The debate about healthcare in Guernsey usually begins in the wrong place. Whenever costs rise, whenever another overspend appears in the health and social care budget, and whenever another delay or complication emerges in the hospital redevelopment programme, we are told that the problem is an ageing population. It has become the standard explanation for almost everything.
The trouble is that it may no longer be true.
We have become so accustomed to blaming rising healthcare costs on the growing number of elderly people that we have stopped looking at what is actually happening around us. Guernsey is not a typical jurisdiction. Nearly half our population was born elsewhere. Large numbers of working age people arrive on licences and leave again a few years later. Our birth rate remains well below replacement level. We are not simply getting older. We are constantly changing.
That matters because it changes the nature of the challenge facing our healthcare system.
The real question may not be how we cope with more elderly people. It may be how we cope with a smaller pool of working age people who are becoming increasingly unhealthy. Obesity, type 2 diabetes, cardiovascular disease, poor mobility and mental health problems are all becoming more common, often appearing much earlier in life than previous generations would have expected.
If that trend continues, the greatest burden on our health and welfare systems may not come from people in their 80s and 90s. It may come from people in their 40s, 50s and 60s who spend decades living with preventable chronic conditions.
That brings us to a question that politicians rarely ask.
Why are we spending so much time discussing how to treat illness and so little time discussing how to prevent it?
We have already committed well over £130m. to new operating theatres and hospital facilities, yet far less attention is being paid to preventing the conditions that fill those theatres and wards in the first place. It is rather like constantly expanding the fire brigade while ignoring the growing number of people playing with matches.
Obesity provides perhaps the clearest example.
The direct cost of obesity to Guernsey’s healthcare system is often quoted at around £6.5m. a year, but that figure captures only part of the picture. Once obesity contributes to knee replacements, hip replacements, heart disease, diabetes treatment, lost productivity, disability support and other associated costs, the true burden becomes far larger. Some estimates suggest the overall impact may be closer to £25m. annually.
That is a remarkable amount of money for a small island to spend dealing with a problem that is, at least in part, preventable.
For the first time in my lifetime, we possess tools that genuinely appear capable of changing the situation.
The arrival of GLP1 medicines such as Mounjaro has the potential to transform public health in the same way that antibiotics transformed infectious disease. For decades we told people to eat less and move more. Sometimes it worked. Often it did not. Many people found themselves trapped in a cycle of weight gain, failed diets and deteriorating health.
Now we have treatments that are producing results that would have seemed almost impossible only a few years ago.
I know because I am one of the statistics.
Over the past year I have lost almost 60kg. My type 2 diabetes has gone into remission. My mobility has improved dramatically. Activities that once required planning and determination are becoming routine again. If those benefits can be achieved for one individual, imagine the impact if hundreds or even thousands of islanders experienced similar improvements.
The current pilot programme involving around 300 people is a welcome beginning, but it should be viewed as a starting point rather than a destination. If these medicines continue to demonstrate long-term benefits, we should be thinking much bigger. Every case of diabetes prevented, every heart attack avoided and every joint replacement postponed represents a saving not only in money but also in human suffering.
Yet drugs are only part of the story.
A second revolution is already under way.
Artificial intelligence and robotics are advancing at extraordinary speed, and healthcare may ultimately become one of the greatest beneficiaries. Many people hear the word robot and immediately imagine machines replacing nurses, carers and doctors. That is not what is being proposed.
The real opportunity lies in supporting human care rather than replacing it.
Imagine an elderly person remaining safely in their own home for several additional years because intelligent monitoring systems can detect falls, remind them to take medication, monitor their health and alert relatives or healthcare professionals when intervention is needed. Imagine routine administrative tasks being handled by artificial intelligence, allowing doctors and nurses to spend more time with patients. Imagine a small island able to stretch scarce healthcare resources much further without compromising standards.
That future is approaching whether we like it or not.
The danger is that we respond in the way governments often respond to innovation. We regulate first, worry second and innovate never.
Guernsey has historically succeeded when it has embraced new opportunities before larger jurisdictions. Our finance industry grew because people were prepared to think differently. Our future healthcare system may require the same mindset.
Instead of viewing technology as a threat, we should view it as one of the most powerful tools available to help us build a sustainable health and care system. Small jurisdictions possess one advantage that larger countries often lack. We can move quickly when we choose to do so.
That requires a fundamental shift in thinking.
For generations healthcare policy has focused primarily on treatment. Someone becomes ill and we attempt to make them well again. There will always be a need for hospitals, operating theatres, consultants and specialist services. Nobody is suggesting otherwise.
What must change is the balance.
Every pound invested in preventing obesity, reducing diabetes, improving mobility and helping people remain independent for longer has the potential to save many pounds later. Prevention may not generate dramatic ribbon-cutting ceremonies or impressive artist’s impressions of new buildings, but it often delivers far greater value.
The Health & Social Care Committee frequently speaks about creating a sustainable health and care model. If that ambition is genuine, then this is the moment to be bold. Expand access to proven weight-loss treatments where the evidence supports it. Become an early adopter of healthcare technologies that improve outcomes. Encourage innovation rather than smothering it beneath layers of caution. Focus less on managing illness and more on preventing it.
We stand at a crossroads.
One path leads towards ever larger healthcare budgets, ever greater demands on taxpayers and an endless struggle to fund the consequences of preventable illness. The other path focuses on prevention, innovation and personal responsibility, supported by technologies that previous generations could scarcely have imagined.
We cannot build enough hospital wards to solve every health problem that lies ahead. At some point we must reduce the number of people needing those wards in the first place.
That is why the future of healthcare in Guernsey will not be determined by how many bricks we lay. It will be determined by how successfully we keep people healthy enough never to need them.
