By Neil MacLachlan
BOLD decisions are urgently needed to provide the level of funding that our health care system needs to survive. Using top-up funds from the Budget is merely a form of assisted dying for what was called Health and Community Services but is now known as Health Care Jersey.
A fortnight ago we saw that the cost of Long-Term Care had risen to such an extent that we may pay another hypothecated 1% tax for care of the elderly. We are currently operating a health care system that is running on empty. Year on year underfunding has led to high staff sickness rates, poor morale, difficulty in recruitment of consultant specialists, with many patients looking to the private sector and going to the UK or abroad for private care. This is loss of revenue for the Island and results in disjointed medical care and inconvenience for the patient.
Surgeons are frustrated with the lack of access to operating theatres and patients are also aware that delays in diagnosis and treatment lead to poorer outcomes. HCJ is pressed into reducing spending on medical care and are now getting so desperate that certain medical conditions will not be funded in the future. It is little wonder waiting lists remain a problem. Funding for some of the seemingly superfluous middle-manager posts appear, however, more protected. If money is tight, perhaps first and foremost it should be used for more theatre, nursing and other staff who are directly involved with patient care?
The Australian health care system is rated very highly and is one that we should look at closely. Residents there pay 2% of their income towards the public funded Medicare system, which covers the cost of hospital and GP visits and contributes to the drug budget. The government also “encourages” people to get private medical insurance (PMI), reducing the pressure on the public system, by penalising high earners (£45k) who have not taken out PMI, with an additional 1-1.5% surcharge known as a Medicare Levy Surcharge. The younger someone takes out PMI the cheaper it is, and the government also subsidises premiums up to 30%. In the future, one might envisage some health care subsidies being adjusted according to lifestyle choices. It should not be difficult to model what revenue such a system would produce in Jersey, still a relatively low-tax jurisdiction. Many businesses are already offering private medical insurance, which serves to attract talent, reduces absenteeism and gets employees back to work faster and also makes them feel valued. Unfortunately, the private facilities and access to private care are currently hindered by an overburdened, short-staffed public system and our hospital has seen a real reduction in effective bed numbers over the past ten years; we now only have one private ward with the other, Rozel, now being used as an overflow, decant ward. We should accept that it is possible to provide both excellent public and private care, and that the future hospital must have facilities for both, without detracting from each other.
Indeed, if we did this, we could attract the best staff to the Island, whether it be medical, surgical, nursing or ancillary and retain them by providing health facilities and staffing with the financial resources required. The NHS is losing excellent but demoralised staff to overseas jurisdictions, which includes Australia.
No political party in the UK dares suggest changing the way the NHS is funded, because the idea of the NHS being free at the point of delivery remains a sacrosanct belief and any party which dares to consider change would lose an election. With our own elections next year, the same could apply in Jersey. So far there has been no suggestion that a cross-party group, perhaps working with the highly respected King’s Fund think-tank charity, could suggest a “new way”. For those who are less well off, care would remain free at the point of delivery. It is clear that the current system is not working and that if the troublesome medical inflation rate (17% in UK for 2025) continues to outpace the general inflation rate (3.4%), the prognosis will remain poor.
If the Health Minister is to create yet another health advisory board, then first on the agenda I hope will be a good look at the way Jersey’s health system could be more appropriately funded. This will require some good modelling and then potentially some bold decisions. A close look at the Australian system would be a good starting place.
Neil MacLachlan was a consultant obstetrician and gynaecologist from 1991 to 2021 and is now working part-time at the Jersey Women’s Health Hub. Neil and his family have worked both in the NHS and the Jersey health care system and he continues to have a keen interest in health politics.
