C&AG's report into the HIF

2026.02.24

4.7   Deputy J. Renouf of St. Brelade of the Minister for Social Security regarding the Comptroller and Auditor General's report into Jersey's Health Insurance Fund. (OQ. 30/2025):

Further to the Controller and Auditor General's report into Jersey's Health Insurance Fund, the H.I.F. (Health Insurance Fund), will the Minister provide her initial response to the findings of the report?

Deputy L.V. Feltham of St. Helier Central (The Minister for Social Security):

I am very grateful to the Comptroller and Auditor General and her team for the detailed analysis that they have undertaken of the H.I.F. I worked closely with the Comptroller and Auditor General when I was chair of the Public Accounts Committee, and I have great respect for her and her work. The report that they have produced is comprehensive and fact-based, exactly as I would expect, and I was pleased to see that the recommendations are in line with the actions that are already being taken by my team to improve the governance of the fund. These recommendations made by the Comptroller and Auditor General, and the findings, will only serve to strengthen the work that we are already doing.

1. Deputy J. Renouf :

I am pleased the Minister referred to the recommendations. Recommendation 4 says: "The Minister should prepare a detailed plan to ensure the longer-term viability of primary care and pharmacy services which are currently funded by the Health Insurance Fund." Does she accept this recommendation and if not, why not?

Deputy L.V. Feltham :

Yes, of course, I accept that recommendation. It will, of course, in the near future be up to possibly another Minister to take that forward, but I will say we are already undertaking work in respect of this and that is being led by the Minister for Health and Social Services. As the Deputy will know, as vice- chair of the Scrutiny Panel that scrutinises me, I have always felt that Health funding needs to be looked at holistically and as a whole so that we can get the whole picture. The very important services that are currently funded by the Health Insurance Fund can lead to savings in secondary care. We also need to look at things like health promotion and how we make sure that our whole health system is funded adequately and that is indeed a priority.

2. Deputy H.L. Jeune of St. Jon, St. Lawrence and Trinity :

The Minister has touched on this within her last answer but given that the Government accept that the H.I.F. will run out by the early 2030s, what is her preferred source of revenue for meeting ongoing costs that are currently funded by the H.I.F. beyond this date?

Deputy L.V. Feltham :

As I said in my previous answer, I think it is really important that we understand the pressures on health funding as a whole, and it is only when we have got the full understanding of all of those costs that I believe that we can look at the correct level of funding and how we fund those going into the future.

3. Deputy H.L. Jeune :

Now we are coming to the end of our time in the States Assembly, I believe that we have heard this before that there is an issue with health funding and that we need to look at it but we have yet to see any concrete strategy around this. I was just wondering if the Minister can put a timeline on that because 2030 is coming close and fast. I have got that in my mind because it is a big birthday year for me. If we are going to run out of money for the H.I.F. we do need to get on with finding a strong strategy for the health funding, so if she could put a bit of a timeline on that in that we have not had that for the last 4 years.

[10:30]

Deputy L.V. Feltham :

I think that the report that was produced and made public last week gives a really sharp focus to the need for dealing with this issue. It also enabled me to have a conversation with my chief officer around the work that is being undertaken across Government around health funding. I have asked for further assurance that there is a good concrete project plan in place with timelines and I have asked for evidence of that, but of course any further decisions  around where funding comes from within the next Government will indeed be done by the next elected States Assembly. I do urge people who are thinking of standing for the States to think very carefully about that when putting their manifestos together, and I also encourage voters to think very carefully about that when they are placing their X in the boxes.

4. Deputy I. Gardiner of St. Helier North :

Recommendation 3 says: "The Minister should prepare and implement a formal policy statement specifying the minimum balance to be held in the Health Insurance Fund." Does she accept this recommendation and, if not, why not?

Deputy L.V. Feltham :

I think the recommendation presupposes that the Health Insurance Fund is to continue as it currently is. I think until that piece of work is undertaken with regard to health funding as a whole, it would be very difficult to say what the balance of the Health Insurance Fund should be. My main focus and priority is, at this point in time, ensuring that that piece of work on health funding as a whole is prioritised, is delivered and then can inform future investment in health. I think what we are seeing now is around underinvestment in the past. What is happening and what has happened to the Health Insurance Fund is not just due to the actions of this Government. This Government has been in office for 2 years. We need to look at the actions of past governments; funding decisions that were made by past governments. We need to learn from that for the future.

5. Deputy I. Gardiner :

It is an interesting comment that there was an amendment to the Budget when we tried to restrict spending from the Health Insurance Fund and the Minister's Government said: "No, we will continue to spend from the Health Insurance Fund." Going forward I would like to ask the Minister if any policy decision or any development they have done over the 2 years of her tenure will be presented to the States before the end of this term?

Deputy L.V. Feltham :

Let us be clear, the additional money that has been spent out of the Health Insurance Fund has been about very important primary care needs for our community, things like wound dressings, things like diabetes care, things like free G.P. (general practitioner) access for children. Children were previously being taken to the Emergency Department because that was the only way to access free medical treatment. I am committed to working together with the Minister for Health and Social Services and the Minister for Treasury and Resources. As I said in my previous answer to a question, I am also committed to ensuring that the correct project management process is in place to ensure that the civil service is working on this very problem during the purdah period and beyond and has very, very clear performance indicators on that project.

6. Deputy J. Renouf :

The Minister seems to have read a slightly different report to the report that I read. This report was a report looking at the performance over the course of the last few years. It is one of the most critical reports I have read from a Comptroller and Auditor General. It says that the H.I.F. is not sustainable in its present form, there are no tangible plans for primary care in the context of a sustainable integrated health model and the Government do not routinely assess value for money from new initiatives. It says that the Government have not established a mechanism to ensure that the increased grant to G.P. surgeries goes towards fully reducing fees. It says that the Government said they would intervene if this happened but produced no mechanism for doing so. Will the Minister accept any of these criticisms that have been made and explain why these things were not done, as the Comptroller and Auditor General has clearly identified? She does not dispute the fact that the money has gone to good causes. It is about the mechanisms that have been used.

Deputy L.V. Feltham :

I will remind the Deputy that a number of those criticisms he referred to were actions that took place when he was in Government. That aside, I think what is important is the actions that we are taking, the actions around the digital health services, actions to improve systems so that we get better data, so that we can look at value for money into the future, but also not making people wait for the health help that they need right now while we get those systems in place.

The Deputy Bailiff :

That brings to an end all the questions that have been listed but there is a further question that has been approved as an urgent oral question under Standing Order 15. Deputy Renouf will put his question to the Minister for Health and Social Services.