He cited an ageing population, increased waiting lists, and a current lack of certain facilities as severe issues facing the Committee. 

“If you push me, I will have to put up fees - I would prefer not to, and I would prefer it to come from the public purse... from general taxation. 

“But, if you give me the choice that ‘you're not going to have [funding] but [there are] people suffering who need to be helped', then I'm afraid somebody will have to pay.” 

That somebody was alluded to during questioning by Scrutiny President, Deputy Yvonne Burford, who asked earlier in the hearing: “One of the components of the Partnership of Purpose is the definition of what services can be offered without charge to the public, in other words, the universal offer. 

“What do you believe could be excluded from the current offering and should charging for certain items which are currently free be implemented?” 

Deputy Brouard said ‘yes’ and gave several examples. 

“Charging at A&E... A&E costs us roughly £4 million a year, we recoup back about £2 million. It's a private service from that point of view, we could increase the fees there,” he said. 

“Do we necessarily need to have free ‘pills and potions’ for those over 65, that's another area where we could look to increase our income - should we have our ‘pills and potions’ at the same levels that they have in the NHS which is probably double what we're charging?” 

Pictured: In Guernsey at the moment, over the state pension age do not need to pay prescription charges. 

Deputy Brouard continued, identifying the £12 subsidy on doctor appointments.

“The £12 pound grant to doctors, is it really providing the service that we want it to?  

“[Making these changes would be] quite difficult and would need the support of the States.” 

He went on to say, that with Policy and Resources support he would hope to bring some of these topics to the States for debate this term. 

During the discussion on tight finances, the newly appointed Vice-President of HSC – Deputy Mark Leadbeater – said there is an ongoing discussion around private medical insurance, and how often it isn’t being used. 

“We're also looking at various different ways we can encourage or compel people to use their medical insurance, because at the moment we've got a considerable number of people that... have medical insurance that comes along with their job,” he said. 

“Many people don't use that medical insurance... now, if we could find a way to encourage people to not do that... or even if we can compel them to in some way, that will make a considerable dent.” 

Following the Scrutiny hearing, Deputy Brouard published a clarification statement:

"While it has been known for more than a year that we are reviewing our charging structure for the Emergency Department, this is still at the review stage. There are no active plans to remove subsidies.

"There is of course the work Policy & Resources is undertaking, looking at savings and charges through the 'Reducing the cost of Public Services Sub Committee'. 

"I thought I was clear in the Scrutiny hearing that we have a challenging position in health and care where even though we hope to increase capacity to deliver services, with initiatives like Our Hospital Modernisation, we are under pressure with increases in costs of providing those essential services that islanders need, due to increasing demand – this demand is difficult to control and where prevention can play a part.

"So from a financial perspective, my preference is the States fund healthcare through the Budget and general taxation, but we all recognise that public finances for the whole of the States are also challenging. However, if we in HSC had to generate more money ourselves, then increasing charges or removing subsidies are the only levers we have to pull, as we think that is preferable to switching off services."

Pictured top: (Left to right) Dr Peter Rabey, Deputy Leadbeater, Deputy Brouard, and Director of Operations, Dermot Mullins.