Funding of primary care

2020.01.21

2 Deputy G.P. Southern of St. Helier of the Minister for Health and Social Services

regarding the funding of primary care: (OQ.3/2020)

Will the Minister summarise his plans for funding primary care, including whether there is any intention to move spending from secondary care to primary care, how the Health Insurance Fund will be used and whether any new funding streams are envisaged?

Deputy R.F. Renouf of St. Ouen (The Minister for Health and Social Services):

The economics of how this part of the healthcare system will work in the future is part of the stress test review that is ongoing at the moment as part of the Jersey Care model. It would be wrong for me at this point to prejudge the outcome of that review. It is looking at activity, that is current activity and future activity, it is looking at funding and commercial approaches in order to ensure that the changes outlined in the Jersey Care model are sustainable. I would urge the Deputy , as I am, to wait for the outcome of that review.

1. Deputy G.P. Southern :

I think I heard there the hint that outsourcing may be one of the functions by which we can afford this change in emphasis in our health provision; is that the case?

The Deputy of St. Ouen :

I do not know how I hinted at outsourcing or exactly what the Deputy means by that. But the answer is I am not in a position to state categorically any direction that future funding will take. All that is being reviewed by those who know systems far better than I do. It will be the subject of discussion with the Deputy , with Members of this Assembly and will come before this Assembly for debate.

2. Deputy R.J. Ward :

Has the move from secondary to primary care not already happened by the back door? I refer to, for example, oncology patients who are now having to go to their G.P. (general practitioner) and pay for blood tests when they were not having to do them before. Is that going to be part of the model of the primary healthcare system we look at. If so, is that not a concern?

The Deputy of St. Ouen :

In putting together the Jersey Care model we have certainly envisaged that services presently taking place in secondary care could move into primary care. We believe that is the proper setting for them. But, as I have said, that needs to be stress tested and carefully modelled to come back to this Assembly with the detail of such a move. As to the oncology service; I have heard that from other Members. It should not be the case that anyone is being sent to their G.P. at the moment to pay for their care when that care is available and previously been delivered by the oncology service. Of course there will be occasions in the course of events, regardless of the Jersey Care Model, a G.P. would assume the care of their patient and I do not know whether that is happening in this case. If the Deputy wishes to give details to me privately about those who have mentioned that to him we can certainly look into it. But it is not the case that we are expecting people to pay for service that is presently offered in secondary care.

3. Senator K.L. Moore :

The existence of the Health Insurance Fund has been described as a transformational part of the move to primary care. Could the Minister explain and describe how it is intended to be used as a transformational part of this transition and, second, reassure the Assembly that the cash balance in that fund will not be eroded by its use.

The Deputy of St. Ouen :

I cannot describe in detail how it might be used but it has been pointed out in the Jersey Care Model that the Health Insurance Fund has a healthy balance at the moment. That is Islanders' contributions for their primary care costs and therefore it might be appropriate, subject to the stress testing I have spoken about, for that fund to be used, particularly to manage the transition into new systems of care because there will probably be a time when we are double running services and secondary care and, at the same time, trying to upskill primary care services. So it might be appropriate to use the Health Insurance Fund for that element of funding. But, as I say, all these plans will be worked through and will be reported back in due course.

4. Senator K.L. Moore :

Could the Minister assure us and reassure us that those balances will not be eroded during that process? How would he safeguard against that?

The Deputy of St. Ouen :

Is it necessary to freeze the balances that are in the fund? The fund is there for a purpose. If it is appropriate to use the balances for particular purposes, and that is agreed by this Assembly as a way forward, then it is public funds to be used for the benefit of the public. I do not think they should be frozen funds never to be touched.

5. Deputy K.F. Morel of St. Lawrence :

Given the reduced scale of the proposed hospital is dependent on the success and the adoption of the proposed Jersey Care Model yet we still do not have, as the Minister has said today, any funding concept of the Jersey Care Model, how much it is going to cost or how it is going to work, would the Minister please explain how we are able to decide on whether the reduced scale of the hospital is appropriate or even feasible given we do not know what the cost of the Jersey Care Model is?

The Deputy of St. Ouen :

Work is running in parallel to assess what is needed in a hospital build and to assess how we deliver the Jersey Care Model. It is not without doubt the case that we will have a reduced bed capacity in the hospital. It is true that is what the Jersey Care Model has alluded to and has given a specific figure as a possibility. But that figure is being subject to the testing that I have spoken about and it may work out more because the people who have put together the Jersey Care Model are not qualified as health planners - they are health professionals in other areas - but it is right that we subject that to strict testing and the results will be made available.

6. Deputy K.F. Morel :

Should the Jersey Care Model costings turn out to be greater than is currently spent on the health service, would the Minister then accept that he would have to ask his officers to find another way forward with care in Jersey?

The Deputy of St. Ouen :

Not necessarily. I think that is a question of conjecture. What might happen in certain circumstances. What is happening now is iterative. We are moving to a new model. We have an aspiration out with some detail but there is a lot of work going on. So of course at this time we cannot buttonhole every process within it and know for certain the precise spending that is going to be needed but we are working on that and I would ask Members to be patient. I feel that frustration too that we have not quite got the answers yet. We know where we would like to be but we have not got the precise roadmap of exactly how we get there. But I know it is coming and hard work is being done and those results will be brought back to the Assembly.

7. Deputy K.G. Pamplin of St. Saviour :

It is a good moment to remind Members and members of the public listening that our Health Scrutiny Panel are indeed doing a thorough review of the future care model as we speak and we are still calling for evidence. So please do approach us if you would like us to hear your views. It would be a good time I think if the Minister could just give us some timelines with the work that he has mentioned in his answers this morning of those reviews going in and sort of an estimation of when those reviews will be on his desk and we can get a sense of which direction and when we are going to be heading to those decisions.

The Deputy of St. Ouen :

I am advised that the health planners will report at the end of March, maybe the beginning of April, but I am told the end of March has been stipulated. Of course that will need then to be read and digested and discussed among departmental officers and then we need to consider the way forward from there and how we bring matters before the Assembly. I think debates in the Assembly will align closely to any discussions on our hospital. It may be just before the summer recess, or shortly after, I think the Assembly will be dealing with these matters.

8. Deputy G.P. Southern :

Will the Minister release to Members the terms of reference under which his health economists are operating?

The Deputy of St. Ouen :

As I recall, the Deputy asked that very question in question time before Christmas and I agreed and the document has been released to all Members already.