MSG contract is ailing and needs major surgery

IT IS time to tear up the contract with the Medical Specialist Group. And if there is one thing the parties concerned with the delivery of secondary healthcare seem to agree on, it is that an agreement drafted in 1996 and largely unrevised when renegotiated in 2002, is no longer fit for purpose.

One step further than that, a new independent report by Sector, which has publicly shone a spotlight on the MSG in a way not done before, says that taxpayers are not being guaranteed value for money by it.

When the contract with the MSG was introduced, it was a landmark development, but one that has not grown with the new ways of thinking about healthcare delivery.

MSG chairman Dr Steve Evans argues that there is a high quality health service, and this happened despite, not because of, the contract.

'We expect that contract to look very different, but that's a good thing, not a bad thing,' said Dr Evans.

A modern contract will focus on outcomes, not just waiting times.

Everyone seems to recognise the deficiencies in it - Sector said it contained few specific measures of either quality or quantity.

'The ability of the States to manage the contract is compromised as it has no equivalent clinical skills to oversee the contract and to assess the outcomes,' it said.

And one of the major problems, for the islanders at least, is that a lot of the work done on evaluating the service is not in the public domain.

When challenged on the idea of scrutiny, Dr Evans said that each area of its work was independently assessed and benchmarked, but these reports remain confidential.

He would have no objection to them being released, but said as they were commissioned by Health and Social Services or the Social Security Department it was for them to decide.

There were other areas for scrutiny.

The number of consultants has grown from 19 in 1996 to 39 - a reflection of the services being offered, and the specialisms expected in the modern health world, as well as shifting demographics perhaps, but again where is the evidence of value for money?

One of the weaknesses of the system is that fees are paid monthly based on the number of consultants employed, but there are no requirements on hours worked or what they do.

Sector uncovered concerns about the amount of private work done by the MSG consultants, in one case reporting this was more than 50% of one consultant's work.

Dr Evans made a defence of the £750,000 spent on the MSG's premises in 2010 - Sector argues there are savings to be made here, perhaps using facilities at the PEH.

MSG does not own the building, but some of the consultants are members of the company that does, he confirmed.

'It's a small minority of the consultants. They tend to be the founding partners of MSG,' he said.

'It's in the interests of the rest of MSG to make sure rent is fair, which is why it's dealt with on a commercial basis.'

He said there was very limited space in the new building at the PEH - HSSD was already struggling to accommodate visiting consultants.

The amount of money spent by the MSG for employing locums is also eye opening at £677,000 in 2010.

'We can't provide services without them and they are expensive to get,' said Dr Evans.

It tended to be to cover out of hours work, he said, so without them the service and waiting lists would be compromised.

Sector made comparisons with other jurisdictions, although this has left it open to challenge about how they were worked out because of the different systems in place elsewhere, for example the use of junior doctors in places such as Jersey.

Still, it appears resolute when it states: 'it is clear that the directly employed consultants on Jersey cost considerably less than is the case on Guernsey.'

Providing secondary healthcare in Guernsey is always going to suffer from diseconomies of scale - a population of 60,000 would not in the UK even warrant a general hospital.

But it seems there are other models that could be explored, all of which Sector said had their pros and cons.

These range from essentially the status quo, but with an improved contract that is not just about hitting waiting list targets, to putting control of the hospital into the hands of the MSG - a radical step that no doubt the States would baulk at because of the control it would lose.

Health and Social Services is under way with work on its 2020 vision for health care.

This includes the contract with the MSG, up for renewal in 2017. If a rethink of the entire model is on the cards, investigations need to begin early with everyone involved.

Things become even more pressing as the shortcomings of the current arrangements have been exposed.

* The Sector report was commissioned by the Public Accounts Committee, which will now begin its own work on the findings.