Pilot scheme will not fly in the long term

It is not, and is not intended to be, a worthy replacement for the long-lamented reciprocal health agreement.

That RHA was terminated without notice by the UK in 2009 and islanders have spent a decade bemoaning its demise.

The ESS plan is a stopgap, not a solution, which will satisfy few. It is a pilot scheme which, if successful, should help those islanders who cannot get medical cover leave the island to see family and friends.

The difficulty is that the committee is worried about the size of the blank cheque they are writing. How many islanders will bill them for hospital treatment in the UK? They estimate 160 a year.

To keep it that low the restrictions come in. ESS says that it is simple to administer and understand. It may be the former, it is not the latter.

Applicants have to jump through a number of hoops to get a card promising a UK hospital that they have cover.

First, they must go to two different insurers and have savings of less than £100,000. There are further questions about complex needs, pre-existing conditions and age.

Having got the card, they must understand its limitations. They still pay the first £250, for example, and it covers only secondary care up to a £250,000 limit.

In theory, the individual is liable for bills over £250,000. Even in the expensive world of medicine that seems unlikely but it will worry some.

What will happen if, as seems likely, the patient is unable to pay?

Islanders liked the original reciprocal agreement for its simplicity. People felt that they were covered for everything.

It wasn’t strictly true – repatriation of a body and renal dialysis was never covered – but it involved minimal effort and it gave peace of mind.

An RHA like that will never return. Even when the UK stops worrying about Brexit and gives thought to a new agreement, it will not match the 2009 model.

For now, the best that can be said about this interim scheme is that it is better than nothing.