This property row could be good news for us

That having a premature baby would cost you, in today’s money, around £40,000 for the care and treatment required?

No, I thought not. Because things have moved on and the health issue of the ’80s – how islanders afforded specialist or ongoing health care – has disappeared.

As a result, we don’t hide under the bed when someone in a white coat enters the ward as all that’s now free at the point of use because we’ve separated primary and secondary health care.

Instead, we now benefit from, in effect, a compulsory private health insurance scheme that gives us unlimited access to the skills and care of the doctors at the Medical Specialist Group.

But when it became clear in 1991 that the MSG operation was going to begin at the start of the following year, very little was actually in place to make it happen. No premises, no partnership agreement, no staff, nowhere to work.

Which is why MSG first opened in an enlarged bungalow called Amorel at Grandes Maisons Road, St Sampson’s, alongside the Saab garage. Both are still there, although the house is now unrecognisable.

It was a leap of faith as the founding partners had no contract in place, no idea whether they’d make any money or whether they could even remain in Guernsey – the health authority of the day was threatening directly to employ its own doctors.

No change there today, then, and you could perhaps forgive the current partners if they were to feel under threat much of the time, especially with the new, 1 January, contract being for only five years.

The need for ‘proper’ premises led to an MSG search and possibilities were the old Tektronix (now Specsavers) accounts building or a place in Havilland Street – both of which presented problems.

Anyway, the current MSG HQ at Les Frieteaux came about as the then partners were offered part of the old Alexandra Nursing Home site by Jeff Kitts, who used the sale to fund the filling station and convenience store he built alongside.

The purpose-built Alexandra House emerged but, because the partnership model of the MSG caused ownership issues, it was easier to put it into a holding company, called Vignon Properties Ltd.

I mention all this because, 25 years later, the MSG is back in the news… because it wants somewhere to operate from.

As things stand, the current MSG partners have no financial interest in their current HQ but pay about £770,000 a year for Alexandra House and adjoining Mill House (forget other sums you may have heard).

We know they have concerns about the cost and suitability of the premises and, presumably, engaged property consultants to scope alternatives. Park Place has been identified as a suitable, if controversial, possibility which, I believe, was on the market for £6.4m.

Having poked this around a bit, I gather that the rent for the current Les Frieteaux premises has, after a full rental and market review, been reduced by around 70 grand a year and the owners are prepared to sell to MSG – or anyone else come to that – for a valuation based on the lower rental.

There have been suggestions that the existing premises are not fit for purpose. Yet the architects who designed them incorporated future-proofing into the steel frame so the internals are stud, and easily moved to increase office accommodation, lifts, extra consulting rooms or air con as required.

I also gather that the current landlords have offered to fund improvements, subject to detailed specs and costing, with the rent being adjusted to account for any improvements.

Park Place, it should be noted, will also need remedial work before it can be used by MSG.

Either Mill House or Alexandra House could be extended or linked and I gather the ground conditions for building are excellent, although it’s obviously very disruptive to have work like that going on while you’re using the premises.

Anyway, you can see this is a complex picture. And that’s before you factor in any irritation there might be with today’s partners effectively funding the retirement of their predecessors through what they pay in rent.

After all, I think we’d all like to own our business premises, especially if they provided an income after we stopped working, wouldn’t we?

Similarly, the complaints about location look overdone. Outpatient and inpatient medical care are separate services and it’s rare for MSG to admit someone to hospital from Alexandra House.

As long as you and I can park, and up to 30 spaces will be available for patients, where you see the MSG doctor or their staff becomes largely irrelevant.

So far so good, then. This ought to be a largely commercial matter between the MSG’s business managers, the landlords and the vendors of any new property.

There is a slight twist, however. The two leases on Alexandra House and Mill House aren’t synchronised. I believe MSG declined an earlier offer to have them renew on the same date.

So while rent on Alexandra House is payable to the end of the year, extendable to 31 March at the reduced sum, that on Mill House runs until June 2025.

MSG is required to honour that – in excess of £2.25m. over the period as far as I can judge, and which no doubt impacts on the Park Place costings. That’s also dead money which, from a States perspective, is being funded by taxpayers.

If you’re still with me, you’ll notice a few things. We’re talking big sums. The location of the MSG has some significance, whether overdone or not. Patient care and outcomes haven’t been mentioned.

Enter Health & Social Care. Yes, back in the 1990s when MSG was being mooted it rejected a request to locate the specialists in the hospital complex but, by 2012, it was back on the agenda and work had started on planning co-location at the PEH.

Well, times move on and HSC is a very different animal from the old HSSD. It is determined to achieve true service transformation – not just cost-cutting – and believes that the specialist service it largely funds should be part of that.

With 98 employees at the separate MSG HQ, what scope for merger and rationalisation of back-office staff if they were incorporated into the PEH operation, it wonders?

Add to that savings on rent, improvements in integration, record-sharing, risk management, greater control of outcomes and practices and secondary care could become really joined-up, even if the doctors remain self-employed within MSG.

Some of this thinking will emerge shortly when HSC publishes a major report on the future of healthcare, which will also touch on the affordability of GP fees – that should be one to watch.

Meanwhile, the MSG’s stated view is that HSC should prioritise building a larger maternity unit closer to theatres, a larger Critical Care Unit, a bigger Day Patient Unit, a fifth operating theatre, a new orthopaedic ward, enhanced private patient facilities and a large central equipment store before worrying about where the specialists are accommodated.

Enhanced private patient facilities eh? But we’re all private now, aren’t we?

Well, yes. But not everyone has separate health cover on top and there are big benefits all round if enhanced facilities encourage patients to use their insurance cover.

Using the hospital and consultants to generate extra income and encourage people to come to the island to recuperate here is also an attractive proposition and one, I believe, that is actively being considered.

So while this looks like a bit of a row over property, it could end up hastening real and significant transformation of secondary healthcare and generating more income all round.

So what’s not to like? But the negotiations to get there will be crucial.

u Richard Digard is a freelance writer, consultant and a former editor of the Guernsey Press.

richarddigard@guernseypress.com