Expansion of the Health Access Scheme

22.10.04

2 Deputy G.P. Southern of the Minister for Social Security regarding the expansion

of the Health Access Scheme (OQ.98/2022)

Can I assure Members that this part of the Assembly will attempt to fill the allotted time to its maximum? Will the Minister advise what consideration, if any, has been given to the expansion of the Health Access Scheme, which groups have been considered for inclusion and in what timescale would they be included; would she further indicate what consultation, if any, has taken place with professional bodies or not-for-profit bodies involved with the scheme, what these bodies were and if none has taken place, why not?

Deputy E. Millar of St. John , St. Lawrence and Trinity (The Minister for Social Security):

I thank the Deputy for his question. This question builds on that asked by Deputy Alves at the last sitting when I was asked to commit to extending the Health Access Scheme to people with long-term conditions. My answer is essentially the same. I will be reviewing the scheme and will consider the role it plays in helping people access general practice service when that review has been completed.

1. Deputy G.P. Southern :

For the first time today we see the use of that very vague word “review”. I think the Minister could usefully inform Members when she expects to have completed her review and when she will therefore come forward with mechanisms to expand the system or not.

Deputy E. Millar :

It is difficult at this stage to put timescales. The review has not yet commenced. It will be far- reaching, it will have to consult with all relevant bodies, it will have to engage the Minister for Health and Social Services, and it will be designed to ensure that people who need access to healthcare can achieve that through appropriate means. I would hope the review will be concluded by the middle of next year but I am still working my work plan. There is quite a lot to do next year and I have not yet ... although Ministerial priorities have been set out I have not yet finalised the work plan.

2. Deputy S.Y. Mézec :

Can the Minister just confirm, to leave no doubt about this whatsoever, that this is a review with the aim of expanding access to the Health Access Scheme?

Deputy E. Millar :

The review is intended to consider whether health access is appropriate in the Island. The Health Access Scheme was aimed at ensuring people on low incomes could access healthcare. The interests of people on low incomes will be paramount in that review. There are many ways in which primary care may be provided and the review will be far-reaching.

3. Deputy S.Y. Mézec :

That could have been a yes or no, and we got neither there so that was not particularly helpful. Can I ask the Minister: if we are not going to find out until some point next year what the conclusions of this review will be, could she not at least, as an interim step, commit to extending eligibility for the Health Access Scheme to those with long-term illnesses, which could very easily be done by simply saying those who are in receipt of a disability benefit of some sort now qualify to be part of the Health Access Scheme, and provide much needed help to that part of our society?

Deputy E. Millar :

Again, I think this was discussed at the last sitting. The health needs of people who are not on low income but have long-term illness will be different. The support needed for people with long-term conditions needs to be understood and may need a different approach, and that may not necessarily be fulfilled by multiple G.P. (general practitioner) visits. The healthcare needs of people differ according to the conditions and circumstances and grouping, such as long-term incapacity allowance recipients, do not indicate the need or extent of how it can be addressed. I do not believe a one- size-fits-all expansion simply by extending it to long-term incapacity allowance recipients is necessarily the best approach.

4. Deputy L.V. Feltham :

The Minister has said that the review has not yet commenced and she has been unable to give us a date for when the review will be completed. Can she give us a date for when the review will commence?

Deputy E. Millar :

The review will be commencing the early part of next year.

5. Deputy L.V. Feltham :

When the Minister says “the early part of next year”, can she confirm that that will be in January?

Deputy E. Millar :

It will be in quarter one, I expect.

6. Deputy R.J. Ward :

May I ask the Minister whether she would include in the review a look at the access to screening tests, blood tests and so on, for those who perhaps are not on income support but may miss out simply because they do not want to pay the cost of the doctor?

Deputy E. Millar :

Health access is part of a wider review, as I have already said. The Minister for Health and Social Services already has a review of health funding underway and I am sure access to all those services will be part of that review.

7. Deputy R.J. Ward :

Does the Minister agree that screening programmes are essential and, if you think purely economically, they save an absolute fortune in the long run and also improve people’s lives?

Deputy E. Millar :

I agree that screening programmes are essential but I do not believe they sit with Social Security.

8. Deputy G.P. Southern :

Does the Minister have any indication from her officers as to how effective and how accurate the scheme has been so far on which she can base her justification for an in-depth review?

Deputy E. Millar :

The review is intended to ensure that the scheme is working. It was introduced at the end of 2020 to help people with low-income access general practice services. It enables people who receive income support or Pension Plus to access surgery consultations for a low fee. I believe some 11,000 low-income people have access to that scheme who may also have a long-term illness. The review, as I say, will commence next year with a view to ensuring the scheme is operable and is working well. I do not have specific facts at my fingertips as to how far it is being accessed.