HSCC: Gov Stifling Manx Care Progress

Manx Care is doing the best with the resources it has, but issues with funding have left it in a state of year-by-year survival mode.

That is the untempered view of the Health Services Consultative Committee’s outgoing chair in its annual report to the DHSC for 2022/23.

The independent regulatory consultive body found that several issues faced by the DHSC and wider gov in the last 18 months had had a detrimental impact on the island’s healthcare system which, outgoing chair Andrew Cole said in his preface to the report, needs to decide what it wants to be.

Noting the sudden departure of Karen Malone as CEO, one of the casualties of the fallout of the Dr Ranson tribunal, the Mr Cole said there had been an attempt to carry on business as usual, but that ‘the loss of an expert in policy and legislation that inevitably impeded progress’.

Mr Cole said: ‘We are very disappointed to note that legislation change has since slowed further, with some major needs unmet. The most prominent example is the NHS Reform Bill, planned to enter the branches in December 2024 and now at risk of not being achieved in the lifetime of this parliament.

‘This issue was acknowledged in the November 2022 Department meeting. There is clear evidence from the Island Plan, Transformation Project Key Milestones and DHSC Department minutes that legislative resource was diverted to address other urgent priorities.’

Dr Ranson

While not looking to comment in detail on the Dr Rosalind Ranson tribunal, the HSCC outlined that it is ‘self-evident that the time, effort and funds diverted to it in the past two years have clearly resulted in resource usage that could have been effectively invested elsewhere, notwithstanding the emotional impact upon all those involved’.

Funding

With health funding always in the spotlight, especially given the annual pilgrimage of successive ministers to Tynwald to explain why they had a cheque they needed a signature on to cover overspends, the HSCC said that Manx Care ‘through its dialogue with DHSC officers and Public Board Meetings, has maintained its transparent and realistic ethos’.

Mr Cole added: ‘It is an ambitious organisation, aiming to be ‘one of the best person-centred sustainable health and care services’. The HSCC is disappointed that initial expectations for a long-term funding model have not yet materialised.

‘The funding shortfall for 2023-24 and reducing Transformation Fund budget is of immense concern. As a result, Manx Care’s long-term strategic plans remain stalled and the system is bound to a year-by-year survival model.’

HR

Recruiting and retaining healthcare staff has remained a challenge for organisations all over the world, with the HSCC saying Manx Care’s People Committee has ‘attempted to make the Manx Care OHR function as visible as it can in the absence of a dedicated OHR function’.

Mr Cole said: ‘At the same time, we have observed that OHR as a pan- Government service has hindered rather than helped; key people have been lost from both organisations with slow recruitment processes resulting in missed opportunities to fill vacancies, often for reasons that remain opaque.

‘The Chief Minister’s review of OHR commenced in May 2022, coinciding with the resignation of the service lead. The HSCC has seen neither the result of this review nor any impact on OHR service improvement despite repeatedly raising this concern in its monthly commentary to DHSC.’

Recommendations

The HSCC’s report is broadly positive of the work being done by Manx Care, but said that improvements can be made with outward engagement and demonstrable progress being made in the Autism Strategy development, Respite Care Review and monitoring patient discharge planning.

It has also recommended that the DHSC needs to developed an agreed sustainable funding model, though this is not entirely within its gift and would require Treasury/Tynwald agreement.

It has also recommended that the department prioritises the use of allocated funding to ‘sustainably address the insufficient staffing that is seriously impacting on the capacity of legislation and policy teams to deliver the Government’s health and social care legislative programme’. Again, how much of this is in the department’s gift isn’t clear.

Conclusions

The HSCC also reached a number of conclusions on the current state of Manx Care and the DHSC, including that while the organisations has used its ‘limited resources efficiently to prioritise culture change within and beyond its organisation’, that further development is possible ‘if DHSC and Treasury make a commensurate effort’.

Some of the conclusions reached are already in the pipeline, such as establishing a long-term funding model.

You can read the full report here.