The UK’s decision to end a 33- year-old reciprocal health agreement with the Channel Islands threw Department of Health officials and ministers into a nine month row, documents obtained by HSJ reveal.

The agreement was supposed to ensure free urgent healthcare for UK residents visiting any of the Channel Islands. However, the DH generally advised visitors to take out travel insurance and now viewed the agreement as an “unjustifiable” cost.

But when health minister Dawn Primarolo wrote to the island’s four separate governments in May last year asking them to propose a date to end the agreement, a barrage of pleas and complaints of “unilateral action” putting patients at risk ensued.

Only Guernsey agreed to the termination, but not until after Ms Primarolo sent the islands a letter serving formal notice, which expressed her annoyance and complained none had proposed a sensible end date.

Sir Norman Browse, president of the states of Alderney, was stirred to remind her that responsibility for the healthcare of its 2,400 population had passed to Guernsey “way back in 1948”.

On 13 August 2008, Jersey health minister Ben Shenton urged Ms Primarolo to note an earlier letter from his chief minister requesting a meeting “to discuss the far-reaching implications of the termination” and asking for reassurance “no unilateral action will be taken”.

Ms Primarolo replied that she had never received that letter, remarking “I can only presume that my private office and indeed this department were never in receipt of this correspondence”.

Ms Primarolo said a meeting would be pointless as “I would only reiterate the messages given”.

Then in December Jersey’s chief minister Terry Le Sueur wrote back, setting out his “deepest concerns” about the UK’s “unilateral termination” via “email ultimatum”.

He said Ms Primarolo’s “reluctance” to meet meant Jersey’s ministers were forced to deal with DH officials whose handling of the matter was “to say the least, quite unsatisfactory”.

The island of Sark was equally angered. Chair of its medical committee Roger Olsen wrote to Ms Primarolo concerned about the “unjust” and “ironical” removal of an important “safety net” which guaranteed care on the basis of need “rather than pecuniary considerations”.

The agreement formally ended on 31 March this year.

The letters were released to HSJ after a freedom of information request for details of the cost of the arrangement. Those details were refused. Additional letters were also withheld under a section of the act which relates to information which would “prejudice relations between the UK and any other state”.

“Releasing these particular pieces of correspondence would prejudice international relations and make future negotiations with these states more difficult in the future,” the DH said in a statement.

Channel Islands row

Dawn Primarolo to Ben Shenton, Jersey health minister, August 2008

“…[the agreement] is both out of place and does not offer the UK taxpayer value for money. The latter point is the key issue: we are unable to justify the business case for the UK providing an allocation of funds to the Channel Islands [for this].”

Roger Olsen, deputy chair of the Sark medical committee, to Dawn Primarolo, January 2009

“The committee also considers it ironical that UK citizens are able to travel throughout the EU with confidence that emergency medical needs will be met but that travel to Sark would not include that assurance… It seems… unjust or unfair…”

Senator Jim Perchard, Jersey health and social services minister, to Dawn Primarolo, January 2009

“It saddens me that there has been no face to face ‘co-operating and communication’ and the dialogue has been by email… I would have thought that by the very least there should be face to face consultations in order that an amicable agreement can be reached… With due respect, I do not agree with your view and I now firmly request of you that we do meet.”