Manx Care says it's had to make some tough decisions to try and avoid overspending this year.
But what exactly is putting the healthcare provider under such pressure?
Sian and Ben have been speaking to the Treasury Minister Dr Alex Allinson to find out:
Hi, I'm Sharn, one of the news editors at Manx Radio, and in recent weeks, Manx Care's finances have dominated the headlines, with the Health Care Board predicted to overspend by £16.8 million in the current financial year. It's led to the Board announcing cuts to elective surgery, and also the Chief Minister saying Manx Care must come in on budget this year. So just what is putting the health care provider under such financial pressure? This morning, Treasury Minister Alex Allinson joined myself and Ben on Manx Radio Breakfast. Was it Treasury's decision to cut elective surgery? No, it wasn't. I mean, in terms of the separation of responsibilities, Manx Care is responsible for using the budget it's given in the right way to ensure the proper and efficient provision of what's called mandated services. So earlier on this year, you remember that Trit Timwald agreed a mandate from the Department of Health and Social Care with the key priorities for Manx Care, and a lot of that was around primary care, expanding that GP services, but also hospital care, really concentrating on efficiencies, quality, and also safety. And so it is the responsibility the Manx Care Board to use the money wisely, but we know that they've come under significant pressure, and yesterday we released the first government management accounts to show that several other departments were also coming under significant pressures in terms of their budgets. Do you agree with the Chief Minister's comments that Manx Care must operate within its budget? As Treasury Minister, it's the responsibility for me to balance the budget and come to Tim Walden, to the country once a year, to show where the taxpayers' money is being spent. I think it's the responsibility for all departments to come in on budget, but obviously we also appreciate that there are significant pressures on them in terms of the legacies of the high inflation we've had over the last two years, but also above inflation pay increases as well, which, for instance, in Manx Care are an additional risk of up to £4.5 million. So we do understand that, and we are doing as much as we can with all departments, to give them the tools and resources they need to try to come in on budget. Well, you mentioned that the risk of pay increases and how that affects the budget. We know that the budget is set in February. It comes in from April. It's October now, and the pay negotiations are still ongoing. I mean, not just for Manx Care, but for all government departments, how difficult is that when you don't know what you're going to be paying out for more than half the year? It's incredibly difficult because often these negotiations take ages. Quite rightly so, because there's lots of consultations with the various trade unions. But what happens is if you have an agreement, let's say eight months into the financial year, you then have to backdate that to the previous April, and then look forward to your constantly playing catch up, which is why the PSC have proposed a three-year deal to try to get some of this stability and allow departments to budget, not just for this financial year, but in future financial years. Now, all departments have various contingency budgets, but some of them have already spent those. And one of the things that we've done as Treasury is to publish the quarterly accounts, which is the first time we've ever done this, so that the people on the Isle of Man can actually see in real time, every three months, exactly where various departments are. And also, hopefully, see the significant work that's being done by the offices in these departments to try to bring them in on budget and achieve value for taxpayers' money. Now, since April, there has been the higher income tax rate that went up 2% in your budget in February, and that was meant to be ring fence for health. And now, with this elective surgery announcement, we're essentially seeing less from the health service than before that 2% increase came in. What are taxpayers actually getting out of that pay rise, the tax-wise? Yeah, you're very right. I mean, and it gave me no pleasure to have to put up income tax as temporary measure while we looked at other funding streams for the health service. I mean, the bank's care budget was an increase of 43.8 million pounds. Part of that was the 2% part of that was additional revenue. That's gone really towards the existing services, improving services, especially the quality and safety of services, which something people often don't see if they walk into a GP surgery or walk into nobles. But we know that with the CQC examination, there was a lot of money that needed to be invested to improve quality and safety. What we've had this week is the announcement by Manx Care that they are adjusting the way that they run the theatres. Actually, a lot of departments in the UK do this anyway, as we approach the winter, they scale down some of the elective surgery to create capacity for winter pressures. But also Manx Care are going to be using those consultants to actually clear some of the other waiting lists, which are the waiting list for outpatient appointments. I think they've done this in a responsible manner. I know that it hasn't been popular, but they've been quite open about the reasons for this and the reasons why they need to do this. And there will be other issues coming up. I mean, when Laurie Hooper gave the mandate and moved it in Timmels, he did say that it was going to be tied to stick to this budget. And there will have to be difficult decisions to make in terms of how we prioritize the competing objectives of long-term transformation against short-term delivery. But what Manx Care have been quite clear on saying is that they will absolutely prioritize emergency services and crisis services and make sure that those are available right through the winter seasons. How fraught are your discussions, Minister, with Manx Care? Obviously, the Chief Minister, absolutely adamant that they have to stick within budget. When you talk to them about the money, the poststrings, do you get kickback from them about the expectations set out by yourself and government? Again, there's a clear relationship between Manx Care and their reporting to the Department of Health and Social Care. The boards meet on a regular basis. And a lot of that challenge does take place. Both ways, Manx Care was set up and is being led by a doctor. And all the doctors in nobles are actually now being managed by doctors in terms of the clinical directors. They've gone a huge way in terms of involving the medical profession there. But there are challenges. The entire Council ministers met with the Chair of the Manx board and the CEO, Tracey Cope, last week, to express our concerns about the budgetary situation, to express our concerns about their ability to deliver the mandate and listen to them in terms of the challenges they were facing, but also to offer extra help and resources, if they needed it, to actually make sure that operationally they were providing a good service as possible, and also in terms of the finances that that information flowed straight into the Department of Health and Social Care and then on to Treasury. So extra help has been requested, it is being delivered. As part of a plan to try to help Manx Care, I'm not just coming in on budget, but actually preserve some of these emergency services and crisis services that they do with everything else they do, because it's a huge organisation. As we touched on, there was this tax rise in your budgets earlier this year. We know there's this predicted overspend for Manx Care. As you said as well, there was an announcement yesterday about overspend in three other government departments, education, sport and culture, enterprise and infrastructure. So the Manx taxpayer listening to us now, should they we be concerned that in your budget in February next year, will there be further tax rises to cover all of this? We were working out the budget. Now, I think it's safe to say that, as I said, with the management accounts, we have tried to identify where these costs are coming. I mean, supplies and services are currently £6.4m over budget. Things are more expensive than they were last year. My job is to try to balance that budget. Being a Treasury Minister is not an easy job right across the British Isles. We've seen issues in the UK. We've seen the Darcy report on their health service. I'm saying it's broken. Our health service is not broken, but it is having significant significant pressures in terms of workload, demand and finances. And my role and the role of government is to support these key frontline services, whether they be health, whether they be our police and fire and rescue and civil defence services or education and infrastructure. Will that require more money from the Manx taxpayer? The budget at the moment, we are not looking at tax increases. No. But what we are looking is having to make some difficult decisions about how we prioritise those. Health is incredibly important, but we must not take our eyes off other important factors for the way we run the Isle of Man and we provide services, particularly things like education, our security, our connectivity and our infrastructure. All those are important as well. If there's not likely to be a tax rise, you mentioned a moment ago that Treasury working with Manxcare to provide additional assistance on the budget. Does that then mean that realistically there will have to be more service cuts? I think what Manxcare will be doing over the coming weeks is looking at some of the services they provide, some of the ambitions of the mandate, they may have to pause or roll back, some services that they provide may have to be reduced and some may have to be cut. I think this is a responsible thing that, I mean, we've just been talking about Christmas. The when you get get halfway through the financial year, if you spot an overspend at that point, if you know that you're heading out of your budget, it is absolutely responsible to try to reset that, to look again at what your priorities are and make sure, with particularly the wind coming, that you're in A&E departments, your ambulance services are absolutely properly resourced and that may need you pruning back on some other areas of the significant services that Manxcare provide.
