Decrease in value of the Health Insurance Fund

21.11.23

5 Deputy G.P. Southern of the Minister for Social Security regarding the decrease in

value of the Health Insurance Fund (OQ.230/2021):

Given the declared intention of the Minister for Health and Social Services to undertake a "wider health economic review during 2022 to inform funding for increased healthcare costs", will the Minister explain the Government Plan 2022-2025 proposals to allow the Health Insurance Fund to decrease in value from £100 million to approximately £48 million by 2025, including how this does not pre-empt options in her colleague's review?

Deputy J.A. Martin of St. Helier (The Minister for Social Security):

I can reassure the Deputy that on page 177 of the 2022 Government Plan there is an explicit confirmation that the future role of the H.I.F. (Health Insurance Fund) will be included in the Minister for Health and Social Services' review.

1. Deputy G.P. Southern :

Could the Minister explain why then, while this review is taking place, she is proposing running down the H.I.F. to one year's worth?

Deputy J.A. Martin:

I hope the Deputy will recall that the approval of the Government Plan last year set out the proposed transfers from the Health Insurance Fund to support the development of the Jersey Care Model. This went through the Assembly. The 2022-2025 Government Plan confirms the proposals set out last year. It has all been approved.

2. Senator S.C. Ferguson:

Why does the Minister think it is right to divert taxpayer funds away from the original purposes of the Health Insurance Fund?

Deputy J.A. Martin:

We have signed up, Senator, to the new Jersey Care Model. They are not taxpayers contributions that go into the H.I.F. and we keep doing everything the same. We want to look at the whole funding, the health funding, the Health Insurance Fund, we are trying to bring in doctors to do more work and I do not think I did this on my own, Senator. As I say, it has come to the Assembly every time and it has been approved.

3. Senator S.C. Ferguson:

Why should the fund be used as a magic money tree by States departments to finance a theoretical proposal for a policy which experience has shown to be inefficient and expensive?

Deputy J.A. Martin:

I can only presume that the Senator is talking about the new Jersey Care Model, which I am fully behind. The fund, as I say, is money that supplies some funding, there is a massive amount of money that is over in the Health Department but neither of those 2 together are going to do it. That is why the Minister for Health and Social Services is doing a total review in 2022 of the health funding need and hopefully how it is going to be paid for.

4. Deputy R.J. Ward :

May I ask the Minister what level of available fund in the Health Insurance Fund is acceptable to the Minister?

Deputy J.A. Martin:

We collect money in each year and we are always meeting what we have to pay out each year. I just think, and it will be explicit, that this fund has been doing the same thing for lots and lots of years. We are moving the healthcare model. It may not be there, we need to merge some of this. We need to work together. It is acceptable to me, Deputy , that what we are asked to pay is still being able to be paid out because we are still collecting in.

5. Deputy R.J. Ward :

I am tempted to ask the same question again. Can I conclude from that answer that a single year of available Health Insurance Fund is acceptable to the Minister as long as what we are paying out is the same as we are paying in? That is fine, so we can run the Health Insurance Fund down to just a single year of funding?

Deputy J.A. Martin:

I am saying to the Deputy that the whole of the health funding needs to be looked at in this review, whether it is a year, whether it exists in a few years; until the review is done I cannot answer that. I am saying at the moment we can pay out everything that is asked of the Health Insurance Fund but is this the best sustainable funding and way to go with a new healthcare model? I am not sure.

6. Deputy I. Gardiner :

Would the Minister advise why the contribution from the Health Insurance Fund towards the G.P. (general practitioner) cost has not been increased for 12 years? It has been increased for us as residents and this money will not be spent on primary care and now it is spent for the development of the Jersey Care Model?

Deputy J.A. Martin:

Sorry, the Deputy is pre-empting the total review that is about to start or has just started.

Deputy I. Gardiner :

Apologies, I will make my questions simpler. The Bailiff :

I am sorry, you cannot interject when an answer is being given, Deputy , but you do have a supplementary question afterwards.

Deputy J.A. Martin:

I am not sure this has anything to do with the original question.

The Bailiff :

Do you want to answer? You started your answer Deputy J.A. Martin:

I will try. There are many reasons for the Deputy 's question and we have been working with G.P.s over many years. They get different things for different monies, free smear tests, but there is lots of money that is paid out from the Health Insurance Fund. There is the new health access scheme for low income, children under 17 do not pay and everyone else pays £12. These are all things that have found their way for me to pay out of the Health Insurance Fund, which I am happy to do, but it does need this overall review with the Minister for Health and Social Services and all the funding and it will be a big cost with the ageing population - and I include myself in that - that will need to be supported in the years to come.

7. Deputy I. Gardiner :

The Minister indicated that we voted in the Government Plan 2021-2024 to move the money to use for the development of the healthcare model. Were any additional funds transferred after the vote in December 2020?

Deputy J.A. Martin:

If the Deputy is asking me how the funds are transferred, they have not actually been transferred. My officers are going line by line through what Health are spending with health officers and as soon as we are happy then we transfer the money. It may not be that actual full amount, it certainly will not be any more than that but we do not just give a blank cheque.

[10:45]

8. Deputy K.F. Morel :

Would the Minister confirm whether or not money has been passed to Modernisation and Digital? So some of the monies that were taken out of the Health Insurance Fund for using in developing the Jersey Care Model, have any been passed to Modernisation and Digital and can she confirm, if so, how much and was any of that for use next year rather than this year?

Deputy J.A. Martin:

I thank the Deputy for his question but I think I have just answered that. Everything that was asked for is then dependent on being proven. It is needed at that time. The work can be done and we are literally we are doing this all year. We did not give over the amount that was in the Government Plan and we will not be giving over the amount until we are absolutely sure. There was some money for Digital and I might have to check what that specifically was but, again, no money has been transferred yet.

9. Deputy K.F. Morel :

If money has been passed to Modernisation and Digital, or is to be passed to Modernisation and Digital, would the Minister confirm how she or the department are going to ensure that the monies passed to Modernisation and Digital are only spent on development of the Jersey Care Model or I.T. (information technology) in this case for development of the Jersey Care Model? What oversight will she be placing over that?

Deputy J.A. Martin:

There are tight business cases and, as I say, my officers are going through line by line. We know that the healthcare record and lots of things in Health need to be modernised digitally so we know that some of that money was for that. Until we are absolutely sure that is what it is being spent on, it will not be passed across. I think the money does need to go across and once it is across the oversight will be from the officers in the Health Department.

10. Senator T.A. Vallois:

In the Jersey Care Model Strategic Outline Business Case there was a multi-year implementation plan developed that stated key projects were prioritised in tranches. Will the Minister commit with her colleague, the Minister for Health and Social Services, to provide an addendum to the Government Plan to identify what money has already been spent on those individuals phases and what is expected in the next phase in terms of the funding that is required in 2022-2025, please?

Deputy J.A. Martin:

Commit to what has been spent. I can find out exactly where we are going through the business plans and what has gone across or what is proposed to go across. I am dubious to speak for the Minister for Health and Social Services but, as far as I can, I will try and supply what the Senator is asking for.

11. Deputy G.P. Southern :

The Minister seemed to suggest that she was content with the operation of H.I.F. provided that what was coming in equalled what was going out in benefit payments. Has she not noticed on page 169 that her table reveals that costs are something like £4 million down on benefits? So the scheme, at best, is running at a deficit.

Deputy J.A. Martin:

I thank the Deputy . What I am saying is we know the H.I.F. has been doing what the H.I.F. does for many, many years and if you carry on doing something you get the same results. I think, and I know, the commitment is the whole of the Health funding, including the Health Insurance Fund, has to be put into this review. It will be a thorough review and we will know by the end of 2022. There is enough money in H.I.F. at the moment to do the daily payments in and out.