Comptroller and Auditor General, Lynn Pamment CBE, has today issued her report on Sustainable Healthcare Funding.
The funding of healthcare represents a significant financial challenge to many jurisdictions. Jersey is no exception to this.
An independent report was commissioned by Government in 2022 and published in September 2023. It concluded that by 2043 total healthcare expenditure (including public and private expenditure) was forecast to reach £1,296 million and to be 39.35% greater than the total healthcare revenue. The public financing gap was forecast to be £298 million by 2043.
According to Statistics Jersey’s Public Spending Statistics, last produced in 2023, Jersey spends more on health as a percentage of total government spend than any country in the OECD (Organisation for Economic Co-operation and Development) and 10 percentage points more than the UK.
Since 2022 work that has been undertaken includes the development of a model to underpin future projections in healthcare expenditure.
The Budget 2026-2029 includes two new fees planned to be introduced in 2026 (use of the Emergency Department and Did Not Attend Fees) as well as investment in prevention measures and the digital health strategy.
The Comptroller and Auditor General (C&AG) audit that commenced in December 2025 has assessed the:
- assumptions underpinning the model being developed by Government to support options appraisal and decision making on future healthcare funding
- design of the controls supporting the implementation of new fees by Health and Care Jersey (HCJ); and
- extent of progress being made in the development of sustainable healthcare funding in Jersey including by taking learning from previous initiatives.
The C&AG found that the approach taken to develop the model is sufficiently robust to provide a view of the underlying future cost trajectory, while accepting that it has some limitations and no long-term forecast can be exact, due to the evolving nature of demographics and healthcare delivery. At the time of the C&AG’s fieldwork, the model was due to be subject to external quality assurance and peer review processes which are ongoing. The C&AG concluded that the model provides a useful starting point for the consideration of future policy options that seek to put in place a sustainable healthcare funding solution.
It is clear from the output of the model that a range of policies and actions will need to be put in place beyond the Health and Care Jersey (HCJ) Financial Recovery Programme in order to fund public healthcare expenditure in a sustainable way.
The Government is developing a suite of ‘charging’ policies designed to change behaviour, target services in the right direction and reduce costs. These policies are intended to influence the choices that patients and carers make when accessing healthcare provision. They are aimed at encouraging the overall better use of healthcare resources and are not intended to generate significant funding.
However, the C&AG highlights that, without firstly publicly explaining the wider strategic challenges facing the Jersey healthcare system over the next 20 years, this suite of operational policies risks being seen as a series of piecemeal initiatives, rather than part of a wider solution. This creates a risk that Islanders do not
understand the importance of the suite of policies in contributing to financial, behavioural and cultural change.
The C&AG reports that in order to obtain the full benefits, future long-term funding (including possible reform) should go hand in hand with wider healthcare and social care reform, to ensure that the future monies spent deliver the best possible value for money. The audit has identified six key areas that need to be considered and addressed in conjunction with one another:
- healthcare system constraints
- social care system constraints
- New Healthcare Facilities Programme
- fragmented health and social care accountability
- how change works in practice; and
- capability and continuity of leadership.
Comptroller and Auditor General, Lynn Pamment CBE, said: “The risk of ever rising publicly funded expenditure on healthcare has been known for a long time. It is not an issue that can be resolved by HCJ or the Government in isolation. The solutions that will be required will need a wider public consensus.
“Prioritised action is now required in order to bring forward a range of options for future long-term funding hand in hand with wider healthcare and social care reform.”
