Hello, I'm Simon Richardson from the Manx Radio Newsroom. Manx Care has been in the news a lot in recent days after announcing its plans to reduce the number of elective surgical procedures across several disciplines, in a bid to reduce the £18 million overspend. Then, on a political level, Douglas Central MhK Chris Thomas calls to stir when he tabled a four-part tinwalled motion, part of which called for a member of tinwalled to be added to the Manx Care Board to monitor developments and answer questions and queries tinwalled members may raise in the chamber. Not surprisingly, the plan hasn't gone down well with Health Minister Ramzi MhK Laurie Hooper. I think that sounds like an absolutely fantastic idea, in reality, you have a ministerial system for a reason, I think if you really want to hold ministers to account for delivery within the things they're responsible for, they have to be the ones answering questions on the floor and being responsible for the information that's given to tinwalled. Ultimately, though, if tinwalled decides, no, they'd rather have a member on the floor who will answer questions directly, but not have a vote or a say around the Manx Care Board table. If I was the member nominated for that role, I'd be very nervous and very unhappy being put in that position, but ultimately, that's really up to tinwalled to decide. Personally, it's not a good idea, as I said. Mr Thomas claims it would prevent the minister, in this case yourself, from having to be Manx Care's mouthpiece in tinwalled, and have somebody, effectively with a finger on the pulse, as a member of the Manx Care Board to field questions and queries, is that not effectively side-lining yourself? That's kind of my point, is it would basically say, well, we don't need a minister anymore, which, like I say, I would be very happy with, personally, because you wouldn't have to do any actual work, because everything that'd come up, I could just say, no, no, talk to the political member on the Manx Care Board, please, and they will answer all of your questions. But, like I say, if I was the member on that board, I'd be very uncomfortable being put on the spot and made responsible for things that I had no say over, so, ultimately, it just feels like someone at the other end wants to rearrange the deck chairs, because they want to be seen to be doing something, and that's kind of what this motion feels like to me. What do you believe is behind this, and do you see any merit at all in the idea? So what I think is behind it is, Mr Thomas wants to be seen like he's doing something, rather than actually doing something, and that's kind of the challenge here, is there's been no conversation about this, no one has picked up the phone, or even bothered to come and ask how things work, how things are working. It has simply come out of the blue, and like I say, I think it is because there's been a lot of interest in the press over the last few weeks about things happening over at Manx Care, and this is, I think, quite typical of politicians using activity as a replacement for achievement. Picking you up on that point, there has been a lot in the news about Manx Care this week. We've had much about plans to cut back on elective surgery to save over £200,000 pounds of the £18 million overspend. This of course is Manx Care's decision, not yours per se, but you must have a view on this course of action, if simply as a member of the House of Keys representing Ramsey. So I think as I've explained already, has been reported by Manx Radio, whilst this is technically an operational decision made by Manx Care, it has come at the behest of those on high. So we've, as you've seen publicly reported, the Chief Minister has been quite clear that Manx Care has to come in on budget, I think his words were irrespective of demand, that's how it was reported. The Treasury Minister has also made his position very clear that we are required to enact what he calls our contingency plans, and ultimately, to like I say whilst, yes, Manx Care's decision was made, by them it was made in that context of very clear messaging, very clear communications from those at the top of the tree. I don't think this is a decision that would have been made by Manx Care if they'd have been given any options around it, I think. So what is your view? I think my view is the same as Manx Care's, we've been told to do it, so it's being done. Like I said, it's not something that I think anyone would choose to do, I had a nice long conversation with some members of the Medical Society this morning, and you'll see in their letter as well, saying that what they believe the consequences could be of these things, and actually we've made that case as well to the Council of Ministers, where we've explained quite clearly that ultimately it's all about demand, and the demand doesn't go away simply because you decide not to address it today, actually the people that need these surgeries are still going to need these surgeries, so I say the perfect world. I think Manx Care would have made very different decisions, but in the context that we have been placed in with the very clear instructions and messaging that's coming out from the top, it's not like we have a lot of room left to manoeuvre. I mean, Manx Care's CEO, Theresa Cope, says cutting elective surgery list isn't unusual in hospitals elsewhere, ahead of winter, when there's greater demand for beds. So what was this the best of worst option, if you like? I think she's right when she says that, actually, and what you do tend to see is reactive cuts, so what will happen normally is if you have a spike in winter demand, then the service might decide not to run lists at a short notice because they have to deal with the demands coming to the door. The reality is if you do it on a reactive basis it doesn't save any money, but you still lose out on the surgeries, so in some ways this is a relatively standard bit of practice. You can see the consequences of that crossing the UK when they stop doing these things, you know what the end result is going to be, it shouldn't be a surprise to anyone. The Minister, there has been a lot going on in the health sphere at the moment, and I think you've gone on Twitter and said that we're not telling the full story, maybe you could enlighten us. So that's more to do with way Manx Radio reports things, so you tend to have a story, and then there'll be another story and another story, but you tend to have to follow links through one story to the other to the other to actually get the full picture, and that I think is unhelpful, and that tends to be what's fed back to me by people who are listening to stories. I get a lot of feedback from people saying this is what they've said on the radio, and you have to say yes, that's what that story says, but you also have to look at these other three stories that the radio have reported on to actually get the full picture, and so it's more to do with, I think, the way that reporting is done as opposed to it not being reported at all. It just doesn't provide the clarity that I think people need, which is sort of what you expect from a public service broadcaster is from Manx Radio to actually explain things to people in a way that all of us can understand. But surely, stories emerge, and different things happen, so they're reported as and when they happen, you can't sort of look back and record everything that's happened in the past. You have to record what's happening in the future and what's happening at the time. I completely accept that, but like I say, when you look at other organisations in the media, they somehow manage to pull this trek off quite successfully. It's a particular failing, I think, of our local media landscape. Now, you will, I'm sure, concede that the whole area of healthcare in terms of the Department of Health and Social Care, Manx Care, and your role, in fact, can be confusing to members of the public. How in light of what's being suggested, would you now or would you then, whatever, define your role as Minister? That's a really valuable point, actually, is there is a lot of confusion out there as to the various levels of responsibility that exist within the system, so Manx Care are responsible for delivering the service we as government ask them to deliver and is done through the Department, through what's called the mandate. Manx Care have a lot of flexibility within that, determined by and large how they might go back delivering some of these services, but the services that are required to deliver are specified by the government. So if the government wants to make cuts to services, essentially, that has to be changed through the mandate, because, you know, if we decide it actually, we're not going to run, I don't know, patient transfer flights anymore. That's a mandated service, we have to take it out of the mandate. That's kind of the way the system works. So it's not the politician's job, I think, to get involved in the detail, and again, this is a conversation I've been having with medical society and with others around saying, you kind of employ professionals to do a professional job, but that's the point, right? So the people that should be making professional decisions and clinical decisions are clinicians, it shouldn't be politicians. People that are making decisions about the best way of delivering care actually should be those who are involved directly in delivering care, that's the job, that's what we pay people to do. And I think it's distinctly unhelpful, then, when you have ten more members deciding that they want to step into that quite operational space and make some of those decisions directly. I mean, one part of the motion next week is around it, the way we appoint people to the board of makes care. That's set out in statute, ultimately, the law says this is what you do, follow the law. To say we need to change that, fine, the valid arguments could be made to change the law, but I think I'd need to understand why the law needs to be changed. The key thing about health reform and health service delivery is it's a massive system. It has a lot of moving parts, a lot of people involved, a lot of stakeholders, you've got delivery, you've got consultants and professionals and nurses and management, you've got the public, you've got patients, you've got their families, everyone needs to be involved in that journey. Which means it takes time to change things, it takes time to turn that super tanker. And the reality is politicians are not good at that, we're not good at saying, here's the plan, it's going to take five, six, seven years just to do that, let's crack on and let's stick with it, because the moment you hit a bump in the road, that's when you start getting people saying, I need to be seen to be doing something, whereas actually sometimes the right thing to do is the hardest thing to do in politics, which is to not do anything, it's to say no, we are moving in the right direction, things are happening, changes coming, savings are being made, efficiencies are being delivered, reform is happening, but it will take time and we have to accept that it will take time to deliver on these things. Instead of saying every five minutes, no, let's have another top down reform of the system because when we did 12 months ago it didn't work. And that's kind of what you've seen in the UK, for example, the Darzio report says pretty much the same thing, you've got to stop politicians every five minutes trying to reform the entire structure of the NHS because actually you spend more time focused on structure than you actually do on treating patients. Let's take it a step further, say Mr Thomas' motion is successful, would that force you to consider your position as Minister? No if Mr Thomas' motion is successful, I will be nominating him to be the shadow member of Manx Care's board, if he believes that it should be the responsibility of a member of Tim Hall with no actual responsibility or power to answer those questions, I am more than happy for Mr Thomas to take that role on. The reality though about the motion is it is quite misguided because a lot of the things it's asking for, we're already doing. So there's a first part of the motion talks about reforming the way we engage with healthcare professionals, well that's already happening, it's already in train, work's going on about how we do that. There's a bit of in there around the governance structure and how the relationship between the Department of Manx Care is developed and is legislative for and again, we're actually consulting on that right now, that's live, that consultation to start that process of reforming the NHS Act and the way we deliver and oversee health services, that is a live consultation right now. So the fact we now have a Tim Hall motion saying go and do this thing that you're already consulting on doing is absolutely mental, I mean I have no idea why we are going to be spending time being asked to do something that is already underway. And that's kind of the issue with this motion, it's been tables like I said by, it feels to me at least, by people who want to be seen to be acting rather than people who have actually spent five minutes looking at the work that's going on and trying to help and try to be productive and trying to be positive about things. I'm not saying everything's perfect, by any stretch. But just jumping straight to I don't like this, therefore we should have a Tim Hall debate without taking a step back and going well what work's already ongoing, where are we up to with that work, how is it going. Those are kind of important questions and that's hopefully what will be fleshed out during the debate a little bit is just to explain that this stuff's already ongoing and it's all public information, we publish all this stuff, you know the consultation is a very public document, it's none of this is being done behind closed doors and it's very easy to find out and like I say if anyone wants to ask questions about where we're up to, the doors always open. That said though, if the motion is successful you would be in a very uncomfortable position. I think it's fair to say I'm in a very uncomfortable position right now, I don't think the motion changes any of that. My position on health service funding is quite clear, Liberal Vannin are absolutely robust on the fact that we have a national health service on the Isle of Man that is free at the point of use and that is not something we are going to compromise on, not something I'm going to compromise on, that is very clear which should be funded through a progressive system of taxation, if you want to reform things that's where we need to start, that has been my position since day one, that is the Liberal Vannin party position, that is not where we are, that's not where the government is, that is not the direction of travel that has been communicated as you've seen from other ministers. I accept that, I accept that I have a very different perspective than my colleagues, that is the nature I think of, of collective government on the Isle of Man, so if the motion is successful saying yes we should do another top down sets of reforms, crack on Tim World, ultimately I'm a servant of Tim World in my ministerial capacity, if that's what Tim World really wants us to do is to spend time and energy and resources reshuffling the deck chairs that we can do that, I don't think it's a sensible use of resources, I would much rather be spending our time helping Mags Care actually deliver services for patients, actually improve things, if anyone can point to me how putting an MHK on the board of Mags Care is going to improve things for patients, I'm open to listening to that, but if it's just going to be done to make Mr Thomas feel better, I don't think that's a good use of our time. Thank you for making it to the end of the Mags Radio newscast, you are obviously someone with exquisite taste, may I politely suggest you might want to subscribe to this and a wide range of Mags Radio podcasts at your favourite podcast provider, so our best bits will magically appear on your smartphone, thank you. [Music] [ Silence ]
