Our reply to the minister 15/3/24

Dear Mr Hooper,

Thank you very much for taking the time to read the proposals made by the IOMMS to improve healthcare provision on the Island and responding to us. We feel very encouraged by your welcome of our input. We would however make it clear that we did NOT share this with the media and therefore will be grateful if your records are amended to reflect that. This paper was sent to the members of Tynwald for two reasons; one, they represent our real masters, the members of public and two, most of the changes we recommend requires the support of Tynwald.

It will now be appropriate to address what you refer to as misunderstandings in our paper. There may be misunderstandings, but not necessarily on our part. We shall address them one by one:

1. “You assert in your opening paragraph that the organisation has “overspent by £30 million in the 2023/24 financial year” and that funding is “primarily drawn from reserves and higher taxation rates”. Unfortunately neither of these statements are entirely accurate.”

The source for this assertion is this quote attributed to you: https://www.manxradio.com/news/isle-of-man-news/manx-care-overspend-due-to-predicted-increasing-demand-says-health-minister/

We recognise that it is possible that you were misquoted in which case we apologise.

Similarly, reference to a drawdown on reserves was sourced from this article: https://www.iomtoday.co.im/news/budget-government-plunders-reserves-to-support-public-spending-596377

If this is incorrect, we again apologise.

“The Mandate from my Department is a comprehensive document and fully reflects the political priorities for health and social care on the island as set out in the Island Plan by the Council of Ministers and approved by Tynwald. I would encourage you to refresh yourselves on what is in the Mandate, as we have recently published the 24/25 version along with a budgetary envelope for the year that genuinely reflects the financial pressures that Manx Care has experienced in the current financial year.”

We thank you for your advice. We did review the extensive mandate. While extensive, it remains somewhat woolly and we believe that it will be very difficult to hold Manx Care to account based on the mandate as written. In order to make it shorter, yet watertight, we recommend that the following be added: a. Service specifications (e.g. NHS England Service Specifications), b. standards (e.g. NICE/CQC standards) and c. volume of non-urgent procedures (e.g. Cannot provide fewer elective procedures than previous three years)

2. “Establish a medically led governance structure, supported by global evidence indicating improved performance and safety.”

We stand by our assertion that the Manx Care board should have both a medical and Manx Resident majority.

We agree that Dr Wendy Reid will be an excellent Chair for Manx Care and we look forward to welcoming her to join the IOMMS when she moves to the island.

Also please note that your appendix lists Dr Marina Hudson’s profession incorrectly.

3. “I have no intention of allowing an increase in executive management expenditure to balloon to a limit of 5-6% of the budget proposed in your letter.”

This statement lends itself to being viewed as disingenuous at best and misleading at worst. We are confident that there are many more managers within Manx Care than the executive and to claim that the executive directors are the only managers is not correct. You may wish to clarify with your executive team how many medical and non-medical managers work for Manx Care and their wage bill. if indeed the total wage bill of all medical and non-medical managers working for Manx care at all levels is less than 1% of the budget, we congratulate you and Manx care for this incredible achievement.

4. “Reducing this to an annual exercise would be a significant backwards step.”

You appear to misunderstand our recommendation, which is to produce independently audited accounts annually in addition to the accounts you describe and not instead of.

“I have no intention of asking Manx Care to reduce the frequency of their regular reporting down to quarterly.” Again, our recommendation is for quarterly reporting in addition to what you describe and not instead of.

“I do however welcome your suggestion for the inclusion of a broader range of metrics within the reporting framework and would be happy to discuss this with you further.”

We are very pleased to hear this and will be pleased to invite you to meet with the executive committee soon.

5. “Comprehensive Workforce Strategy:”

With respect, this has been on the agenda ever since the inception of Manx Care and we are yet to see a draft three years down the line

6. “It is worth noting that the costs per capita that you quote are not directly comparable, as Manx Care’s budget includes social care costs which are not included in the NHS budgets in the UK.”

We beg to differ, as the Scotland figure quoted includes social care spend also and we have not taken into account private and third sector spending in the Isle of Man.

Similarly, it is Guernsey that has a largely privatised and not Jersey. Jersey has a much higher population (105,000) and spends £60 million less per year than us on health and community services (fulfilling many social care functions), although GP services are charged to patients.

7. “Removal of Redundant Structures”

We wish to emphasise that our paper is very much a high-level strategic overview. We will be pleased to help draft operational plans if the need for reform of Manx Care is accepted and we are requested to do so.

On a positive note, you have not pushed back many of the other points we have raised, which we take to mean that you have accepted them and are taking immediate measures to remedy them:

1. The culture of care is poor and needs urgent measures to improve

2. Staff morale is low and also needs immediate attention

3. Staff engagement remains low

4. Unlawful appointments contrary to Tynwald Regulations of underqualified doctors to consultant positions and their ongoing employment

Many thanks,

On behalf of IOMMS Exec

Dr Vineet Varshney Secretary, IOM Medical Society secretary@iomms.org

Dr Ben Harris President, IOM Medical Society president@iomms.org

Dr Prakash Thiagarajan Chairman, IOM Medical Society chair@iomms.org