THE pot which helps pay for GP visits and prescription medicine will run perilously low within the next three years, with ministers accused of having “no tangible plan” for primary care and failing to assess new funding initiatives.
In a new report, Comptroller and Auditor General Lynn Pamment has said the Health Insurance Fund is unsustainable in its current form.
And she levied a series of criticisms of how changes to the fund were implemented with little evaluation of the long-term implications.
She said: “The HIF is not sustainable in its present form and there is no tangible plan for primary care in the context of a sustainable, integrated health care model for the future.
“The government does not routinely assess value for money from new initiatives funded from the HIV – and the changes since 2022 have increased the risk of overpayment from error or fraud.”
There has been no clear plan of action developed for the HIF since the 2021 actuarial review, despite clear indication that the fund would run low on funds in the near future, she added.
What is the forecast?
The fund, which is financed through Social Security contributions, subsidises primary care for Islanders, and has seen many new initiatives in recent years.
But they, alongside pressures related to an ageing population, have resulted in the 2026 to 2029 Budget showing a deficit within the fund for each year of the period.
And by the end of 2029, the balance is anticipated to be £61 million which is less than one year’s expenditure, she warned.
She also added that “increased expenditure against the Health Insurance Fund” means “the fund will be exhausted during the early 2030’s”.
One of the factors expected to influence the future performance of the fund is the Island’s ageing demographic.
Jersey’s population, as of the end of 2024, was provisionally estimated to be 104,540. The largest change in the five-year period between the end of 2019 and the end of 2024 was among the population aged 65 and above, which increased by 12%, whilst the population aged under-16 decreased by 7%.
That is a trend that is expected to continue and will place additional pressure on States funds like the HIF.
The changes to the fund over the past 10 years – and their estimated impact in 2026
- 2015 Jersey Quality Improvement Framework – £2,963,000
- 2017 Flu vaccination service – £2,266,000
- 2018 Cervical screening service introduced for eligible individuals to receive screening check-ups free of charge – £310,000
- 2018 Diabetic supplies scheme – £964,000
- 2020 Remote service contract – £712,000
- 2020 Health Access Scheme – 2,393,000
- 2022 GP workforce support package – n/a as scheme ended
- 2022 Allied Health Professional fee – £2,000,000
- 2023 Reduced GP fees – £5,202,000
- 2023 Free GP appointment for all patients under age 17 – £1,600,000
- 2023 Free GP appointments to all students – £128,000
- 2023 Hosiery and wound dressings for patients with a clinically assessed need – £300,000
- 2023 Pharmacy Quality and Performance initiatives – £558,000
- 2023 Pharmacy Package of modernisation initiatives.
- Increased dispensing fees – £2,430,000
- Wage support scheme/training independent prescribers – £416,000
- Commissioned patient services – £520,000
- 2024 Reduced primary care fees – £3,600,000
- 2025 Reduced primary care fees, including remote services – £986,000
Which changes in particular were scrutinised in the report, and what issues were raised?
2023 – £20 reduction in GP Fees plus £5 payment to GPs for each consultation
- Despite high risk noted that GPs may simply increase fees rather than pass the price reduction, no guarantee or robust control was put in place to prevent this happening.
- It was universal rather than targeted, so it didn’t take into account that groups of islanders feel the cost-of-living impact differently, or may have private health insurance.
- There was no justification or analysis to support additional £5 contribution to business costs.
- There was no assessment of potential for volume of GP appointments to increase.
- The longer-term impact on the HIF was not rigorously considered.
- There was no detailed assessment of the longer-term impact or implications of the cost-of-living pressures on residents.
- The system implications were not evaluated for Government or GP practices.
2023 – Free GP appointments for all children plus no charge for common tests and procedures
- The basis for calculation was simple with limited evidence to validate assumptions.
- Its report did not consider risk of increased volume of GP consultations.
- It’s difficult to measure impact.
- The affordability and impact on the fund were not considered.
- The system implications for government or GP practices have not been evaluated.
2024 – Free GP appointments for students
- The basis for calculation was simple with limited evidence to validate assumptions.
- It has an inconsistent method with assumptions and method used for children.
- Its report did not consider the risk of increased GP consultations.
- It is difficult to measure impact.
- The affordability and impact on the fund were not considered.
- The system implications for Government or GP practices were not evaluated.
2024 – Free wound dressings and hosiery for patients with clinical need
- There was no reference made to the overall affordability and longer-term impact on the HIF.
- The efficiency savings in secondary and acute sector were not included.
- There were no measures to enable outcomes to be assessed.
- There was no cost of implementation included.
- There was no detail provided on controls to be added to the system.
- The system implications for government or community pharmacies were not evaluated.
2024 – Additional £10 deduction from GP and other practitioner fees, including remote consultations. Extension of financial support to include home visits.
- It was considered before the £20 reduction had operated for a year and without evaluation of this.
- There was no evaluation of the impact of subsidised home visits.
- The system implications for government or GP practices were not evaluated.
- The report asked if the highest cost of the three options as considered.
What did the report recommend?
A total of 13 recommendations were contained within the C&AG’s report – as well as four areas of work which she deemed should be prioritised and one “area for consideration”.
Among the core recommendations was a suggestion a clear “governance map” should be created which should “seek to eliminate duplication and inefficiency”.
Several of the recommendations also suggested more thorough reviews of the various projects which require funding from the HIF, while a formal policy statement on the minimum balance to be held in the fund should also be proposed, according to the C&AG.
Another was to update the States proposition and Ministerial Decision procedures to ensure future changes are backed up by evidence and consider the implications on the fund.
It also suggested that developing a joint audit programme should be considered to monitor the HIF should be considered.
Who holds responsibility?
Overall responsibility for the HIF lies with the Social Security Minister – currently Deputy Lyndsay Feltham.
But it added that the Treasury and Health Ministers – currently Deputy Elaine Miller and Deputy Tom Binet respectively – also play key roles.
The responsibility of income collection and investment activities falls on the shoulders of the Treasury Minister and her department.
Meanwhile, the responsibility for healthcare delivery, primary care, governance team and digital health team belongs to the Health Minister.
In her report, Ms Pamment said: “The governance arrangements for the HIF involve a number of departments and include a range of strategic, operational and working groups as well as informal groups. The relationships and interdependencies between these
groups are not formally documented.”
She added that monitoring of the HIF performance and activity “takes place at different levels” and there are “no routine key performance indicators” provided to the Social Security Minister regarding how the fund’s performance should be reviewed.
