Wanted – dynamic, brave, collaborative, evidence-led deputies capable of consistently making and implementing strategic decisions.
In December 2017 a strong Health & Social Care Committee, led by Heidi Soulsby, brought to the States one of the most comprehensive and pivotal policy letters of the last 25 years – a ‘Partnership of Purpose’ with the aim of transforming health and care in the Bailiwick. Some described it as too aspirational, others a transformational road map. It was voted through unanimously, including a £3.5m. transformation and transition fund.
The policy letter told us health and care was becoming increasingly unsustainable due to our ageing population, medical inflation and increasing expectations of islanders, many with long-term and chronic conditions, from dementia and cancer to arthritis and diabetes, which were already dominating the population’s health and care needs.
It warned us the health and care budget would need to increase from the then £193m. to £267m. (index-linked, including medical inflation) by 2027 if nothing changed in the way that health and care was provided, and if the States’ financial framework remained the same, putting significant pressure on other public sector budgets, or on the taxpayer.
Clearly identifying the dangers ahead, it provided a 10-year plan to change the health care landscape forever. Key amongst those changes were:
1. The creation of easily accessible community hubs (including Alderney), bringing together a range of community services currently scattered across the island.
2. Ensuring services were joined up digitally, making use of apps, tele-health and tele-care (remote consultations or follow-ups) and other technological advances.
3. Effective commissioning of services from voluntary organisations.
4. Developing a universal offer of services and a care passport setting out individual entitlements with a range of health and care services, either free or at subsidised rates, to provide a core set of services that all Bailiwick residents should have access to, enabling greater equity of access, bringing down the cost barriers to islanders who were struggling to afford the care they need.
5. The creation of a Health Improvement Commission to raise awareness of and encourage healthy lifestyle choices.
6. Social prescribing schemes.
7. Establishment of a panel called CareWatch, made up of representatives from the community, to ensure the voices of services users were heard and embedded in service development.
8. An independent care regulator and health ombudsman to deal transparently and consistently with complaints across all services.
This would all be underpinned by 10 key principles, including:
Fair access to care: ensuring that low income was not a barrier to health;
A focus on prevention;
Effective community care – improving out-of-hospital services and enabling people to receive care closer to home.
During debate in 2017, president of Employment & Social Security, Michelle Le Clerc, reminded the States that the £12 grant towards a GP appointment was introduced in 1991 as a step towards what was envisaged would become a comprehensive health insurance scheme covering primary care, secondary care and hospital services.
A wise plan and an opportunity lost? Perhaps it’s not too late for a dynamically-led Health Committee to investigate the viability of on-island health insurance schemes?
So where are we now? Just eight years on, the 2025 HSC total revenue cost to the States for delivering health and social care services is expected to be an eye-watering £285m., 46% of the States’ total £622m. budget.
Since January 2025 three revealing health reports have been published.
The first, HSC’s Secondary Healthcare Contract 2024 Key Performance Indicators report, slipped unhelpfully under the radar.
Three areas deserve comment. In summary:
Contract inpatient/outpatient waiting time KPIs remain well below the 95% target at 54% and 68% respectively. Despite considerable effort, numerous initiatives, and the completion of Phase 1 of the hospital modernisation, increasing demand has meant waiting list numbers have stabilised but remain stubbornly high. Without Phase 2 of the hospital modernisation, these numbers will only go in one direction for contract patients.
Delayed transfers of care days, or bed blocking to you and I. The target was less than 100 days per month, but the actual figure was 338 days. Many of these patients require home care packages, a bed in a nursing or care home, or are waiting for a review by the Needs Assessment Panel.
Complaints procedure. With a target of 75% resolved within 20 operational days, the actual result was 62%, a decline on last year. Worryingly, we have also seen a 59% increase in formal complaints. Why? With an admission the resources to fully investigate those concerns are not there.
The second report published is the Community Foundation’s Guernsey Quality Of Life Report 2025.
While observation 1 reassures us we have a lot to be thankful for living in Guernsey, it’s a rather depressing read after that. Observation 7 says cost is stopping islanders looking after their health, with observations 8, 9, 10, 11 & 12 highlighting concerns over stress, loneliness, increasing violence and our suicide rates, particularly amongst the young. A focus on mental health services has to be a higher priority.
The third was the Medical Officer Of Health Report, 2023-2024.
Picking out just a few quotes from Dr Nicola Brink MBE, director of public health, who firmly reminds us all:
‘The case for prevention has never been stronger – we need to look further than the next year or two and take bold steps to shape the health and wellbeing of islanders in the decades to come.
'Failing to do so will mean that we leave a larger burden of ill-health for future generations.
‘We cannot continue to focus on acute care at the expense of prevention.
‘We also have to change the narrative from ill-health being a burden to good health being an economic enabler. Quite simply, a healthy population is a productive population.’
Finally: ‘Prevention is the responsibility of the whole of the States of Guernsey.’
In wholeheartedly agreeing with our director of public health I would go further and say it is incumbent on each and every one of us to take much greater responsibility for our own health.
Clearly, since the 2017 debate some progress has been made, but too many of the key elements of the transformation programme have NOT materialised.
1. The review of the model and funding for primary care has stalled.
2. The supported living and ageing well strategy (Slaws) has stalled.
3. The universal offer and care passport remain conceptual.
4. We are yet to see a community hub.
5. No material investment in prevention as evidenced by Dr Brink and Public Health.
6. Plans for Phase 2 of our hospital modernisation, on which so much of the transformation depends, are in tatters.
7. And from the health service-user perspective the lack of a health ombudsman or ‘watchdog’ deprives islanders of the ability to take unresolved complaints to a fully independent and impartial body, limiting transparency and trust in the complaints process.
An organisation that limits its ability to identify areas needing improvement, that is reluctant to recognise and acknowledge mistakes,, or allow challenge from within to enhance standards must itself be challenged.
Undoubtedly, we are very lucky to have the health and care services we do in an island that is the equivalent of a medium-sized town in the UK.
The range of services we have and staff that look after us are outstanding, but we pay a lot of money for that privilege, and it is a privilege that increasing numbers among us are just unable to afford or will not be able to afford in the future, if we continue as we are.
Therefore, in challenging the next States to step up, be bold and make the big decisions, we also need to play our part and accept we will need to pay more for the services we enjoy.
What might that mean when choosing a deputy?
For me they need to support fiscal policy that guarantees the funds required for investment in infrastructure, housing, education, health, the environment and the economy. That means GST-plus stays, it means progressing multilateral corporate tax reform, it means growing the economy, and maybe even a wind farm off of the west coast of Guernsey.
But do not get taken in again by those ‘snake oil’-selling election candidates who tell you taxes do not need to rise.
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