The Health Minister has butted heads with the Island’s spending watchdog for the second time in less than a month over a report looking at sustainable healthcare funding.
The report by Comptroller and Auditor General Lynn Pamment highlights how the Health Department has spent more than 20 years trying to get to grips with the question of how healthcare will be sustainably funded in the future.
But the minister, Senator Tom Binet, has questioned the value of the report, saying it covers little ground that his department was not already considering.
It comes just weeks after the financial watchdog launched an audit into the £710m new hospital at Overdale – in the same week Senator Binet criticised it for making last-minute demands that he said had put the signing of the key contract in jeopardy.
What does the report say?
The latest C&AG 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.
Ms Pamment states that there has not been a single document pulling together all the learning from projects over the past 20 years, and also cited the high turnover in senior government posts affecting the Health Department in recent years – with five chief officers since 2018, as well as five government chief executives.
The C&AG 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.
Ms Pamment 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.
Jersey faces significant challenges around the funding of healthcare, with the report showing 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.
Annual health expenditure set to pass £1bn
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.
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.
How did the Health Minister react?
Reacting to the report, Senator Binet said he doubted that the health service would learn anything from it.
“These reports tend to be written in a tone that assumes people on the receiving end haven’t thought of these things, or aren’t currently dealing with them,” he said.
“Most of what’s been said in the report is quite logical, but it’s not new.”
The Health Minister added that work on achieving greater efficiencies within the health arena were ongoing and that his preference was to carry on such efforts gradually.
“In the past there’s been a tendency to wait until all the elements are in place and all the boxes ticked and then have a big launch, but I’d rather just get on with the work that needs doing,” he said.
