Review of the Islands health and care costs

23.10.03

5 Deputy G.P. Southern of the Minister for Health and Social Services regarding the

review of the Island’s health and care costs (OQ.187/2023)

Will the Minister provide details of what progress, if any, has been made on the review of the Island’s health and care costs, including potential options she has under consideration for funding, financing, and contracting, to include options for the Health Insurance Fund; and will she explain what additional funding, if any, has been provided to address immediate pressures?

Deputy K. Wilson (The Minister for Health and Social Services):

To the first part of the question, I can confirm that we are making good progress and are on schedule with the work in this area. But as made clear in the Government Plan 2023 - 2025, the work is intended to continue throughout 2023. I think there is a lot to talk about in response to this question, and I think given the time constraints that we have around oral questions it is difficult to go into any detail at this moment. But I would be more than happy to answer this in more detail as part of supplementary questions. To the second part of the question, the department is anticipating underlying financial pressures of up to £35 million and, as set out in the Government Plan, a financial recovery programme is in place, which will work to reduce these pressures over a 3-year period. In the meantime, an additional £21 million is allocated in 2024 to maintain existing services. This sum will reduce to £14.5 million in 2026 and 2027 as savings and efficiencies are realised as part of that recovery programme.

1. Deputy G.P. Southern :

If I could point the Minister to the short statement on page 96 of the Government Plan, it says: “The work will continue into 2024 to develop potential options for change which we will focus on.” What potential options focus on funding, who pays, financing, how do we raise the money as needed, and contracting, how do we engage our providers to deliver better value? Can the Minister give us some guidance on what those issues might be.

Deputy K. Wilson :

The first thing to say is that we have established a Ministerial group to direct this work, and that comprises of myself, the Minister for Treasury and Resources, the Minister for Social Security and the Assistant Minister for Social Security. we are at, at the moment, is that we have got a draft national health account, which has been prepared for us. For the first time, we have got a picture of what public and private health spending is in Jersey. We will also, people will know, have conducted a poll to ascertain some of the broad public attitudes to future healthcare financing. We are also undertaking a forecasting exercise, which is currently in the process of being finalised, which sets out what these challenges will be for Jersey over the next 20 years or more. We have also undertaken some informal briefings with the Health and Social Security Scrutiny Panel on the output so far, and we will continue to do this until the work is complete. But at this moment in time, the final stage in the development of the options, I am expecting to consider advice from the Health Economic Unit in the coming weeks, and then I will be in a position to provide more information on that basis.

2. Deputy S.Y. Mézec :

When it comes to the sustainable funding of Jersey’s health and care costs, can the Minister outline what importance she gives to the principle of equity and how any discussion of equitable funding for health and care costs is featuring as they come up with their long-term funding proposals?

Deputy K. Wilson :

I think if we pursue the objective of health for all, then, clearly we need to make sure that we are providing equitable care and services for Islanders. The way that we do that, I think, we still have to explore what options we have got available to us. I think some of those conclusions will be reached through this work.

Deputy S.Y. Mézec :

The question was about equitable funding of services not the equitable delivery of services. Deputy K. Wilson :

I think that will be in relation to how we use the intelligence that comes from the work that we are doing to address the issue of equity. At this moment in time, I am not in a position to be able to give any further detail, but clearly that is something that I will be mindful of.

3. Deputy S.Y. Mézec :

The Minister will hopefully be aware of a previous attempt by a Government to find a sustainable funding option for healthcare, which involved the introduction of a health tax, which was an inequitable funding solution because it sought to tax those with the broader shoulders proportionately the least, and those with least incomes proportionately the most. Will the Minister, bearing in mind the effects that poverty can have on health outcomes, rule out a similar funding model and make sure that when we fund our health and care costs that we abide by the principle from each according to their ability to each according to their need?

Deputy K. Wilson :

I think I have just outlined that we have got a whole host of intelligence and information that we need to take account of. I am mindful that there will be different perspectives on what the issues of equitable funding, the approach to taxation, the approach to sustainability, and I would not want to be pressured into making any particular comment on that at this stage, but other than to assure the Deputy that, given all of the concerns that people are raising around this particular issue, we need to consider a way forward, in the round really, and making sure that we are providing services that are equitable and fair across the piece.

4. Deputy G.P. Southern :

“A way forward in the round.” How about some details, Minister? Are you prepared to commit yourself to stating who is going to fund the health service we have and how you are going to finance the health service that we have in the future. Will you do that before we debate the Government Plan, which commits us to all sorts of things? When are we going to see any detail about what future health system we are going to have?

The Bailiff :

Deputy Southern , through the Chair, please. “Is the Minister prepared” and all of the other things that you managed.

Deputy K. Wilson :

I think what I would like to assure the Deputy about is that there is really good progress being made with this work. It is vital. It is a complex exercise. People have attempted to do it before and never followed through. I very much want to make sure that we conclude the work in the remaining months but we still have a full range of evidence and data that we have got to pull together. I think that when we bring some proposals to the Assembly, in terms of future options, it will be well- informed and help the Assembly make the right way forward. This will not be my decision alone.

[10:30]

Deputy G.P. Southern :

If I may, Sir, will that mean bringing some detail to the House before we debate the Government Plan?

The Bailiff :

Yes, that was part of your original question, I think.

Deputy G.P. Southern : It was, indeed, Sir.

The Bailiff :

Are you able to answer that? Will information be made available to Members before the debate on the Government Plan?

Deputy K. Wilson :

I think I had actually said previously that this work is going to continue into 2024.