IOMMS review of Manx Care Mandate

Review of "Mandate to Manx Care 2025/26"                                   12/03/2025

Mandate for Manx Care 2025/26

Strengths:

1. Strategic Vision: The document provides a well-structured framework aimed at delivering integrated, efficient, and sustainable health and social care services.

2. Focus on Preventative Care: The emphasis on early intervention and community-based services highlights a progressive approach to healthcare.

3. Financial Transparency: The detailed financial directions and inclusion of efficiency targets reflect fiscal accountability.

Weaknesses:

1.    Risk of Service Reductions: The mandated 2% efficiency target and reallocation of budgets raise concerns about potential reductions in secondary care services, impacting care quality and accessibility.

2.    Ambiguity in Action Plans: Objectives lack specific timelines, milestones, and responsibilities, reducing clarity and accountability.

3.    Lack of Service Specifications: Insufficient details about the precise services and procedures to be delivered leave uncertainties about what will be provided.

4.    Unspecified Volume Commitments: The absence of clarity on the expected volume of procedures and services undermines the mandate's ability to meet public demand effectively.

5.    Lack of Needs Assessment: The DHSC (in conjunction with Public Health) should undertake a thorough assessment of the population's healthcare needs which should inform the mandate that ensures the alignment of services with actual demand.

6.    Limited Public Consultation: The lack of meaningful public engagement during the preparation of the mandate diminishes inclusivity and responsiveness to community needs.

7.    Lack of Consultation with the Isle of Man Medical Society: The apparent exclusion of key professional organisations, such as the Isle of Man Medical Society, misses valuable insights and risks alienating healthcare professionals.

8.    Need for Workforce Review: There is an urgent need for a comprehensive review of the workforce, particularly management staff. The organisation would benefit from a leaner management structure that prioritises efficient resource utilisation while ensuring that leadership is medically and professionally driven. This approach could improve decision-making and align the organisation more closely with the needs of healthcare delivery.

Opportunities for Improvement:

1.    Workforce Review and Leadership Restructuring: Conducting a thorough review of management staff and shifting towards a leaner management structure led by medical and professional experts would enhance operational efficiency and align leadership with core healthcare goals.

2.    Comprehensive Needs Assessment: Including a robust assessment of the population's healthcare needs would help prioritize services effectively.

3.    Enhanced Stakeholder Engagement: Actively involving key stakeholders, such as the public and the Isle of Man Medical Society, would improve the inclusivity and practicality of the mandate.

4.    Clearer Service Commitments: Providing explicit details on services, procedures, and expected volumes would enhance transparency and accountability.

5.    Balanced Efficiency Measures: Safeguarding critical services while pursuing cost-saving initiatives is essential to maintain public trust and care quality.

6.    Detailed Implementation Plans: Incorporating specific timelines, milestones, and responsibilities would make the mandate's goals more actionable and measurable.

7.   Care Record: An integrated care record is crucial for enhancing patient outcomes, as it facilitates seamless communication and collaboration among healthcare providers, ensuring that all relevant information is readily accessible for informed decision-making and coordinated care. The procurement and implementation of an integrated care record for Manx Care must be prioritised.

8.   Rationalising Regulation: Regulation of Health Care providers, premises and professionals are consuming a disproportionate quantity of resources. Consideration must be given to making use of existing health and care regulators.

Threats:

1. Service reductions (cuts):  If allowed to proceed, these cuts will have severe and far-reaching consequences for patients and the health and wellbeing of our community. Elective operations are not merely optional procedures; they are essential interventions that significantly improve the quality of life for our patients. Delaying or cancelling these surgeries will lead to prolonged suffering, increased morbidity, and potentially life and limb-threatening complications for those awaiting treatment.

2. Without a workforce review, inefficiencies and overspends will continue.

3. Manx Care risks being seen as a failure unless urgent reform is undertaken. Our recommendations are here: https://www.iomms.org/recovery-reform-proposals-for-manx-caredhsc

Conclusion:

The "Mandate to Manx Care 2025" presents an ambitious vision for health and social care on the Isle of Man. However, critical gaps remain, including concerns about potential service reductions, a lack of service and volume specifications, the omission of a comprehensive needs assessment, limited consultation with key stakeholders, and an absence of a thorough workforce review. Addressing these concerns, particularly through a lean management structure and medically and professionally led leadership, is crucial to ensure that the mandate achieves its goals while maintaining quality and accessibility.

Isle of Man Medical Society Executive Committee

Notes:

The Isle of Man Medical Society is a professional organisation that represents the interests of the medical profession on the Isle of Man (Established 1896). It plays a crucial role in advocating for healthcare policies, providing professional development opportunities for its members, and ensuring the highest standards of medical practice are upheld. The society is actively involved in discussions on healthcare legislation, as evidenced by its recent survey on assisted dying proposals1. It also calls for reforms to improve the healthcare system, such as the proposed changes to Manx Care, emphasising the need for a medically led structure and better accountability and resource allocation. The society has proposed the formation of a Professional Executive Committee for Manx Care, under the Board of Directors.