The Health Minister Deputy Tom Binet is right to pursue a Health and Care Partnership Board for Jersey’s health and care system. But he should not be surprised by the muted response from some stakeholders.
If anything, that reaction tells us something important: not that the idea is wrong, but that experience has made people cautious. In health and care, there have been too many false dawns – well-intentioned initiatives that promise integration but struggle to shift the underlying reality of how the system works.
The ambition behind the proposed Health and Care Partnership Board is sound. Jersey’s health challenges – ageing demographics, rising demand, workforce pressures and cost – cannot be addressed by any single organisation.
Hospital services, general practice, community providers, charities and care homes are interdependent parts of a single system, whether or not we formally acknowledge it.
The Board is an attempt to make that system visible and to strategically manage it more deliberately.
That is the right direction.
But partnership is not created by bringing people into a room. It is shaped by incentives, responsibilities and, crucially, by how money flows through the system.
This is where realism matters.
Across the health and care landscape, organisations are not just partners – they are also, in a practical sense, independent entities with their own financial pressures, workforce constraints and operational priorities. GP practices are businesses. Charities must remain financially viable. Care providers operate within tight margins. The hospital absorbs the most complex and costly demand.
Each behaves rationally within the system as it exists.
That is not a criticism. It is a fact.
And it means that partnership cannot rely solely on goodwill or shared intent. It must acknowledge that, at times, interests will diverge. Decisions that benefit the system as a whole may not immediately benefit every individual organisation within it.
The Minister’s challenge is not simply to convene a partnership – it is to manage those tensions.
There are lessons here from elsewhere. The NHS has spent more than a decade attempting to do something similar through initiatives such as the Better Care Fund and, more recently, Integrated Care Boards. The goal was straightforward: shift care closer to home, reduce avoidable hospital use, and align health and social care around population need rather than organisational boundaries.
The ambition was widely supported. But delivery proved harder.
Pooling budgets did not automatically align incentives. Shared planning did not always translate into shared accountability. In many cases, hospitals – because of their scale, urgency and political visibility – continued to dominate system priorities, even as policy emphasised community-based care.
Integration became, at times, more about process than outcomes.
These experiences do not invalidate the Minister’s approach. If anything, they reinforce its necessity. But they do underline an important point: partnership must be designed, not assumed.
In Jersey, there is a particular sensitivity around financial transparency. For example, the finances of general practice are not publicly visible in the same way as government-funded services. That is entirely understandable. GP practices are independent businesses operating within a contractual framework, and commercial confidentiality is a legitimate consideration.
But if the system is to plan collectively – especially around resource allocation, service redesign and prevention – there will need to be sufficient shared understanding of how resources are used across the whole system.
This is not about “open book accounting” in a simplistic sense. It is about creating enough transparency to support trust, and enough shared data to support better decisions.
Without that, partnership risks being partial rather than whole.
There is also a broader governance question. The proposed Partnership Board is non-statutory and advisory. That gives it flexibility, but it also limits its authority. Its influence will depend on clarity of purpose, the credibility of its members, and the willingness of Ministers to act on its advice.
If those conditions are not met, there is a risk that the Board becomes a forum for discussion rather than a driver of change.
The alternative, of course, would be a more formal statutory framework – one that defines roles, responsibilities and financial arrangements across the system more explicitly. That may, in time, become necessary.
But it should not be the starting point.
Jersey has an opportunity to do something that larger systems often struggle to achieve: build a genuinely collaborative model, grounded in relationships, clarity and shared purpose. That requires honesty about the challenges, but also a willingness to work through them.
The demographic and financial pressures facing the Island are not going away. Doing nothing is not a responsible option.
If partnership working proves difficult, that does not remove the need for it. It simply postpones it – and risks making the eventual solution more complex, more formal and less flexible.
Better, then, to make this approach work.
That means being clear about what the Partnership Board is for, realistic about how organisations behave, and disciplined about delivery. It means focusing on a small number of shared priorities, and demonstrating early progress.
Above all, it means recognising that partnership is not a sentiment. It is a system.
The Minister is right to try to build it. The task now is to ensure it is strong enough to last.