Financial pressures on the National Health Service have already led to a small number of fee changes being proposed to Health & Social Care which would push up States’ costs by hundreds of thousands of pounds a year.
NHS Trusts are now understood to be carrying out a complete review of their services to local patients, with Health & Social Care warning that the loss of Guernsey’s favourable funding arrangement has the potential to increase the States’ costs by millions of pounds a year.
Senior politicians and officials locally will do all they can to keep costs as low as possible, but fear that inflation-busting increases are now more likely than not.
‘It is believed, but this is not confirmed, that the Channel Islands’ arrangements are being reviewed by NHS Trusts to ensure that they are commercially viable for the trusts,’ said HSC president George Oswald.
‘The discussions to date have been for specific elements, such as particular consumables and any visiting services. However, any change will increase financial pressures and could expand in terms of application.
‘The matter has been escalated to the States’ external relations team, who will liaise with the UK Department of Health on this matter as appropriate.’
The States spent £19.6m. in 2025 funding off-island healthcare, primarily for tertiary services unavailable locally. That was an increase of 9% on the previous year, even without the prospective fee hikes now under consideration.
Just over £14m., approximately three-quarters of the total, was spent on procedures and treatment, mainly to NHS Trusts, but also to a small number of other providers. About £5.4m. was spent on travel and accommodation costs, including the medevac air service.
The current costs are favourable to the island through a reciprocal health agreement signed three years ago which applies standard NHS tariffs to States patients, without any uplift for them coming from outside the UK.
The Guernsey Press asked questions of HSC after Deputy Oswald told the States Assembly last week that there was uncertainty about the island’s arrangements with the NHS. He asked deputies to consider whether such expenditure should be treated as exceptional if they approved proposals for a real-terms spending freeze across the States over the next three years.
Asked to provide an indication of the additional costs Guernsey could face, Deputy Oswald said: ‘For the existing proposed changes, they are estimated at hundreds of thousands of pounds, but with the potential to come millions of pounds per year if there is any expansion of focus or application.’
The States funds more than 2,000 Guernsey residents each year who require healthcare in the UK which is not available locally. About 80% of the expenditure on procedures and treatment, worth £11.2m. a year, is with Southampton NHS Trust.
Deputy Oswald was concerned that the island’s current arrangements could be changed at relatively short notice.
‘Under the reciprocal health care arrangement, an NHS Trust can decline referrals if they have concerns with the impact on their capacity,’ he said.
‘We would work with our off-island partners to agree a reasonable period that enables us to find an alternative provider for our patients in such a scenario. Where we have changed providers in the past, we worked around a transition within six months.’