When news broke that the Health and Social Care Committee is contemplating charging patients for specialist treatment or even staying in hospital, my immediate reaction – posted on X/Twitter – was that it would go down in history as the biggest betrayal of ordinary islanders and an admission that the States has totally failed its people. This is why.
More than 30 years ago this newspaper ran a cartoon. It showed a hospital bed, a doctor in a white coat and stethoscope striding towards it, a patient hiding underneath the bed and a nervous-looking teddy bear propped up on the pillows.
It triggered legal threats from the medical fraternity (some things don’t change), who viewed it as defamatory, because it was a blisteringly satirical commentary on what was the issue of the day – islanders being bankrupted and losing their homes to pay for specialist medical treatment.
Huge bills were being racked up as medics glanced at patients and charged them for the privilege. ‘This one’s not dead, Nurse, that will be £1,200 thank you…’
It was such a scandal that the States – back in those days deputies and committees actually did stuff – said never again. And the system that we now know as the secondary care Medical Specialist Group was introduced, so treatment in our taxpayer-funded hospital by medics who were experts, and knew what they were doing, was free at the point of use. A mark, you might think, of a caring, civilised community.
This was a solemn and binding commitment that never again should islanders be terrified of seeking medical attention because of cost. A package of funding was put in place to secure this aim and much the same was done about long-term care, to stop people from dying on their kitchen floor rather than have the States confiscate the family home to pay for that end of life process.
Both are now under threat and what was presented as an irrevocable commitment to put the interests of islanders first is to be swept away, pretty much on a whim.
However you regard it, this is a colossal betrayal of thousands of islanders who paid into a system they believed – were assured – was part of the deal of being a Guernsey resident.
Now, I get that times change. Giving away business tax revenues of £100m. a year when zero-10 was introduced at the start of 2008 may have been the correct decision at the time and the great recession/credit crunch hitting the same year was unfortunate. So, too, was the devastating impact of Covid in 2020.
But here’s the thing. Pretty much throughout this period the States, your elected government, has carried on as though nothing much happened. While the rest of the world was rapidly adjusting to the new normal these events demanded, for Guernsey it was, and remains, business as usual.
Then Treasury minister Charles Parkinson reported in the 2008 Accounts that revenues of £350m. were £43m. more than expected and costs had been contained. Expenditure was up by just 1%, which was £11m. less than forecast.
Since then, successive States have trashed that inheritance, piled on cost and headcount, failed to commit funds to the OAP pensions pot (although civil service pensions are fully funded), secondary health care or long-term care.
Despite highlighting what was then called the demographic time bomb, it has manifestly failed to prepare for it.
Along the way it has wasted £42m. on bungled IT projects, gifted us the collapse of government through what was called Fallagate, botched the hospital modernisation project and blown £63m. on consultants.
It has presided over a cost of living crisis for islanders, watched house prices and rents soar past London levels and shrugged as islanders either left Guernsey or turned to food banks and charities or borrowing to try to get by. Living standards have declined thanks to those rising housing costs and declining real incomes.
At the same time, the number of States employees has risen from 2008’s total of 5,400 to 6,600 today and the cost of paying them has mushroomed from £163m. a year to not far short of £400m. The average cost has doubled to £60,000 at the same time as median pay for ‘ordinary’ islanders was £42,672, actually a decrease of nearly 1% after allowing for inflation.
It’s also worth mentioning that back then in 2008, there were more than 7,500 people working in finance and while public sector employment has grown, that in financial services has since shrunk by more than 2,500.
So, here’s the double failure for ordinary islanders. Faced with the consequences of the States’ own economic mismanagement, the new president of Health & Social Care’s knee-jerk reaction is to put up prices and reduce the care package that’s available. He will also be looking to charge pensioners for their multiple life-saving prescriptions.
Meanwhile, States expenditure remains untouched and civil service growth unchallenged. At the same time, the new Health president promises the introduction of a new ‘sustainable’ system.
Jesus, Mary, Joseph, and the wee donkey… The States agreed to just that in 2017 under something called the Partnership of Purpose: Transforming Health and Care, which promised user-centred care, joined-up services, where people were valued, listened to, informed, respected and involved throughout their health and care journey.
They were also promised (promised, ha!) fair access to care, improved out-of-hospital services through the development of community hubs, better governance and quality of performance and direct access to services.
Despite this being an approved States direction with, I think, funding, the last Health Committee under Al Brouard did nothing to advance it. Too busy, he said. And Policy & Resources let him get away with it.
Now, a new president who really should know better – after all, he’s lived and worked through everything that led to the existing system – wants to chuck 30 years of Guernsey’s NHS in the bin and ignore an existing States resolution on ‘improving’ what we already have.
If I sound angry, it’s because I am. Hard on the heels of this, Policy & Resources announces a Government Work Plan focused on five ‘super-priorities’ that are nothing of the sort. They’re simple political posturing.
The real priorities for islanders are cheaper rents and housing, easing cost of living pressures – especially States-controlled ones like electricity, waste and water and TRP – and tangible signs that government is controlling its own costs and insatiable demands for higher taxes.
Above all, they want their living standards to improve, real incomes to rise and Guernsey’s economy to improve. Instead, government embraces stagnation and merely grows its own revenues at the expense of islanders.
Which, of course, is why Victoria Park has just distributed 86 Christmas food parcels to struggling local families. That’s not meeting demand, by the way. It’s all they had.
So apologies for being bleak this Christmastide. But betrayal and failure have no place in the Guernsey I used to know – and respect.
