Restructuring Manx Care

Our Evaluation of the Proposed Restructuring Options and Recommendations

Introduction

Following an exhaustive analysis of the proposed restructuring alternatives for Manx Care, we have determined that the presented options do not comprehensively address the distinctive challenges and opportunities inherent to our organisation. In light of this, we advocate for the strategic integration of a Professional Executive Committee (PEC) into the managerial and governance framework of Manx Care.

Evaluation of Proposed Restructuring Options

The overarching strategy to pivot towards medical leadership is acknowledged and appreciated. Nonetheless, the current proposals illustrate this transition at the divisional and care group levels but fail to extend it to the organisational echelon, specifically within the executive and board domains. This presents a potential conflation of leadership and managerial roles, leading to ambiguity.

The initiative to designate professionals as accountable officers is intriguing, as it implies fiscal responsibility for budgetary excesses within their domains. This may be a source of discomfort for some. In instances where leaders are responsible for services outside their direct field of work, it is imperative to establish mechanisms that allow professionals within those services to contribute to decision-making processes. It is essential for all clinical leaders to maintain clinical involvement within Manx Care for the majority of their duties. Moreover, it is vital that grassroots professionals are involved in the selection process to ensure that the appointee has the backing of the staff and meets the expectations of the role.

Despite the thoughtful consideration evident in the proposed restructuring plans, they do not fully align with our envisioned future for Manx Care. They lack a definitive strategy for a medically &clinically led organisation and do not clearly chart the course towards the provision of highcalibre, cohesive health and social care services.

Potential reasons why the restructure plans do not meet the objective of making Manx Care medically and clinically led:

Lack of Medical Leadership at Key Levels:

While there are Clinical Directors in various departments, the overall structure seems to be heavily managerial. The presence of multiple Divisional Directors of Operations and Service Managers might dilute the focus on clinical leadership.

Disproportionate Managerial Roles:

The structure includes numerous managerial positions (e.g., Directorate Managers, Service Managers) which could overshadow the clinical roles. This might lead to decision-making processes that prioritise operational efficiency over clinical outcomes.

Insufficient Integration of Clinical Roles:

Clinical roles such as Clinical Directors and Senior Matrons are present, but they appear to be compartmentalised within specific departments. There might be a lack of integrated clinical leadership across the organisation to ensure cohesive medical and clinical governance.

Potential Overemphasis on Nursing and Allied Health Professionals (AHPs):

While nursing and AHP leadership is crucial, the structure might be placing a heavier emphasis on these roles compared to medical leadership. This could impact the balance needed for a medically led organisation.

Ambiguity in Role Definitions:

The titles and roles such as "Matron" and "Service Manager" are repeated across different departments, which might lead to confusion and overlap in responsibilities. Clearer definitions and distinctions between roles could help in establishing a more clinically led structure.

Limited Representation of Medical Leadership in Community Services:

In the Primary Care & Community Services section, there seems to be a stronger focus on service management rather than medical leadership. This could hinder the objective of having a clinically led approach in community settings.

The New proposed structure contains 3 WTE (Whole Time Equivalent) doctors, 16 WTE AHPs and 22 WTE Managers! Even with a huge stretch of imagination, it is hard to conclude that this structure will be Medically & Clinically led.

To address these concerns, Manx Care must consider:

• Increasing the number of medical leadership roles at higher levels of the organisation.

• Ensuring that clinical leaders have significant input in decision-making processes.

• Reducing the number of purely managerial roles to avoid overshadowing clinical priorities.

• Promoting better integration and collaboration among clinical leaders across different departments.

Clinical Senate and PEC:

While the restructuring document highlights the establishment of the Clinical Senate to incorporate clinical and professional advice into decision-making, there are underlying issues that could hinder the intended outcomes. Here are some reasons why the proposed restructuring will not make the organisation medically or clinically led.

Involvement and Influence:

The Clinical Senate's role, while significant, appears advisory rather than executive. For the organisation to be truly clinically led, clinicians must have substantial decision-making power and influence over core operational and strategic decisions.

Implementation and Integration:

Effectively integrating the Clinical Senate's recommendations into day-to-day operations might be challenging. There needs to be a robust mechanism to ensure that clinical insights translate into actionable policies and practices.

Representation and Authority:

The document does not clearly state the extent of representation from various clinical disciplines in the Clinical Senate. Ensuring diverse and adequate representation is crucial for a clinically led organisation.

Cultural Change:

Shifting towards a clinically led model requires a cultural transformation that emphasises clinical leadership and empowers clinicians at all levels. This transformation might require more than structural changes; it involves training, mentorship, and fostering a culture of clinical excellence and leadership.

Potential Solutions:

• Enhanced Decision-Making Power: Increase the decision-making authority of clinical leaders within the executive structure.

• Clear Integration Pathways: Establish clear pathways for the integration of Clinical Senate recommendations into organisational policies and practices.

• Diverse Representation: Ensure diverse and adequate representation from all clinical disciplines within the Clinical Senate.

• Cultural Initiatives: Implement training and development programmes aimed at fostering clinical leadership and a culture of clinical excellence.

We remain convinced that a PEC instead of and not in addition to CDs & Managers will ensure that Manx Care is truly Medically and Clinically led.

Our mission is to make Manx Care 

• Patient Centred, 

• Doctor Led

• Nursing & Allied Professional Supported, and

• Management Facilitated

Isle of Man Medical Society December 2024