordingly

15. Need for Medical / Travel Insurance Evidence is in place that some local providers have been receptive to such changes (e.g.) Network Direct Others have been in dialogue with the Health and Social Services Department, thereby indicating that they have, or are in the process of, making changes to their policy arrangements (e.g.) Rossboroughs, Insurance Corporation of the Channel Islands

16. Need for Medical / Travel Insurance Other policies are specifically available via local travel agents (e.g.) Wayfarers offer a reasonably inexpensive policy through travel booked with them, which has an upper age limit of 80 and excludes pre existing medical conditions There has also been a recent mail drop by Natwest offering travel insurance at approximately £9 per month but it is not known at this stage what terms and conditions might be attached to this policy There are other providers of insurance that cater for more elderly travellers (e.g.) Saga

17. Insurance Exemptions The above noted, the general feeling is that insurance for those who are elderly or have a pre existing medical condition will either be difficult to source or will carry a substantial policy premium You are advised to check with your medical / travel insurance provider to ensure that it contains cover for treatment received in the United Kingdom, otherwise you will be liable for charges from the NHS Trust providing treatment

18. General enquiries in the United Kingdom If you have any questions relating to information on charges and exemptions, please contact the United Kingdom Department of Health Customer Service Centre on 0207 210 4850 E-mail: dhmail@dh.gsi.gov.uk Website: http://www.nhs.uk/countryguidance/ Non EEA countries European Health Insurance Card (E.H.I.C) Enquiries: 0845 606 2030

19. General enquiries in Guernsey Off Island Acute Care Manager Health & Social Services Department Corporate Headquarters Rue Mignot St Andrew’s Guernsey GY6 8TW Telephone: 01481 725241 Extension: 4711

20. Any Questions?