I have called my stoma Eugene Le Pet. I had to call him something and Eugene seemed to fit. Like a good Guernseyman he grumbles a lot, is often full of wind but at the core is a good friend and a lifesaver. He proudly tells me his family have been grumbling about the States since 1204, although I haven’t yet discovered which parish they came from.
I didn’t know I needed a stoma at the beginning of this month. In fact on Saturday 8 August I didn’t know there was anything particularly wrong with me other than a bad stomach, although by the following evening I was in A&E and shortly afterwards somebody told me I had a complete sigmoid volvulus. I had never heard of one of those either. It means your bowel has twisted, which sounds rather less impressive but hurts considerably more than it sounds. They untwisted it, it twisted again and after rather more adventures than I intended to have during August, I ended up with an ileostomy and Eugene. I have therefore been thinking quite a lot about healthcare recently, although mostly from the wrong side of the sheets, and I have probably cost the States a fortune.
George Oswald’s letter to the Press caught my attention. George is worried about the decision to limit the increase in States spending to inflation because healthcare costs are going up faster than inflation. He gives the example of off-island treatment which cost £19.6m. last year and went up by 9%. I suspect George is right about healthcare costs. I have seen enough expensive-looking people, equipment and machinery this month to believe him and I certainly don’t want to discover the next time Eugene or some other bit of me goes wrong that we decided to save money by not having a surgeon on Tuesdays. What I don’t understand is why any of that is an argument against the cap. The cap is on States spending, not George’s spending. There is nothing, as far as I can see, which says that if inflation is 4% every committee gets another 4%. Health could get 8%. It could get 10%. It could presumably get considerably more if the States decided health was where the money was most needed. Somebody else just couldn’t have it.
I think that last bit is where it gets interesting because we talk a lot about priorities without often having to choose between them. A new priority tends to be added to the old priorities, which rather stretches the meaning of the word. If Health needs another £10m., why does that automatically become another £10m. which taxpayers have to find? Why isn’t the first question what the States is currently spending £10m. on which matters less? There may be nothing, although I would be surprised, but I would like somebody to have a proper look before coming back for more tax. Every pound already being spent has somebody to defend it. There is a committee, a policy, perhaps a quango, somebody employed to do whatever it is and somebody able to produce a very convincing explanation of why stopping it would be a thoroughly bad idea. They may even be right, but it does make it remarkably difficult for the pound ever to escape.
Take Locate Guernsey, Visit Guernsey and Guernsey Finance. I am deliberately choosing things which I don’t think are necessarily a waste of money. Guernsey Finance in particular represents an industry which pays a very large part of our bills and I spent enough of my working life in finance not to underestimate its importance. Tourism brings money into the island and attracting the right new residents and businesses can bring tax revenue as well. All three can make perfectly respectable cases for receiving public money, but that doesn’t finish the argument. For every £1 we give them, what does it actually do and is that more important than what George could do with the same £1 at HSC or what education could do with it in a classroom?
Perhaps the answer is yes. If Guernsey Finance can demonstrate that £1 of States money protects or attracts enough business to produce £10 of tax revenue, it would be rather foolish to take the pound away and congratulate ourselves on saving it. The same applies to Visit Guernsey. If spending money attracting visitors demonstrably brings considerably more money into the island, there is a case. Locate Guernsey might bring us somebody who creates a business, employs people and pays enough tax to cover the cost many times over. Excellent. I don’t want to cut any of them simply because health sounds more worthy. I want to know what we get for the pound, because saying something is a good thing isn’t enough when almost everything government spends money on can be described as a good thing.
Net zero is where I become rather more difficult. If somebody offered me £1m. and said it could either go towards getting Guernsey a little closer to net zero or George could spend it on healthcare, George can have it. I wouldn’t need long to think about it. Guernsey’s contribution to worldwide emissions is minute and however enthusiastically we reduce it, our effect on the world’s climate will also be minute. If insulating a States building saves more than it costs, do it. If using less electricity saves money, wonderful. But spending public money largely so that Guernsey can point to a target and show what good little global citizens we are starts looking like pretty zero to me. Virtue signalling is relatively harmless when you are signalling with your own money. I become less enthusiastic when George wants the same pound for a patient.
There will be plenty of other examples and some will be much less fashionable to question. Grants, quangos, strategies, policies and things which have simply become part of what the States does. Some will be excellent. Some probably weren’t very good ideas even when we started them. Most will be somewhere in between. The difficulty is that almost anything government does can be shown to produce some benefit. If spending £1m. produces a benefit, somebody can write a report explaining why it should continue. What I want to know is whether spending that £1m. somewhere else would produce a greater benefit. We seem much more comfortable asking whether a committee has kept within its budget than asking whether the budget itself is still in the right place.
I can think of hundreds of worthwhile things the States could spend money on. Give schools more teachers, reduce waiting lists, give pensioners more money, plant trees, improve roads, give more grants to sport, promote Guernsey around the world. I could probably fill the rest of this page without much difficulty. All would have supporters and all could probably produce evidence of some good being done. We can’t do all of them, or at least we can’t unless somebody has discovered an unlimited supply of taxpayers, and I think we may have been looking for those for some time.
I suppose I have become rather old-fashioned about what government is for. Health and education come very near the top for me, along with looking after people who genuinely cannot look after themselves, keeping us safe and maintaining the basic infrastructure an island needs to function. That doesn’t give HSC or ESC a blank cheque. Quite the reverse. If something matters that much I want to know the money isn’t being wasted. My recent stay at the PEH left me enormously impressed by the people actually looking after patients, but some of the people who talked to me about waste in the health service were the people working in it. If George can find £1m. inside HSC which isn’t helping patients and spend it on something which does, he hasn’t cut healthcare by £1m., he has made better use of it – and the same should apply to education.
Old spending does seem to acquire a sort of respectability simply by surviving. A policy which would face all sorts of questions if somebody proposed it today can become almost unquestionable after 10 years because removing it is called a cut. I find that rather odd. If we wouldn’t vote today to start spending the money, why does the fact we started spending it in 2012 make it essential in 2026? Perhaps it is still essential. Fine. Explain why. Perhaps it needs more money. Fine again. But I don’t think the fact a figure appeared in last year’s budget gives it a divine right to appear in next year’s with inflation added.
The States has already agreed to move towards looking at material spending from first principles, which is the sort of thing I want, although I have lived long enough to know that governments are considerably better at announcing reviews than surrendering money at the end of them. I don’t much care what the process is called or which bit of the States does it. Every so often take something we spend £1m. on and ask what would happen if we didn’t. Then ask what would happen if George or education had the £1m. instead. It might turn out that the original spending wins. Good. At least we have asked.
Which gets me back to George, although I seem to have wandered quite a long way from his letter. I think he may actually be making a rather good case for the spending cap without intending to. If healthcare costs are genuinely rising much faster than inflation, then health may need a bigger share of what the States spends. The cap doesn’t prevent that. It makes us decide what gets a smaller share. If everything currently receiving public money is protected and every genuine new pressure simply goes on top, then I am not sure we really have priorities at all. We just have a growing total.
Eugene has certainly rearranged mine. At the beginning of August I wasn’t giving much thought to operating theatres, surgeons or whether there would be enough nurses around if my bowel suddenly decided to tie itself in a knot. Then they became rather important. Fortunately the people were there, the equipment was there and when the less drastic attempts failed there was somebody capable of doing what needed to be done. I now have rather less bowel and rather more Eugene than I started the month with, but I am here and extremely grateful for it.
I want that service there for the next person. If George can show that doing so requires HSC to grow faster than inflation, I am prepared to hear his case and I may well support him. Education should make its case as well. So should Visit Guernsey, Locate Guernsey, Guernsey Finance, net zero and every other claimant for the public pound. I don’t want to start by deciding any of them should lose. I want to know what they do with the money and what we are giving up by giving it to them.
I just want somebody to ask the question we seem to avoid. If there is only one pound left, who should have it? Eugene has already expressed an opinion. Mostly wind, but I think I know what he means.
In my last column I called Alisha ‘Alicia’. My apologies to Alisha, or Lish as the charming Merco tells me she is better known. After all the care she gave me, the least I could have done was get her name right.
Lesley has demanded a shout-out, with the fairly serious threat that otherwise my pineapple juice allocation may come to an abrupt end. Consider yourself shouted out, Lesley. I have also acquired important new information since writing the column. Giffard Ward Bay 3 is every bit as good as Bay 2. I appreciate this may cause some controversy in Bay 2, but I can only report the facts as I find them.
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