Over the next few months, the significance of Health and Social Services’ Vision 2020 blueprint for changing the basis on which health and social care is delivered and funded will become apparent.

It is also clear from the thrust of the document that some fundamental decisions – such as how visits to the doctor are paid for – will be required.

But perhaps the real significance of the ‘green paper’ report to the States is that it has been written at all.

HSSD has sat down and asked itself, what are we doing, what should we be doing and how will that be paid for? It also asked what happens if things continue as they are. The answer was brutal: ‘The current pattern of expenditure is not sustainable,’ it concluded.

Probably for the first time, a States department has recognised that constantly rising expenditure and higher taxes is not a credible model for the future and something has to change.

Yes, HSSD is at the leading edge of the demographic timebomb – more elderly islanders demanding more expensive care funded by declining numbers of taxpayers – but the issue is actually one for the island.

Most other government departments still have the old mindset: we exist, we cost £X, the taxpayer must give us RPI-plus next year.

HSSD’s approach demands that to change, which is why its report asks the Assembly to direct all States departments to contribute to its massive change process.

In effect, Guernsey will have to decide what it is willing to spend on health and social care, education, welfare and law and order and how that’s funded rather than giving amounts to a department that has simply grown over time.

That, to a degree, was implicit in Treasury and Resources wanting to move to zero-based budgeting. Under that, instead of ministers justifying only increases, they would have to fight for funds for every single item of expenditure every year.

The financial pressures HSSD is under has pre-empted that process and all that remains is to see whether the other departments are up to the challenge set by it.