The cost of running the Island's healthcare services has been a big talking point over the last couple of weeks.
As Manx Care announces cuts to services, questions have been raised over how the organisation is financed, and whether the model is sustainable.
In this episode of the Manx Newscast, Manx Care Chief Executive Teresa Cope tells Manx Radio what she thinks needs to be done to tackle the funding challenges, and responds to comments from an MHK that Manx Care is 'holding a gun to the head of government'.
Hi, I'm Shahn, one of the news editors at Manks Radio, and over the last couple of weeks we've been talking a lot about health, in particular funding for health services on the Isle of Man. So just what does the future of health care funding on the island look like? I've been catching up with the chief executive of Mankscare, Theresa Kope, but started by asking her about comments made by an MHK, claiming Mankscare is holding a gun to the head of government. I'm quite disappointed when I hear comments like that because I think the language is really unfortunate, and in essence, Mankscare gave a very detailed briefing to all Tynwald members on the 5th of February, which really explained in some detail the gap between the funding formula recommended by Sir Jonathan Michaels and what we were actually getting in terms of settlements, and also understanding some of our cost base, so essentially the financial impact of two consecutive years of 6% pay awards, and each year our pay award at 6% is costing us around £8 to £9m per year. What we've seen in terms of inflationary impact on health care consumables, drugs, and indeed the contracts that we commission and other providers to deliver on behalf of Mankscare, including those on island, but also our asylum partners, and also the extent of the financial savings that had been achieved so far. I guess no one would have been under any illusion just how much of a financial challenge Mankscare was facing in 24/25, despite the very healthy uplift and settlement that we received. So we were very committed and attempting to deliver that full £19m worth of cost savings that we signed off as a board in April. And as we've reported last week, £12m of that original set of savings is now possible. So that is £12m that will be delivered in this financial year, which are all the things which ultimately make the system more efficient and improve outcomes for patients whilst also saving money. Things like medicines, management, medicines optimisation, use of back-off dysfunctions, using different supply models, procurement models to really get the best value for money out of health care. All those things are still happening, and all those things will deliver £12m worth of savings, which in any context would be seen as a real positive. Unfortunately, we still have a gap, a financial gap, which we absolutely from discussions with the Department of Health and Social Care, and indeed we've come in a couple of weeks ago. We must close that gap. And that's why the board has looked really, really carefully at those additional savings that we can make. And the savings that we have signed off on as a board are those ones that we believe will have the least impact to patients. Now, any, any cuts and savings in health and care will often have an impact on patients. So we're, you know, we're not naive to that, but in this context, we absolutely have taken our responsibilities seriously, and we have chosen the schemes that we think we can deliver safely and will have the least impact on patients. And these are short-term schemes. The majority of these are just for a period of time to get through this year. So I think I was just a little bit disappointed because we had taken the opportunity to brief all of the MHKs at the start of the year. Now, I think there is a broader question, and this is what I have been trying to put out there as the solution. You know, the big question we collectively have to answer is what is the cost of health and care for the island, and ultimately what standard of health and care do we want? Now, that can only be achieved through what I would describe as a commissioning process. So what services does the island want Mank's care to deliver? What's the specification for those services? What's the activity levels for those services? What standards needs to be met? And ultimately, what is the cost of those services? What is the work force that's needed to deliver that particular service? And what is the cost? And if you did that for all the services that are included in the mandate, you would have a quantum of money that you know this is what it is going to cost to deliver this mandate, these services for the island's population, at which point then it can be judged whether the Mank's care or efficient or inefficient, and will allow some choices to be made about what things we genuinely do want and what we could perhaps live without and allow that prioritization to take place. I think because we don't have that, that is leading to some claims and counter claims, but collectively, we all have a responsibility to essentially understand what is being commissioned for the island and how much the mandate that has been given to Mank's care to deliver truly costs from which then we can judge. You mentioned there that you did speak to Timmled members in February, ahead of the budget going through. Are you surprised then to see that these issues are coming up now so far down the road? I guess if Mank's care had not been forecasting sort of the overspend, then I suggest these questions probably wouldn't have arisen, but you know the point I really wanted to make was that information was made available. It is there for all of the numbers there to be scrutinized for any questions to be asked. It was really important that there was a collective understanding of that context at the start of the year. I think it's obviously when we reported as an organization our level of forecast overspend, we forecast in a way that we don't actually reflect in our forecastful delivery of our savings until we are sure they are going to be delivered. So that's £16.8m overspend was worth case scenario and there's sort of the next sentence when that was announced at the board is that £11m at that point in time of those savings had been identified. So the gap is actually smaller. It's definitely where we will not end the year with a £16.8m gap, but it will still be a financial gap and that's why we've obviously discussed that with the Department of Health and Social Care and with COMEN and are working to consider and agree how we close that gap. As I say, we will deliver around £17m worth of savings in this financial year. The original 12 and then the 5 that we have identified and we reported on last week, we will then be agreeing how much of that remaining £8m gap are we going to actually close for the remainder of the financial year? You mentioned there about the importance of the collective full understanding of the costs of health and social care on the island. Do you think there is that understanding? I don't think there is because we haven't been able to do that level of bottom-up costing. Manc's care is only 3.5 years old. The Department of Health and Social Care is a new entity in its own right and still working through the backlog of the work that it needs to do around policy strategy and lead legislation. How realistic could it have been that following COVID comprehensive CQC inspections, we could have got ourselves to the point where every single service that we deliver, Manc's care delivers on-demand aid can go through a comprehensive review, a specification developed, all of that costed, the workforce for that service defined and ultimately that level of transparency with all concerned, that this is actually what it fundamentally costs to deliver this range of services to the island's population. That would be the ideal scenario. That would mean everybody had true transparency over the cost base and for decisions to subsequently be made and priorities to be determined from that. We would love to be in that place and I think that would take a lot of the concern out of the system because at the moment it's difficult to evidence that. But that is the piece of work that we truly must all collectively agree to move forward on. That is so necessary, particularly in this context of really understanding that the island has a limited amount of financial resource. It needs to set its priorities and it needs that level of bottom-up costing in order for that priority setting to take place. In terms of what you described as a commissioning process, is that something that should have happened before now three and a half years into Manc's care? Yes, I mean, in an idea, again, we have to come back to in an ideal world. In an ideal world when Manc's care and the department were being separated in response to the recommendations from Sir Jonathan Michaels, there would have been a programme of work to do these service reviews to create very clear specifications for what these services ideally need to look like. What does contemporary practice look like? What are the standards for those services that need to achieve? What are the outcomes we're looking for for those services? What are the KPIs, key performance indicators that will monitor the delivery of those services? In an ideal world, everybody concerned that's where Manc's care would have started from, having very clear specifications. So we knew the budget was as right as it possibly could be at the outset. We weren't in a perfect world and in reality, we were living with a global pandemic. So that just wasn't feasible, but the department is working really, really hard to develop all those specifications. So we can get to that point of saying, "This is the specification for this particular service. This is what it's going to cost us, and this is how it will be delivered." But we haven't got to that point yet, and it will take some time to be able to get to that point. But I think what's happened over recent weeks and with the financial climate that we are all living with across all departments, that piece of work is needed more than ever. When you compare it to the Darcy report, say, in the UK, it's very clear we have to look five, ten years into the future. We have increasing demand. We are going to have to do things differently, and we are going to have to prioritise and make some different decisions about healthcare, because the demand, the complexity of healthcare, the cost of healthcare, the expectations around healthcare are increasing year on year. We are part of many professional networks for our services, and our emergency department and critical care team last week received the visit from the major trauma centre and critical care network. It was a peer review. And you can see year on year, the standards of which these departments have to achieve just rises year on year, more is added in, more expectation. That's right, because this is ultimately around critical care and emergency care for our patients, but the standards always continue to rise, expectations rise, and ultimately that usually results in rising costs. But what I can say from that peer review visit last week is that we are now reporting green on pretty much every single indicator, and the peer review team were incredibly impressed by the service that we offer here on the island and how that compares with other services in England. And that wasn't the position we were in two years ago. So as Manc's care absolutely drive up the quality and standards of the care that we deliver inevitably, some of that does translate to increases in cost, and particularly often increases the level of workforce that we have, and health and care is almost 80% in terms of workforce costs. So it's important that in the midst of these savings, that longer term strategic vision is understood. And I agree entirely with Mrs. Christian's comments around planning our services on a much longer time scale in order to be able to do that strategic financial planning, not just working year to year, but trying to look much more further ahead into the future. So we can make the right decisions and prioritise accordingly. And we know that that was something that Sir Jonathan Michael did recommend in his review. That's not something that came into force. How keen would you be to see that sort of idea, the long term budget revisited for health care? It's absolutely critical for health care. And like you say, it was one of the key recommendations from Sir Jonathan. So we got some of that recommendation delivered in terms of the level of the IP. We have to achieve. We didn't get the level of budget that Sir Jonathan had recommended, or indeed, that sort of three year funding planning. So it is something that we have gone on record repeatedly and said this would be really, really helpful for us to plan delivery of health care over a much longer period of time. So yes, we would very much support that. We do know that's difficult, and we do completely understand and appreciate the reasons why that isn't in place. And equally, we also know that for departments like ourselves, services like ourselves that have been overspending, that in itself is a risky strategy. But actually that strategic financial planning over a much longer term is absolutely what you need to have in health and care particularly. Because some of these savings absolutely can be achieved, the work we're doing on that £12 million worth of the IP will continue to deliver some significant savings over the next few years. These are all the schemes that build sustainable health and care for the future. They're not for alarmist lysing. They're not short termism. They are really setting out that this will look much more cost effective and much more efficient over the next two to three years. And that's the sort of the assurance that we can give, that we are essentially using the resource we have as effectively as we can. But we are building that sustainability into the future. Thank you for making it to the end of the Manxeradian newscast. You are obviously someone with exquisite taste. May I politely suggest you might want to subscribe to this and a wide range of Manx Radio podcasts at your favourite podcast provider, so our best bits will magically appear on your smartphone. Thank you. [Music] You
