Sustainable Healthcare Funding (R.126/2026): Executive Response

Recommendations

Risk of non-implementation

Risk profile (E,H,M,L)

Other considerations in prioritisation

Is the recommendat ion agreed?

Improvement theme

(If applicable)

R1 - Update the Jersey Heal th Accounts on a periodic basis such as every four years to improve strategic and operational healthcare decision making.

If the Jersey Heal th Accounts are not updated on a periodic basis then health funding policy decisions in the future may not be based on the most recent status of Jersey's health funding landscape. At a later stage, it may also be challenging to fully assess the impact of reforms without periodically updated Jersey Heal th Accounts.

Low

• Heal th accounts are useful tools to inform and assess policy decisions.

• The first Jersey Heal th Accounts was completed in 2023, using 2019 (pre-covid) data. They were completed to inform health funding reform work at the time which didn't proceed.

• The 2019 Jersey Heal th Account data has been updated to a 2026 baseline using robust methodology. Whilst this 2026 baseline isn't a fully updated Jersey Heal th Accounts, it provides a picture of Jersey's current health funding landscape.

• Whilst the Jersey Heal th Accounts provide detailed information on how different healthcare sectors are funded in Jersey at a point in time, the principal value of the Jersey Heal th Accounts is establishing a health- system cost baseline to then apply healthcare inflation assumptions to, which then forecasts future costs, informing the scale of reforms required.

• Producing health accounts is resource intensive and requires data collection from external organisations.

• If updated now, resources would need to be reprioritised from other key activities.

• Updating the Jersey Heal th Accounts every 10 years could be worthwhile, balancing the requirement for updated information to inform / assess policy decisions and resource prioritisation.

Agree in principle – deferred for later action.

No action at this time

• As part of the CPMO requirements for policy evaluation, the Heal th Funding Reform Officer Board will decide whether updating the Jersey Heal th Accounts after the reforms have been implemented would provide useful evidence to assess whether the reform objectives have been achieved

• The recommendation will be deferred for later action and monitored to ensure that appropriate action is taken.

R2 - Publish the results of the actuarial review of the Long-Term Care Fund and ensure that the results and impact of the review are considered as part of the wider healthcare funding options.

The actuarial review will be published. Risks associated with failing to incorporate the findings, not the wider health review, would be mainly reputational as it would be viewed that government does not take account of all available information in developing its future health funding plan.

Low

The actuarial review will be published.

Agreed

Transparency of review outputs

R3 - Undertake an exercise to model social care costs (including the impact on the Long-Term Care Fund) to ensure the full estimation of health and care costs is available for future policy decisions.

If social care costs are not taken into account, the full costs of service delivery may not be clear. However, standard methodologies which enable comparison to other jurisdictions exist and are followed by the Government of Jersey. Being a Heal th Account, only the "health cost" proportion of Long- Term Care is included in the Jersey Heal th Accounts. The risk of not including all LTC costs in the updated 2026 baseline and cost forecast is that <10% of LTC costs are excluded from the health cost forecast model. This can be mitigated by referring to the LTC financial forecasts when considering heath funding reforms.

Low

• LTC costs are divided into "social-care costs" and health costs' as per the definitions used by the OECD for the development of national health accounts.

• Note that the term "social care costs" does not refer to the personal care that is the main element of LTC packages (>90% of LTC costs).

• "Social-care costs" refers to a specific small element (<10%) of Long-Term Care costs.

• Financial monitoring and reporting is completed separately for the LTC, which includes 100% of the LTC costs.

• Whilst social care costs will be considered, the Jerey Heal th Accounts and cost forecast is focussed on health costs.

• Complete LTC costs and forecasts will be taken into consideration when health funding reform options are developed.

Not Agreed

No action at this time

R4 - Implement a formal communications campaign to explain the reasons for and support implementation of all fees and charges policies.

If communications plans are not in place, there may be reduced public and stakeholder understanding of the reasons for introducing fees, charges and any other reforms, which could increase resistance to change and make implementation more contentious.

Low

• The Minister for Heal th and Social Services introduced these new charges in 2026:

• patients who choose to stay in hospital receiving long-term care services when a safe onwards package of care is in place, and

• visitors from countries without a reciprocal health agreement for emergency treatment

• Further consideration will be given to whether further charges should be implemented in light of cost-of- living increases on households. No decisions have been taken.

• It is recognised that successful implementation of fees and charges policies requires clear communication, stakeholder understanding, and effective engagement.

• If decided to implement, future fees and charges proposals would be supported by structured communications and engagement plans developed as an integral component of policy and programme delivery. These plans would clearly articulate the strategic challenges facing the healthcare system, the rationale for proposed changes and the contribution that individual policies make towards the wider programme of healthcare reform and long-term sustainability.

• Stakeholder engagement and communications planning would be established at an early stage and maintained throughout development and implementation.

• A formal communications campaign would support transparency, improve understanding of the case for reform, and help manage stakeholder concerns, although it may not remove all opposition to proposals.

Agreed in principle – but only if adopted. In place already – standard GoJ frameworks in respect of communicatio ns and engagement for projects will be adhered to. pending decision to implement new charges.

No action at this time

R5 - Undertake a system- wide review of discharge planning policies and procedures to identify and implement systems improvements.

If a system-wide review isn't completed, then in the absence of other mechanisms, there may be a risk of there being some opportunities for improvement that are not identified.

Low

• HCJ has teams which work with community care providers to review discharge and implement continuous improvements as part of normal working practice.

• In addition, there are safeguards to escalate any concerns in respect of discharge planning at the

Agree in principle but appropriate measures are in place to

No additional action at this time

highest levels of HCJ governance: the Partnership Board has representation from the care sector who can raise discharge-related issues with the Board who can drive required improvements.

• Undertaking such a review and implementing improvements would require resources to be reprioritised from other activities.

• As the Partnership Board will be raising discharge related issues, a system-wide review would be disproportionate to the risk, which can be mitigated through existing HCJ and care sector working practices, as well as the Partnership Board.

identify and resolve issues

R6 - Identify some high- profile early adopters of the Patient Knows Best app to support a successful launch of the app, share experiences and encourage its widespread adoption.

Patient Knows Best is a free, secure online patient portal. More information can be found here. Its functions include the ability to manage your patient information and reschedule appointments. If there is not to widespread and prompt adoption, then there is a risk that the objectives of introducing the app are not achieved, including increasing HCJ productivity through reducing the number of missed appointments,

Low

• Approximately 12,000 appointments are missed per year.

• The Minister has proposed introducing a charge for when patients repeatedly miss an appointment without giving notice.

• Before the charge is introduced, the Minister has determined that Patient Knows Best' should be introduced first, which will allow patients to reschedule their appointment remotely.

• The Patient User Panel will be engaged to identify high-profile adopters of the app to support a successful launch of the app.

• The development and implementation of PKB is being project managed by the Digital health team who will ensure lessons learnt from other projects are considered.

Agreed

Digital adoption to support system reform

R7 - Consolidate all the learning from the various funding options papers (going back to 2008) into a concise view on healthcare funding options.  

If learning from previous healthcare funding reviews and reform programmes is not consolidated, there is a risk that future work may repeat previous challenges. This could reduce the likelihood of implementing successful reforms.

Medium

Key lessons from previous work ranging from the

2008 New Directions' to 2022/3 Jersey Care Model' will be consolidated and reviewed to ensure that health funding reforms avoid previous challenges.

Agreed

Planning health funding reform

R8 - Establish a Ministerial Heal th Funding Reform Group to ensure collective

If cross-government ministerial oversight and accountability arrangements for healthcare funding reform are not established

High

The Ministerial group has now met once and will meet

on a regular basis once reforms are developed further which require decision making.

Agreed

Planning health funding reform

consideration of and accountability for policy reform proposals. Ensure this Group includes the Ministers for Heal th and Social Services, Employment, Social Security and Housing and Treasury and Resources.

and maintained, there will likely be a risk of fragmented decision making across health, social care and public finances. This could weaken the Government's ability to develop and implement reforms.

A Terms of Reference will be drawn up by the end of

2026.

R9 - Review and enhance strategic and operational practices for managing difficult

complex change programmes. The enhanced practices should include more formal structured engagement conversations with a broad range of stakeholders on key reform proposals.

If good practice for managing complex change programmes is not followed, then there is a risk that outcomes, delivery timelines or cost of implementation could be compromised.

Low

• The Government recognises that successful delivery of complex reform programmes requires clear governance, effective project management disciplines, structured stakeholder engagement, and sustained leadership.

• The Government of Jersey has processes in place for managing complex change programmes (CPMO) and any future health reform programme will be managed via the CPMO framework which ensures robust change management practices are followed, including stakeholder engagement.

• This will be, supported by proportionate governance, assurance, and reporting arrangements.

• The Government will continue to build organisational capability in the management of complex change, drawing on lessons learned from previous major projects and reviews, both in HCJ and across GoJ.

• The extent to which formal structured engagement is required is wholly dependent on the change being

delivered.

Agreed in principle – underway via CPMO framework for managing change, including engagement.

Structured communicatio n and engagement

R10 - Ensure that robust programme management disciplines are in place to implement the Clinical Services Strategy when it is finalised.

If robust programme management disciplines are not in place the strategy may not be fully implemented and some improvements may not be made to models of care provision.

Medium

• Implementing robust practice requires appropriately skilled personnel to support the strategy implementation. Currently, funding is not available for dedicated programme management capability.

• HCJ will review funding streams but in the context of existing budgetary pressures, officers are unable to commit to implementing this recommendation at this time, However, the recommendation will be deferred for later action and monitored to ensure that appropriate action is taken.

Agree in principle – deferred for later action.

No action at this time

R11 - Alongside the Clinical Services Strategy, develop and implement an integrated health and social care strategy that provides a road map to the future of integrated care and prevention on the Island.

Without joined-up planning across Jersey's health system, there is a risk of uncoordinated action, reducing the overall effectiveness of improvements and reforms.

Medium

The Council of Ministers' proposed Common Strategy

Policy includes the establishment of a Heal th and Care Strategy.

Agreed

Planning health funding reform

R12 - Ensure robust succession planning is in place for known and expected changes in leadership.

If succession planning for senior executive roles, such as the transition GoJ CEO is not in place, there is a risk of lack of continuity in corporate knowledge and delivering on organisational and ministerial priorities.

Low

• The appointment of the Chief Executive Officer represents the culmination of a deliberate and long- term succession planning approach. It secures continuity of leadership, retains significant organisational knowledge and expertise, and reduces the risks associated with a change in executive leadership. Furthermore, it demonstrates the value of investing in internal leadership development and provides confidence that the organisation has the capability, resilience, and leadership capacity required to deliver its strategic objectives both now and in the future.

• Succession planning for critical roles across government continues to be a focus.

• In considering succession to senior roles, enterprise- wide leadership, the ability to lead outside of one's technical expertise / specialism and to be impactful across the broader organisation, has been identified as a prerequisite.

• The programme enabled the development of enterprise- wide leaders which was launched to senior leaders in January 2026.

• The  programme  enables  the  identification  of  senior employees  ready  for  enterprise-wide  leadership opportunities, now, and those who would benefit from gaining enterprise-wide leadership experience to grow their potential and support their progression.

• This programme enables organisation-wide mobility, builds leadership resilience through the identification of a talent pool to respond to priority need, and supports

Agree - Complete

No additional action at this time.

succession planning for Chief Officer and other senior leadership roles.

• Changes have been made to the Connect Performance last  year  to  encourage  managers  and  employees  to discuss  and  record  their  desire  and  readiness  for progression. A new development planning tool has been launched  to help  employees  and  managers  consider development needs to support individual growth.

• The Enterprise-Wide Leadership Programme continues to  strengthen  leadership  capability  across  the organisation,  while  the  Succession  Planning Programme has enabled the successful recruitment of a Chief  Officer  for  Employment,  Social  Security  and Housing (ESSH), supporting leadership continuity and organisational resilience.

• The Enterprise-Wide Leadership Programme continues to  strengthen  leadership  capability  across  the organisation by developing future leaders, supporting succession  planning,  and  fostering  a  consistent leadership culture.

• Future recruitment to the CO role within HCJ may require  an  external  search  to  access  the  quality, experience and delivery of candidates available in the wider market given the critical services and unique combination of leadership, operational, political and sector specific expertise.

Action theme

Actions

Li nked Recs

Target date

Responsible Officer

Planning health funding reform

R7: develop a paper incorporating the learning from previous health funding reform options for consideration by the Heal th Funding Reform Officer Board and

R7

Q4 2026

Ruth Johns on, Director of Strategic Heal th Policy

the Ministerial Group ahead of deciding on the health funding reforms to take forward.

R8: Agree Terms of Reference for the Ministerial Heal th Funding Reform Group R11: Officers will work with the Heath and Care Partnership Board to establish a Heal th and Care Strategy for Jersey

R8 R11

Q4 2026 Q2 2027

Transparency of review outputs

R2: Publish the long-term care actuarial review

R2

Q1 2027

Sue Duhamel , Associate Director of Public Policy

Structured communication and engagement

R9: Once Ministers have agreed the range of health funding reforms to take forward, Officers will develop a structured stakeholder engagement and communications programme, providing opportunities for stakeholders to comment on proposals before final decisions are made.

R9

Q1 2027

Ruth Johns on, Director of Strategic Heal th Policy

Digital adoption to support system reform

R6: The Digital Heal th team who are project managing the implementation of Patient Knows Best will identify high-profile early adopters of the app, potentially from HCJ's Patient and Users' public engagement panel, to support and encourage the launch of the app.

R6

Q2 2027

Martin Carpenter , Director of Digital Heal th and Informatics