In an extraordinary intervention by a former government official, Ann Esterson has raised serious concerns about the fact that the amount of money the department pays towards GP visits has been frozen for nine years, meaning that ordinary Islanders are footing the bill for price rises.
She says that the government seems to think that it has a ‘magic money tree’ and accuses the current regime of failing to be transparent about what it is up to.
Mrs Esterson, who was chief officer at Social Security from 1996 to 2006, has also warned that the situation is likely to get worse as funds supposedly ringfenced to fund primary care are being raided to cover ‘bureaucracy’ needed for the new Jersey Care Model and for new IT systems in the Hospital.
A leading doctor has added his voice to her criticism, highlighting the imminent increase in the charge of GP appointments to almost £50, while the government’s contribution, drawn from the Health Insurance Fund, has remained at £20 for the past nine years.
The Health Insurance Fund, which includes a system of rebates for GPs, was first set up in the 1960s, partly to meet the cost of patients’ appointments.
The rising cost of healthcare comes at a time when many Islanders have been left struggling financially as a result of the pandemic.
After failing to get answers that she considered satisfactory to questions sent to Social Security Minister Judy Martin, Mrs Esterson has aired her frustration in a letter published in today’s JEP (17 May).
She has accused the government of using the Health Insurance Fund ‘like a magic money tree’ while more health costs are passed on to patients, without informing the public what was happening.
Mrs Esterson said that on moving to Jersey in the 1980s, she had been impressed by the Island’s prudence in having ringfenced funds that were available to meet specific needs but that, more recently, the HIF had been used to meet expenses other than primary care.
More than £44 million was being taken out of the HIF over the next few years, she added, to pay for a hospital IT system and the ‘bureaucracy’ needed for the Island’s new health system, known as the Jersey Care Model.
‘The government is saying that the HIF is not sustainable. Well, it won’t be if they keep drawing out of it,’ Mrs Esterson said. ‘It is indicative of the lack of good governance that has prevailed; there has been a cavalier attitude to the control of finances.’
Through failing to increase the rebate for GP appointments since 2012, Mrs Esterson said the government was causing hardship, especially for those whose financial situation put them just above the qualifying level for income support.
‘Can you imagine the outcry if other benefits and pensions had not been increased for a similar time?’ she asked. ‘Instead, we have all had to pay more and more towards the cost of a GP visit, as the £20 rebate, frozen for the best part of a decade, has been eaten away by inflation.’
She adds: ‘I know this is causing hardship, particularly among those who do not qualify for income support but just about get by. It is a matter of great concern, as I believe a good number are struggling and I have pointed this out to ministers.’
Dr James Mair, of the Island Medical Centre, said that the price of an adult GP appointment at his practice was due to rise to £49.50 from the start of June, with charges at other surgeries also being around £50.
The cost to patients for an appointment had been £39 in 2013, Dr Mair said, with practices putting up their prices to counter rising expenses in other areas – such as building costs, insurance and staff wages – and to compensate for the lack of any increase in the rebate.
Historically Jersey had achieved a balance between primary care being completely free and the opposite extreme, such as in the USA, where everything was paid for, Dr Mair added.
By freezing the rebate paid to GPs, Dr Mair said the government was causing a move towards the American system, with unfortunate consequences such as higher costs for future treatment of serious health issues that had not been treated at an early stage, and the tendency of patients to seek primary care through visits to the Hospital’s Emergency Department.
‘The cost of GP appointments going up in line with inflation should be partly met by the HIF and partly by patients. I think that’s what people in Jersey want,’ he said. ‘But, in fact, it is all falling on the patients.’
Dr Mair said that the HIF was supposed to be ringfenced, but that GPs had no control over how the fund was used.
‘There is no accountability that we can see that [the HIF reserves] are going into primary care, which is where the money is meant to be spent,’ he said. ‘Instead it is going towards patching up holes in the health budget.’
The issue was contributing to a recruitment crisis within the primary care sector in Jersey, Dr Mair said, with major challenges in making the Island a sufficiently attractive destination for potential recruits.
The JEP asked the government for a response to the issues raised in Mrs Esterson’s letter at midday on Thursday, but had not received a response at the time of publication.
Mrs Esterson’s letter is on page 12 of today’s JEP.