Siobhán Fletcher sits down with Manx Care Chief Executive Teresa Cope to talk further cuts announced by the healthcare body to save money this financial year.
Manx Newscast
Manx Newscast: Manx Care chief exec on further cuts
Hi, I'm Siobhan Fletcher, one of the journalists, up at Monks Radio, and welcome to this latest edition of our newscast. Okay, I'm Theresa Kipam, Chief Executive of Monkscare. Perfect. Okay, so we're talking through today some more savings that Monkscare is having to make. The headline here is really is that in September, the overspend figure was around 16 million. All these different schemes and interventions we're going to talk about now should get Monkscare down to around 8 million overspend. Can you just briefly run me through some of the measures that we're sort of going to see go into place? Yes, so this is, as you say, 5 million pounds worth of additional schemes on top of our existing 12 million pounds worth of cost improvements, which are already in our plan. And these schemes are largely short-term schemes to help us reduce that overspend for the rest of the financial year. So these things are, we have taken the decision to temporarily close our mental health recovery college. We are also not going to renew our mental health online contracts regarding Cooth and Quel, and we are also withdrawing our out-of-hours social worker in adult social care. That's not to say there are no social workers on duty out-of-hours, but this is a level of duplication and actually we believe removing this service has no impact. We've also taken the decision to continue for a further three months, the weekend closure of the minor injury unit at Ramsey. We've also talked about the elective cooling, and I think we've talked a lot about that in terms of that temporary reduction of some theatre lists over the course of the next few months. We have put in additional scrutiny around the use of bank staff and agency staff, and that's heavily scrutinised by our clinical professionals. We will always make sure we are safe, but this is about optimising our rosters and being able to ensure our frontline staff are able to work at the frontline. We're also looking at how we accelerate some of that work with our tertiary providers, so where patients don't need to have to travel, but also we're asking our tertiary providers to clinically validate the waiting lists of island patients who are on waiting lists for off-island care and understand whether those can be delayed or not. Obviously that's a clinical process, so that will be subject to the clinical validation by the teams across in the UK, and will only be done if those teams feel that is clinically appropriate to do so. A further scheme is that our medical director has been doing a very detailed piece of work around consultant job plans, and the first part of that piece of work is to look at additional programmed activities for medical staff, which are not frontline linked to direct patient activity. So these are sort of leadership roles that can potentially be consumed within the overall job planning contract, so again that work has been accelerated, that would be a recurrent scheme, so that scheme would continue beyond the end of the financial year, but has been brought forward to try and achieve some savings in this financial year. The majority of those savings are very short-term, but there is just one or two that we potentially would continue longer-term. At the core of all of this, what is the root cause of the overspend that Monkscare is facing? So in essence, we had to set a very ambitious cost improvement program target at the start of the year. Monkscare has delivered around 10 million pounds of cash out savings over the last two years, but this year in order to have a balanced position, we needed to make 19 million pounds worth of savings. When we risk assessed all of those savings, that reduced down to 12, which is why we had a gap. Also during the course of the year, we have been impacted by movements in our monthly spend, so increased costs of off-island care, impact of high-cost placements, individual drug costs. All of that has put essentially in 9 million pounds cost pressure into the organisation. So the level of savings we need to achieve to offset that has increased considerably. I think the main thing we're going to take from some of these measures is kind of like we had last week with the elective surgery list, is that these are now patient facing impact to the frontline services. The tertiary partners asking them to slow down activity for electives is more elective really, around 215 patients. Now that was clarified that that's not older, hey it's not kids, it's not quite a bridge, it's so it's not cancer services, it's not normal, but for example some of the non-time critical procedures there was orthopedic, so herneas, I mean we talked last week about knee and hip, things like that. Again, the mental health, the slowing down, stopping early intervention pilot schemes, which you're not saying will necessarily never be picked back up again, but we're slowing down what we know and we get told is key early intervention. This is all more patient facing, so what is Manxcare's message to the public with this? So Manxcare's message to the public is that we have attempted to choose the schemes which would be least impactful and we will monitor them incredibly closely. We take our financial responsibilities really seriously and ultimately this has resulted in us making some unpalatable decisions in order to achieve this further round of savings. We will always put the safety of our patients first and we do acknowledge that asking the UK providers who have patients on the waiting list to consider cooling down their services, where clinically appropriate, just like we've done here, there is an impact because ultimately a patient may have to wait slightly longer for their treatment and we know that has an impact, but we are in that very difficult place of making some incredibly difficult decisions in the short term whilst we move forward with the wider piece of transformation in order to achieve sustainable high quality healthcare services for the island. Our focus with the £12 million worth of savings is around those long term benefits which take costs out whilst also improving provision and things like medicines optimization and better medicines management are classic win wins. We save money but we also improve the outcomes for our patients and service users and those are the types of transformation programs and savings we really want to focus on but we have an in-year problem and we must take steps to reduce the overspend. The public kind of seems to have lots of ways they think monks could make savings, you know, the appointment system so people receiving letters and the postage cost of that when the letter arrives and the appointment has been missed and then the cost of an appointment missed so electronic communications all these different things were they're like why is this not in place and why not spend money in these sort of area now to save money in the long run. Yeah and we absolutely are and again a lot of this is timing because we can see opportunities for the organisation to take several million pounds worth of costs out year on year without impacting any frontline services and the administrative processes that you've just described as just a case in point we've already started that work and so the organisation is confident that it can continue taking out 10 million pounds worth of cash releasing and efficiency savings every year moving forward by just the things like that. We are looking at an app which will really revolutionise the way we do appointments so this will be an app which will have all patient's appointments on it including their letters if they wish and that will really revolutionise, it will stop us having to spend 300,000 pounds per year on postage, it will stop the issue of missing letters, it will allow people to be able to have their appointments on their phone or their device or their iPad and it is a game-changer and we're pushing that really really hard because that will be something which has a huge benefit to patients whilst also saving a significant amount of money. You know, Mike's care was established on the 1st of April 2021, it's still in its relatively early stages really. Euronal organisation describes this as marking a once in a generation shift in the way we do healthcare here, why does that shift seem to be failing at this point? I would argue it's not failing. I would say we are a, Manc's care is a new organisation that when it was established we were in the midst of Covid. The first 18 months, almost two years of Manc's care was still very much in Covid. I remember the first year of Manc's care starting having the highest number of inpatients with Covid that there had ever been and then we moved to living with Covid. And then in year two of Manc's care we prepared for comprehensive inspection across all of our services. So we invited the Care Quality Commission and offstead into all of our services and as a result we have almost 90 inspection reports of comprehensive inspection and we have been responding to that. We also are improving the quality and the performance management and the financial governance of the organisation. So getting much better at the data we have available to us, the reporting, reporting on outcomes and really improving the safety and the quality of the services that we provide whilst also trying to transform services and look into the future and plan what services need to look like for the population in the next 5, 10, 15 years. So I think it was always a big ask in the context of Covid, comprehensive inspection. And so Jonathan Michael's funding formula not able to be offered to Manc's care. Well just to jump in there, I mean he gave you that funding formula. The Manc's labour party we've heard from this week, they say the health service has been routinely underfunded this entire time that might cause some existence so do you agree with that? Absolutely, the evidence is there. So the funding formula from Sir Jonathan Michael's was very transparent and we know what we should have had as a settlement and we know what we've had and there is a very clear gap. However we do acknowledge as an organisation that the economic landscape has changed and probably that funding formula is no longer affordable but what we have is a quite an ambitious mandate and we still have a full sign up to the 26 recommendations of the Sir Jonathan Michael's report. So what that means for us as a system and this is broader than Manc's care is that we will collectively need to make some difficult choices about what the funding settlement for health and care can really afford and that's an active and ongoing discussion. But yes I think if you just come back to the funding formula Sir Jonathan Michael's said was needed to transform services and create a fit for purpose health and care system for the island and no we have never received a settlement which matches that funding formula. So you're trying to make all these savings but it's like I say some of these are hitting you know it's mental health it's out of our social work being withdrawn it's quite key interventions being taken away here what's the approach then if there's a patient failed during this will that policy change? So this is why the monitoring of all of these schemes is really important so we have to understand the impact we don't anticipate there would be impact so recovery college is not a statutory service there are still alternative services to put a patient or service user into who may have access recovery colleges there are still alternatives it's a different pathway it's a different provision but yes the the monitoring of the implementation to ensure that no harm has come as a result of these schemes is really important and we have processes to identify that and and review that and as I say you know sometimes these schemes potentially are likely to make savings which don't materialize well then of course we we will stop trying to push that and but it is about making those short-term savings nobody wants to make additional savings halfway through the year it's very disruptive for staff and and you know we have to pay tribute to the staff who work incredibly hard in responding to to these continued chat challenges and work with us on this but it's it's never ideal to have to sort of go back and look for additional savings part way through the year particularly as you're heading into winter but it has been necessary and the board has looked very very carefully at the schemes that have been agreed there's a number of schemes we just absolutely said no no we do not believe we can implement that safely we basically hear seeing some of the ambitions of monks being stripped away I mean this this is early intervention schemes this is things maybe that you say are statutory requirements are we seeing some of that ambition that we saw monks care be set up and basically being stripped away then rather than necessarily core services I mean is this the kind of item on the top been scraped off like what are we what are we seeing here yeah no I think that's I think that's fair so recovery college is a real passion of mine it feels really important to have a psychosocial educational model of supporting people in the recovery from their mental illness it is an early intervention it isn't a core or a statutory service we're not mandated to do it it's something that we feel is important as an organization with our ambition of moving services out into the community and also supporting early intervention so it is it is difficult from that perspective because it's against some of the principles of of monks care and we only want in to provide those enhancements but actually we haven't got the budget for it and it is something which can be paused and removed temporarily with very little impact and and certainly preferable to say stopping frontline mental health care which which wouldn't be acceptable to us we've got the culture of kerbrom from the bma has been published but you know some of the comments on that it's again that they want to see management cut and things like this and again that's going to be the comment from the public on this at what point will we see sort of will we see a just a gutting of that middle management that you know is perceived as not being that being needed to be there yeah now and I can understand that and we within the saving schemes that are already in place there is a reduction of of managerial roles and looking really really closely at you know those corporate and back office functions and protecting frontline with regards to the barometer of care we we take the comments of our medical colleagues and this survey really really seriously we are listening we know we know it is really really difficult so for example our medical colleagues we're still in pay dispute for the last two years so we haven't been able to settle the pay award for last year and for this year medical colleagues have seen other jurisdictions and England settle with their medical colleagues and get a much more favorable outcome than what manks care is able to offer and we are also trying to progress transformation at pace so we we do understand that often the ask of our frontline staff is is is a big ask and some of this change does not always sit comfortably but we absolutely are committed to to working collaboratively with our with our medical staff and colleagues and indeed all of our colleagues that includes our nurses and our allied health professionals and our managers we have looked at the management costs of the organization and they are around two percent which benchmarks um quite low and if you look at the Darcy report which has just been published in England um it is basically saying we need more managers um a lot of our managers are clinical managers so they're clinically qualified um leading services whilst also professionally leading staff groups um so perhaps just because they have a manager in their title does not mean they are without a clinical qualification or not professionally leading a number of our frontline clinicians because actually that's that's not correct then you sort of prepared it there as well there's a comparison with some of these measures with things that happen in the UK as well and it's kind of already in place that the government there has not been shy about saying that they see the NHS as it stands in England as as broken is it right to be copying the UK on some of these measures should we not try and be a bit more aspirational or is this that we're seeing the aspirations and then not the money to back it up I think we've got huge aspirations here and huge opportunity we are an integrated health and care system um and I think we have so many more benefits to the UK um yes in some ways you know we have been slightly behind and we are trying to transform and bring in some of those uh new service models which we know work really well in the UK but equally we we are in a much much stronger position in terms of um our the quality of our service offer um how we do things but the opportunity to transform and do things differently um we we are on a a smaller scale but with lots and lots of opportunity so I wouldn't ever say we're broken um we are struggling to take the costs out as quickly as what we would like um and I think for me it's definitely a timing issue we have taken 24 million pounds worth of cash out savings over the last three years with a further 16 17 identified to come out this year this is cash out of this system and a huge amount of additional efficiency gains we just need longer to be able to do that in a way which is safe and allows our staff to change and evolve and be engaged in those in those changes some of we have been hugely successful in recruiting substantively to a lot of the workforce gaps that were in place uh three years ago so we inherited a sort of 22 percent vacancy factor um as we've said in the briefing with with a couple of exceptions we have now recruited to all of our consultant workforce and uh and we have dramatically reduced the number of vacancies for our allied health professionals and and our nurses but the consequence of that is that we now have staff who's got you know employment contracts and and right and and if we are going to change services or do something different with their employment contracts we have to go through a period of consultation and do that in a really appropriate way um so so that is when you build sustainable health services and the downside is you can't just turn the tap off sometimes and and that's not what we would want to do we are committed to building sustainable clinical delivery models um with us with a workforce that is based here that has all the expertise and training to deliver what manks care need them to do and they feel professionally supported in this organization and and I think we've got a huge amount of success around that um but obviously you know we are struggling with um with our finances health and care is almost 80 percent workforce costs so it's difficult to think about um taking costs out of health care which actually don't take staff away and and that's why we've got to balance some of these um some of these thorny issues but ultimately um the we have to change we have to make the savings this year but it's really important we have that conversation about what next year's settlement looks like and what we're going to have to do differently in preparation for that settlement thank you for making it to the end of the manks 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 manks radio podcasts at your favorite podcast provider so our best bits will magically appear on your smartphone thank you You