Isle of Man Medical Society Calls for Health System Reform

The Isle of Man Medical Society (IOMMS) has declared that the current health and social care governance model is “not fit for purpose” and urgently needs reform. This statement follows the release of an independent review that scrutinized the operational relationship between Manx Care and the Department of Health and Social Care (DHSC). The Medical Society’s response to the MIAA Governance Review highlighted concerns regarding governance capacity, commissioning expertise, financial oversight, and insufficient engagement with clinicians.

In its assessment, the IOMMS voiced its readiness to collaborate with government ministers and Tynwald to establish a medically-led governance framework that can effectively meet the needs of the island’s health services. The MIAA review is set to be debated during the upcoming December 2023 Tynwald sitting. It evaluates the current operational model and suggests four strategic options: maintain the status quo, dissolve Manx Care, fully adopt the recommendations from the Sir Jonathan Michael report, or enhance the collaborative arrangements between Manx Care and the DHSC.

The option of doing nothing has been dismissed, and the MIAA consultants observed little desire to revert to the previous system that existed prior to the establishment of Manx Care in April 2021. Nevertheless, the interim chief officer of the DHSC, Professor Tim O’Neill, indicated that all options, including the previous model, could still be considered after further consultation. He emphasized that the report identified critical areas needing attention and provided a clear direction for necessary improvements.

In their official response, the Medical Society noted that the review echoed many of the issues that it has consistently raised over time. The society stated, “This review has recognized many of the issues that we have consistently identified as requiring urgent improvement.” It expressed satisfaction that the review confirmed the deficiencies previously highlighted, particularly concerning governance capacity and the lack of meaningful clinician engagement.

While the IOMMS supports a statutory board model, it insists that profound changes are essential in how Manx Care is governed and how the DHSC maintains oversight. The society articulated a vision where Manx Care operates in a patient-centered manner, led by doctors and supported by nurses and allied health professionals. It called for management to facilitate rather than direct, with oversight provided by a board accountable to Tynwald.

The IOMMS also welcomed constructive discussions with the Minister for Health and Social Care and the Chief Minister, but stressed that the composition of the Manx Care board and its connections with clinicians must undergo fundamental changes. They backed the review’s conclusion that the current governance arrangements are ineffective.

The MIAA review highlighted that the island’s limited size, along with its governance and funding structures, has hindered Manx Care’s ability to function as an independent entity. The review pointed out that the annual funding allocation presents a significant challenge, and recommendations from the Sir Jonathan Michael report regarding the funding model have seen little advancement. Consequently, the focus remains primarily on reducing annual overspends, limiting opportunities for long-term planning.

Additionally, the report underscored that the DHSC’s existing governance framework does not adequately meet the needs for engagement, information sharing, and accountability concerning Manx Care. This shortcoming is partly attributed to the absence of a DHSC director of finance, which raises concerns about potential role duplication since Manx Care already employs its own finance director.

As discussions move forward, the IOMMS stands prepared to advocate for a transformative approach to health governance on the Isle of Man, emphasizing the necessity of a system that prioritizes clinical engagement and effective oversight.