The island's Finance and Resources Committee and Douzaine report has said it needs to "inform Chief Pleas and the wider population of Sark about the nature of health and social care and how its increasing cost will impact on the future provision of Sark’s Procureur services if no action is taken" with further details about how demand for the Procureur's support has grown in recent years.

The service has "supported the poor and needy of Sark for centuries with an evolving service" but now, with steadily increasing financial costs, the service has "exceeded the budgeted funds" for three years running.

Pictured: The statistics presented in the Sark Chief Pleas agenda for the Easter meeting in April 2018

The funds are predominantly directed at supporting Sark's frail and elderly residents, paying for their care needs in Sark and in some rare cases in Guernsey, as well as helping to pay for a range of other items depending on individual circumstance and need, for instance medical insurance cover, heating or electricity bills.

In 2017, the total cost of running the Procureur Services cost the Sark Exchequer £193,836, which made up14.4 % of the island's overall budget.

In 2016 the cost was £158,364, making up 11.8% of the yearly budget, while ten years ago the Procureur Service cost £50,320, or 5.9 % of the budget.

Currently any recipients of support by the island must meet the criteria of being poor and needy. This is means tested through what's described as a careful assessment process focusing on the financial state of each individual claimant and any other source of funding available to the claimant or family. This is undertaken confidentially by the Procureur, with the Douzaine, as a Committee of Chief Pleas, deciding if support should then be given. The Douzaine has to apply for funds each year for the following financial year with Chief Pleas needing to agree to release those funds.

If funds are released to individuals they are treated on a "loan basis" meaning that if the claimant should come into funds, the financial support may cease, and funds may be reclaimed. A claim can also be made against property assets to repay the support provided. However, repayments are very rare - in the past three years less than 5% of the Procureur spend was repaid.

The concerns over future funding of the scheme have been raised now because as is the case elsewhere, people in Sark are living longer, and the cost of providing health and social care are increasing, with many of those rising costs not being in the control of Sark itself. Chief Pleas is being asked to consider how to meet these future costs now to "enable the island to continue to provide assistance to the poorest and neediest in our community."

To do that, the Finance & Resources Committee has said it is beginning the process of "examining sources of income, protection of dedicated funds, the level of care and support that may be provided and to those who qualify for support."

Being a poor and needy resident of Sark will continue to be the criteria for assistance, but the island's government will have to decide what criteria there is to describe someone as a resident going forward. F&R has said it will need help to do that, and it is waiting on the result of legal advice to define a Sark Resident and whether being a Sark Resident for the purposes of being eligible for support only apply to those who are for example:

• Physically born on Sark?

• Born in the Bailiwick of Guernsey of Sark Resident parents?

• Born on Sark, but returned to retire on Sark after a life elsewhere?

• Have lived on Sark and paid tax for more than 15 years?

• Should someone retiring to Sark expect the same level of support as someone who has lived all their life on Sark?

• Should newcomers to the island have to provide a bond to meet any future care needs?

• Should those who move to Sark from another jurisdiction in which the claimant has the right of financial support, return to their ‘home jurisdiction’ to receive the care they need?

• Can claimants who would receive care if they returned to the UK or Guernsey, draw down on funds from those jurisdictions as if they still lived there?

• Should a claimant expect Sark to pay for years of residential care off-island? (Currently residential care is approximately £650.00 per month and standard nursing home care is approximately £1,300.00 per month. Specialist care, such as Dementia Care, is considerably more. These costs are similar to the UK outside London. Definitions of what each type of care actually means can be found in Appendix 1). The current Island Insurance AXA PPP does not cover any residential or nursing home care or home nursing costs.

• Should families have to contribute?

• Should Sark have its own residential care home and claimants have to move from their own homes to receive care?

• What happens if there are too many claimants for the Sark exchequer to support to the level the claimants expect?

• Should medical insurance be compulsory for by all residents and temporary workers on Sark?

The policy letter to Chief Pleas said:

"Of course there are many in our community who do assist their family and their neighbours without giving it a second’s thought. They do this quietly, serving their community in many practical ways. There are always those that criticise and are vocal in their views on who should or should not receive help. There are those who say the care given is not the right help or at the right time. The care given by the Procureurs directly or at their request is undertaken following a careful assessment and using advice given by professionals on and off the island. Care cannot be forced on an individual."