By Bernard Place
DEPUTY Tom Binet is right to argue for more health funding in the 2026 Budget. Islanders see the pressures every day – longer waiting lists, rising costs and staff stretched thin. But every new pound must buy visible results, not just more process.
The main public debate so far has been about whether the health, and overall government budget, is too large. My concern is different. The case for investment is strong. What’s missing is assurance: proof that new money will lead to measurable deliverables for patients.
Too often, funding grows without the same growth in outcomes. That’s how trust is lost – not through bad intentions, but through weak delivery. I have written before that Jersey’s public services need to show not only integrity of purpose but competence of delivery. This is as true for health as it is for housing or education. Islanders judge value not by the size of the budget, but by the difference it makes.
A value and efficiency test
Before new funds are released, government should apply a simple but powerful value and efficiency test. Can the service achieve the same result more efficiently? If not, can it achieve it differently – through redesign, new roles or better co-ordination? Only if neither is possible should more money be added. This test should not block progress; it should guide it. Its purpose is to resist what behavioural economists call status quo bias – the natural pull to stick with what we know assuming it must be best.
In public services, that bias quietly drains innovation. The new Health and Care Jersey Partnership Board could lead this discipline, requiring every major funding proposal to include a short, public statement of deliverables: outcomes that are visible to patients and measurable by Islanders. That might mean shorter waiting times, faster discharges or better continuity of care for people with long-term conditions. Whatever the metric, results must be tracked and published. Why this board? Because opportunities for doing things more efficiently and/or doing them differently will be realised predominantly through whole health community actions.
Turning resources into results
The danger is that new funding disappears into process – new plans, committees and co-ordination groups that sound busy but change little. True reform happens when resources become results.
Earlier reforms in the NHS proved this point. The Transforming Emergency Care programme redesigned patient flow, cutting unnecessary admissions and treating many patients in hospital safely within the same day – the “zero length of stay” model. The Hospital at Night initiative showed that reorganising staffing around multidisciplinary teams could keep patients safe, free doctors for complex work and improve morale.
Both programmes worked not because they added money, but because they acted differently. The same mindset can guide Jersey now: innovation before expansion.
Tests of reform
From those lessons, five tests can help Jersey ensure that new funding delivers genuine reform:
- Define deliverables upfront. Every investment should promise a measurable result – fewer delayed discharges, shorter waits or higher patient satisfaction.
- Design for flow, not just capacity. A full bed is not success. Movement and recovery are.
- Empower professionals. Enable nurses, therapists and pharmacists to work at the top of their licence and lead improvement.
- Benchmark relentlessly. Compare, learn and improve – even small systems can apply the Getting It Right First Time (GIRFT) principle to expose waste and raise quality.
- Reward what works. Reinvest efficiency gains in staff development and new service models.
These are not management slogans. They are the habits of systems that consistently deliver better care and better value. We are lucky that for many of our Island clinicians these tests are already part of how they provide their service.
Resisting the pull of the familiar
Every reform effort faces gravity. The pull of the familiar is strong. Budgets expand, but the model of care stays the same. That’s how inefficiency becomes institutionalised.
Deputy Binet can choose differently. Instead of spreading new resources thinly across old pressures, he could deploy them radically – building the next model of care, not just sustaining the last. That might mean community-based multidisciplinary teams managing frailty and chronic illness outside hospital, digital services that reduce travel or extended professional roles that give patients continuity without hierarchy.
The New Healthcare Facilities will not succeed unless this happens. Bricks and mortar cannot deliver reform on their own. Without service redesign, we risk building a 21st-century hospital for a 20th-century system.
Accountability and trust
This focus on deliverables connects directly with a wider public concern: trust in government’s ability to make systems work. The same question arises in housing, education and social mobility – are we getting results for what we spend? Islanders want to see that their taxes are being used to make a tangible difference. That is also the foundation of intergenerational fairness: showing younger taxpayers that today’s spending builds tomorrow’s capability.
Jersey’s public institutions must now model the culture they expect from others – disciplined, transparent and outcome-driven.
Deliverables or drift
The forthcoming Budget debate is more than a fiscal exercise. It is a test of whether Jersey can combine compassion with discipline. Deputy Binet’s case for funding will likely succeed, and rightly so. But success should come with conditions: visible deliverables, transparent reporting and the courage to challenge the status quo. If that link is not made, the new money will vanish into the system like water into sand – absorbed but unseen. The real danger is not overspending, but under-delivering.
Islanders want to believe their health service can work better and differently. This is the moment to prove it. If the new funding delivers measurable improvement, confidence can be rebuilt. If it doesn’t, we will have bought comfort today at the cost of reform tomorrow.
The next chapter of Jersey’s health story will not be judged by the size of its budget, but by the clarity of its deliverables and the courage of its reform.
A registered nurse for nearly 40 years, Bernard Place has been a clinician, teacher and researcher in intensive care units. From 2012, he managed departments in Jersey’s healthcare system and from 2015 to 2019 was the clinical project director for Jersey’s new hospital.
