Health & Care Funding

I made this speech in the debate on the annual report of the contributory benefit scheme.

I’d just like to pick up on the aspects that overlap the mandate of HSC and in particular the resolutions arising from our Partnership of Purpose policy letter. 

As acknowledged in this report, the current funding structure for health is complex and not conducive to timely or consistent decision making. Indeed, I think this has been evident just in trying to disentangle what is actually in place now.

But, I believe it will make a significant difference and enable us to really push on making transformational change. I should point out that this is in no way a criticism of ESS. Far from it. Whilst some may believe there is a silo mentality in the States, this is certainly not the case between our 2 Committees which I am sure Deputy Le Clerc would agree. The success of the under 21 free contraception, being a case in point. 

But, the various structures put in place date from another era, with everything based in legislation meaning there is limited flexibility and barriers to keeping up with changes in health and care, an area of constant innovation and change. Just looking at this month’s agenda with 4 amendment regulations to Health Benefits provides a good indicator of the problem we face. Reducing bureaucratic structures means we can more easily ensure we target health and care where it is needed and when it is needed.

I therefore welcome the transfer of policy and operational control for services funded through the GHSF. 

Just responding to Deputy de Lisle and the £12 and £6 grant, as part of the Partnership of Purpose, approved by this Assembly, HSC is currently reviewing the funding of primary care and we expect to be able to report on this earlier next year. However, we need to think differently from just increasing grants which will do nothing to solve the underlying problems of what is a demand led system with no conditions around the grant that is paid to the primary care practices. The primary care model will have to change if we are to ensure greater equity of access and greater focus on prevention and early intervention to name but 2 but at the same time not destroy all that is good about the care received at the primary level. 

Now, whilst the fund restructuring is welcome from an administrative point of view, more fundamental is the need to determine how we fund health and care in the future. I’m not going to talk at length about that here, it is a debate to be had in the budget, or as part of the debate on the requete laid by Deputy Roffey later this year.

On the latter point I think it is worth just noting paragraphs 6.4 to 6.7 on the pharmaceutical service which clearly demonstrate the benefit of controlling entry on the prescribing list and the pragmatic use of generic alternatives. It’s also worth noting the joint working that has happened to amalgamate the bodies who advise on prescription matters which should cut down bureaucracy and simplify decision making.

But on the issue of future funding, we are living in cloud cuckoo land if we believe that greater efficiencies are going to be enough to keep the health and care budget within the fiscal rules of no real terms increase in expenditure. We are finding new ways of working every day and avoiding future costs by doing so. However, this will not prevent future cost increases arising from growing demand. This policy letter mentions new consultant posts – a third oncologist and second gastroenterologist, both directly linked to our ageing population. On the back of these appointments our general revenue budget submission includes the nursing support for those additional consultants. In addition, we expect that we will need to appoint additional anaesthetists in the near future.

So, it is disappointing that little if any progress has been made on reviewing future funding. We can’t fiddle around with various pots for much longer to make out things are fine. As I say, more on that in the budget debate. In the meantime, I welcome the report from ESS and the support they have given HSC over the last year.

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