WORK to tackle a future funding crisis for healthcare in Jersey may be perceived as “piecemeal initiatives” by Islanders, leading to a lack of public support and understanding, a financial watchdog has stated.
In a new report addressing sustainable healthcare funding, Comptroller and Auditor General Lynn Pamment raises concerns about the range of different approaches adopted by successive governments and health officials without there being a single document that collates the learning achieved.
Ms Pamment also highlights the lack of continuity in leadership in both central government and the Health Department, calling for funding solutions to be considered alongside work to reform health and social care in order to achieve the best value for money.
The report, released officially today, could set the C&AG on a collision course with Health Minister Tom Binet, who recently criticised Ms Pamment over her involvement in the process to finalise the contract for the Island’s new hospital at Overdale.
Senator Binet described the intervention as “very heavy-handed”, placing him under “unreasonable” pressure and threatening to scupper the contract, which was eventually signed just two days prior to last month’s election.
‘Significant challenges’
In common with many other jurisdictions, Jersey faces significant challenges around the funding of healthcare, however the report shows that the Island devotes a higher proportion of total government expenditure to health than any country in the Organisation for Economic Co-operation and Development. Jersey’s figure of 29% in 2023 was more than 10 percentage points higher than the UK’s, Ms Pamment notes.
The Health Department has highlighted that it is under severe strain, with steep rises in costs contributing to an annual deficit of £18 million.
Senator Binet has frequently acknowledged the rising cost of healthcare, driven by the Island’s ageing population, increased life expectancy and the wider range of treatments available, and several new charging options have either been introduced or proposed.
The report includes a projection that total annual health expenditure, currently £787m, will pass £1 billion in 2035 and reach £1.295bn by 2045.
New charges
Ms Pamment acknowledges work to prevent bed-blocking by charging those who decline to leave hospital when medically fit, review eligibility for free healthcare and prioritising treatment and interventions, as well as potential new charges for failure to attend appointments and inappropriate visits to the Emergency Department. But she also expressed reservations about the level of public acceptance of these changes.
“Without firstly publicly explaining the wider strategic challenges facing the Jersey healthcare system over the next 20 years, this suite of operational policies risks being seen as a series of piecemeal initiatives, rather than part of a wider solution,” the report states.
“This creates a risk that Islanders do not understand the importance of the suite of policies in contributing to financial, behavioural and cultural change.”
The intention to take a relatively “light touch” approach to enforcement of charges is noted by Ms Pamment, who states that this creates “a risk that implementation of the policies will not have the desired impact either financially or culturally”.
Recommendations include a formal communications campaign to explain the charging policies, featuring “high profile early adopters” of a new app that will help patients secure suitable appointments, as well as a system-wide review of discharge planning policies and procedures aimed at identifying and implementing improvements.
Previous attempts
The report spells out a history of sustainable healthcare funding policies dating back to the Health and Social Care Modernisation Fund in 2002 and including A New Way Forward in 2012 and the Jersey Care Model in 2018.
She adds: “It is clear therefore that the need to take action on the future funding of healthcare has been known for a considerable amount of time.
“There is not however a single document that pulls together all of the reflective learning of the projects since 2008 that have commenced and subsequently ceased or not fully delivered.”
The C&AG notes that Jersey’s government has had five different chief executives over the past decade, while there had been five chief officers at the Health Department since 2018.
Ms Pamment recommends that learnings from funding options paper since 2008 should be consolidated, and that a group of ministers should be established to consider funding reform proposals. She also advocates “robust programme management” for a new Clinical Services Strategy, as well as “robust succession planning” for known and expected changes in leadership.
Consideration should also be given to two further areas, the report states: whether legislation is needed to facilitate the eviction from hospital of medically-fit people who refuse to transfer to a suitable facility, and whether a single minister should be made accountable for the Health Department, the Health Insurance and the Long-Term Care Fund.
Senator Binet hinted at the potential transfer of the Health Insurance Fund in the JEP Saturday interview, stating that this could potentially be accompanied by the return of charges for prescriptions.
