The previous States directed that benefits from the long-term care insurance fund, which is built up through social security contributions and helps with the cost of beds in residential and nursing homes, should be paid only to residents who have lived in the island for 20 years or more.
But when the Assembly was presented with legislation to put that change into effect, deputies narrowly agreed an amendment from Employment & Social Security vice-president Jayne Ozanne which reduced the residency rule from 20 years to 10 years, albeit replacing the previous rule which required only five years’ continuous residency.
Deputy Ozanne said that 10 years ‘strikes the right balance’, a view supported by most of her colleagues on ESS, which manages the long-term care insurance fund, and backed by Health & Social Care president George Oswald.
She reminded the States that the previous ESS Committee had recommended a 10-year rule which had been increased to 20 years by an amendment from former deputy and Health president Al Brouard.
‘Ten years reflects a genuine and meaningful connection with Guernsey, one built through living, working and contributing here and making this island your home, while at the same time preserving the integrity and sustainability of the long-term care insurance fund,’ said Deputy Ozanne.
Deputy Inder disagreed and claimed that paying long-term care benefits to someone who had lived in the island for only 10 years would be unfair on more established residents who may have paid into the fund for decades longer.
‘Someone who has lived, worked, paid taxes and contributed in the island for 20 years has demonstrated a significantly greater long-term commitment than someone who has only been resident for 10 years,’ said Deputy Inder.
‘Reducing the qualification period from 20 years to 10 years risks creating a situation where newer arrivals gain access to the same benefits, despite having made substantially fewer years of contribution.
‘We simply cannot be an open door where you can come here for 10 years and act like health tourists, getting into a very good health system.’
Deputy Ozanne argued that setting the qualifying period at 20 years would make it even harder to relocate patients from the Princess Elizabeth Hospital into residential and nursing homes.
That risk had persuaded Deputy Oswald to second Deputy Ozanne’s amendment. He claimed that a 20-year rule ‘set the bar too high’ and would have ‘unintended consequences’ on other parts of the health and care system.
‘My support for this amendment principally relates to the need to allow free flow of patients through our acute system into care more appropriate to many clients’ long-term needs. At worst, they will need to remain in hospital while HSC tries to sort out where they should go,’ he said.
He revealed that at one point last winter 34 hospital beds were occupied by patients waiting for places in care homes and as recently as August the number had been 31.
Deputies Andy Cameron and Gavin St Pier pointed out that bed blocking at the PEH was the result of a lack of space in care homes rather than who was funding them.
It had been estimated that a 20-year rule would reduce expenditure from the long-term care insurance fund by about £2m. a year. But approximately three out of every four people denied benefits from the fund would instead require financial assistance totalling about £1.5m. a year through income support, which is funded by general revenue rather than social security contributions.
‘The need for care doesn’t disappear and the public cost doesn’t disappear. It simply moves from one public fund to another,’ said Deputy Ozanne.
But Deputy Cameron said he suspected that ‘most of us would be over the moon to find a saving of £500,000 a year in a committee budget’.
Deputy David Dorrity, a former member of ESS, said he was certain that the amendment proposing a 10-year qualification rule, rather than a 20-year rule, could only increase States expenditure overall.
‘I struggle to understand how reducing the qualifying period from 20 to just 10 years can ever be a cost-saving measure,’ he said.
‘It is far more likely that the financial consequences would increase over time, placing further stress on the fund, when we are already facing significant pressures on public expenditure.’
But the Assembly backed Deputy Ozanne’s amendment by 20 votes to 18 and went on to approve the amended legislation, which will set the qualification period at 10 years’ residency and put into effect other changes to the scheme initially approved by the previous States.