An Even Bigger Job Than Anticipated

The man whose report led to the major restructuring of the island’s health service has praised the work done so far, but admitted the job is much bigger than he first thought.

Sir Johnathan Michael has delivered a report into the transformation of the Manx health system, including the creation and establishment of Manx Care.

In his report, Sir Jonathan said that good progress has been made in some areas and the fundamental restructure to deliver the separation of responsibilities that he set out in his final report which recommended taking healthcare delivery away from the DHSC.

He added: ‘Manx Care has made a determined and effective start but the size and number of challenging issues it needs to address was even larger than I anticipated, and it will take time and resource to resolve them all. The new DHSC needs to assess and focus on its new obligations, but I believe it is aware of the changes required.’

Positives

Overall Sir Jonathan is quite positive about the changes made, especially given the pressures of the pandemic.

He has praised moving the Public Health Directorate out of DHSC into the Cabinet Office and the creation of Manx Care which he said have ‘undoubtedly inherited a challenging service’.

Sir Jonathan said: ‘A baseline assessment of activity and quality performance of the services inherited showed a worse position than had previously been anticipated. The challenge for Manx Care was further heightened by the impact on costs, staffing and other aspects of service delivery arising from the Covid pandemic.’

The separation of policy and deliverance was intended to result in DHSC being smaller. His report outlines that this has not really happened but Sir Jonathan recognises that DHSC is ‘effectively a new organisation’ and how separate it is able to be from Manx Care will be something that becomes more obvious as time progresses.

There is also praise for the partnership with Great North Air Ambulance to deliver an improved air bridge for the island, which Sir Jonathan said is a ‘game changer’. He said: ‘Whilst initially a trial for around 6 months, I have no doubt that there will be further development of this new service to maximise the benefit to the people of the Isle of Man. One of the long-standing challenges for the island has been how best to care for those patients who need urgent specialist treatment that cannot or should not be provided on the island. The ability to transfer such patients quickly, whilst continuing treatment safely, will allow new and improved care pathways to be developed across a number of clinical services.’

Less Progress

However, while Sir Jonathan does praise what has been done, he says ‘progress has not been made with the speed and depth that I would have hoped to see on some other aspects of my recommendations’. He adds: ‘This does not entirely surprise me as these are complex, deeply seated areas, which, in my experience, are never straightforward. However, they are critical to the overall transformation of health and care on the island.’

A key part of the transformation has been in digital information. Sir Jonathan has said ‘this essential component remains some way away with unsatisfactory progress across data availability, data accuracy and information governance, including data sharing’. However, He has praised the intervention of the Chief Secretary to recalibrate the project.

The Care Pathways and Service Delivery Transformation project has been particularly impacted by the lack of availability of clinical and managerial staff due to their necessary focus on the Covid pandemic and by the travel restrictions, however Sir Jonathan says that he has been advised that additional clinical input is being sought.

Sir Jonathan also uses his report to look at primary care, something he said was very important to the future of the island’s health and care system.

He adds: ‘More care can, and should, be provided in the community and by community- based practitioners. In the case of General Practice, this will require significant changes in the current Practice based model where each of the 11 GP Practices on the Island has relative autonomy on the “what and how” of service delivery.

‘I am pleased to see the development of the much talked about Primary Care Network (PCN) of GP Practices to help address, at least in part, the critical need to deliver at scale service in Primary Care. I recommend clear service targets and outcomes with demanding dates for their delivery to be established, in order to confirm that the PCN can truly help deliver at scale in line with my Final Report.’

And notes that while the PCN ‘talks a good talk’, it fails to deliver when real change is set out.

Conclusions

Overall, Sir Jonathan says that ‘good progress has been made in some areas’ and the fundamental restructuring of the separation of responsibilities has been delivered. He adds: ‘Manx Care has made a determined and effective start but the size and number of challenging issues it needs to address was even larger than I anticipated, and it will take time and resource to resolve them all. The new DHSC needs to assess and focus on its new obligations, but I believe it is aware of the changes required.

‘There is a high price to pay for inefficiency and poor service delivery. Thus, it is crucial for key policy and difficult operational decisions to be taken swiftly to enable timely service improvement and financial sustainability. Costs will continue to be higher than necessary (due to historic inefficiency, poor practice and poorly negotiated contracts with off Island providers) unless and until these issues are addressed. I support plans for long term arrangements for funding exceptional costs to be considered as part of the New Funding Arrangements project, but it may be necessary for some tactical arrangements to deal with these issues to be agreed in the short term.’

Full Report

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