Debate is wider than just MSG

One of the questions posed by the Public Accounts Committee's publication of a report into the value for money of the island's consultant-based secondary healthcare system is, what happens next?

Consultants Sector had a specific brief, to look at secondary care, because that is funded by money raised compulsorily through Social Services and is therefore a public funding issue.

But as the Health and Social Services Department's earlier Future 2020 Vision document highlighted, paying for health and social care is a substantially bigger issue than islanders' relationship with the Medical Specialist Group.

In total, the wellness sector consumes in excess of £300m. a year – equivalent to a little over £7,000 per taxpayer.

But because that is not enough given the demand for services and the fast-approaching impact of the ageing population, making sure it is efficiently spent is one way of making it go further.

One of the anomalies of the island's system, which grew from private practice doctors, is that GPs have a financial incentive to treat as many patients as possible while MSG consultants get paid irrespective of how many they see but have the facility for more lucrative non-contract work if they have time on their hands.

If a GP or one of their nursing staff performs, for example, a surgical routine, that's further income generated from the patient but if the same patient had the same procedure with a consultant they would not be charged.

The cost versus quality of care issue is complicated but, with the States having agreed to pursue a policy of keeping people healthy in preference to treating them when ill, there is little sense in having conflicting systems in a population of just 62,000.

So while the matter of renegotiating the contract with the MSG, or finding some alternative way of delivering secondary care, has to go ahead well before its 2017 expiry date, whatever emerges must dovetail into the much wider – and significant – 2020 Vision initiative.

That represents a considerable amount of detailed work plus some crystal ball-gazing but getting it right will be vital if the Bailiwick is to have a sustainable health and social care system.