Isle of Man Medical Society Calls for Urgent Health Reform

The Isle of Man Medical Society (IOMMS) has declared that the island’s current health and social care governance model is “not fit for purpose” and urgently requires reform. The society’s statement follows the release of an independent review analyzing the relationship between Manx Care and the Department of Health and Social Care (DHSC).

In its response to the MIAA Governance Review, the IOMMS highlighted that the findings reaffirmed long-held concerns from medical professionals about deficiencies in governance capacity, commissioning expertise, financial oversight, and inadequate engagement with clinicians. The society expressed its readiness to assist ministers and Tynwald in creating a governance structure that is led by medical professionals and capable of effectively delivering essential services to the island.

Review Findings and Strategic Options

The MIAA Governance Review, scheduled for debate at the upcoming Tynwald sitting in December 2023, evaluates the operation of the existing model and presents four strategic options: maintaining the status quo, dismantling Manx Care, fully implementing the recommendations of the Sir Jonathan Michael report, or enhancing partnership arrangements between Manx Care and the DHSC. According to the review, doing nothing is not a viable option, while there is limited interest in reverting to the pre-April 2021 system that existed before Manx Care was established.

Interim DHSC Chief Officer Professor Tim O’Neill indicated that members might still consider the option of reverting to the previous system, subject to further consultation. He emphasized that the review outlined specific areas in need of improvement, providing “a clear steer” for future actions.

The Medical Society’s response noted that the review acknowledged many issues it has consistently raised. “This review has recognized many of the issues that we have consistently identified as requiring urgent improvement,” the society stated. Their sentiments reflect a sense of validation, as the review confirmed deficiencies related to governance, commissioning, and clinician engagement.

Proposed Changes in Governance

The IOMMS advocates for a statutory board model but insists that fundamental changes are necessary regarding how Manx Care is governed and how the DHSC oversees operations. The society’s vision emphasizes that Manx Care should be patient-centered, led by doctors, and supported by nurses and allied health professionals. They propose that management should facilitate rather than direct, with oversight from a local board accountable to Tynwald.

While the Medical Society welcomed constructive discussions with the Minister for Health and Social Care and the Chief Minister, it stressed that the composition of the Manx Care board and its engagement with clinicians must undergo significant transformation. The society endorsed the review’s conclusion that the current governance arrangements are not functioning as intended.

The MIAA review pointed out that the size of the island, along with its governance and funding structures, has constrained Manx Care’s ability to operate as an independent body. It identified annual funding allocation as a significant challenge, noting that progress on recommendations from the Sir Jonathan Michael report regarding the funding model has been minimal. Consequently, the focus has remained on managing in-year overspends instead of facilitating longer-term planning.

Moreover, the review commented on the DHSC’s existing governance arrangements, which do not adequately meet ministerial needs for engagement, information sharing, and accountability regarding Manx Care. A key observation was the absence of a DHSC director of finance, which raises concerns about potential role duplication, given that Manx Care already employs its own finance director.

As discussions around health governance reform in the Isle of Man continue, the IOMMS remains firm in its call for immediate action to address these critical issues, ensuring that the health system can effectively serve the needs of the community.