What are you prepared to do without?

THREE neighbouring islands – three different approaches to identifying and meeting health priorities. The contrasts, and they are marked, are between Sark, Alderney and Guernsey.

Just eight miles away, healthcare is limited to a resident GP and whatever you or your insurance can afford if you’re unfortunate enough to need an emergency transfer to Guernsey for more major treatment.

In Alderney, with its 22-bed Mignot Memorial Hospital and links to this island’s range of services, the priority is how its States is to fund a £737,000 overspend at the Connaught Care Home, which desperately needs extra capacity for its much older resident population.

Here, the expectation is that health care should be as close as possible to that in the UK, but with shorter waiting times and better outcomes, funded by income tax at just 20p in the £, no capital gains or inheritance tax and no GST.

This isn’t to rehearse the debate about Nice TA drugs or the cost of providing super-expensive treatments. But it is a vivid illustration of the different expectations the three communities have of what their respective governments should be providing.

Move to the smaller islands and some facilities and services will not be available. Live here, and welcome to the equivalent of offshore Hampshire.

The post-war boom years were kind to Guernsey and, as consultants Capita said in 2009, regular States surpluses enabled ‘gold plated’ services to be provided ‘or indeed services where there is no clear rationale at all for government intervention’.

Those times are past and none of the alleged government reforms to date have tackled service provision or seriously addressed outsourcing.

This matters in the run up to the taxation review, as we argued earlier, because that’s presented in black and white fund-raising terms. It should be more nuanced and recognise that services have been provided here simply because the island could then afford to do so.

Like Sark and Alderney, it’s equally valid to ask islanders what they’re prepared to go without to remain a low tax jurisdiction.

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