In an age long forgotten, before 2021 anyway, health ministers were observed performing a strange ritual known across the land as the Oliver Twist routine.
Such a routine was done by successive health ministers from David Anderson to Howard Quayle to Kate Costain to David Ashford and to Lawrie Hooper, in truth it goes back before these ministers.
However, in 2019, a magic man appeared.
That man was Sir Jonathan Michael and he devised a strategy to solve this funding crisis, a simple formula, which has proved totally impossible to follow.
Nothing New
In 2018, it was reported that since 2015 the DHSC, which then ran the health service, had gone over its budget by a total of over £30m.
This was followed by another overspend in 2019 of £3.9m.
For fairness, the Covid years were impossible to predict and it is hard to realistically argue against the department going over budget given what the island and its health service faced.
However, we then move to the first year of Manx Care 2021/22 saw an overspend of £9.4m, followed by £8.8m in 2022/23.
Now with the most recently DHSC Minister Claire Christian also agreeing a deal for Treasury to find £800,000 for Manx Care (on top of its overspend), we thought it was a good time to explore this year’s funding.
The Budget
To consider this year’s finances, we go back to February 2024, when the Manx public were told the upper rate of income tax was going up by 10% (to 22%) with the extra revenue being used to pay for health and social care.
This formed a large part in finding Manx Care some an extra £43.8m for its budget, which rose to £347m.
As you’ll no doubt all remember, people were on the streets cheering the name of Treasury Minister Dr Alex Allinson, the saviour with a stethoscope!
That tax rise was due to be one year, it was going to be replaced by a health levy, a new form of tax essentially, but it just hasn’t worked out that way, it proved more difficult to do and so Treasury kicked it back a bit.
However, in amongst all of that, was the reasoning for rise and the additional budget.
Appearing before the Economic Policy Review Committee, Dr Allinson said: “So this extra income that is going to be put into healthcare should allow Manx Care, not only to budget properly for this year and provide those services they have been asked for, but also to develop that long-term financial plan, as outlined by Sir Jonathan Michael, so that we do not lurch between one overspend and another in the future.”
A Bridge Too Far
Fast forwarding now to July 2025, news emerged that Manx Care was on course to be £18.7m over budget.
At the time, the then health minister Lawrie Hooper made clear he would not support cuts to services to plug the gaps.
Voicing his very public support for more money to pay for health and social care, Mr Hooper stunningly quit in the middle of a Tynwald sitting, saying he believed the Chief Minister wanted to “privatise our health service” and told members he wouldn’t support it.
This also led to an outpouring of criticism from backbench MHKs and islanders, especially those who agreed with the idea that the health service was underfunded.
Alf Cannan refuted this and said that the “difference between his idealism and the reality of the position that Manx Care finds itself in is a bridge too far for him”.
Always Over Budget
Mr Cannan then took the reins as DHSC minister and released a copy of an audit report produced for the DHSC in April 2024 which showed how bad the finances were looking.
Mr Cannan then told Tynwald that Mr Hooper “knew and was informed in April that Manx Care’s financial planning was not effective, or indeed a priority”.
The Chief then told islanders that the overspends were “destabilising already finely-balanced” public finances.
At the time, it was hoped the overspend would be reduced to about £11m, Manx Care said it could get to £10.
However, now Manx Care expects its overspend to be £15m.
Next Month
Even with the measures announced to make savings, Manx Care will be over budget again this year, carrying on a fine tradition of healthcare overspending.
While the figures have grown, the results are still the same, healthcare will always spend what is available and as history tells us, always a bit more too.
While Teresa Cope has said the Sir Jonathan Michael review’s funding model is no longer that helpful in setting out future health funding, a model has to be decided on.
We will soon be faced with the big question of how to fund social care, we are talking about millions more needed to pay for that and let’s face it, that isn’t going to be done in the last year of an administration.
However, failure to resolve this before 2026 will make Manx Care’s future an election issue and with people being asked to pay more yet get what the public see as diminishing returns will make candidates saying it is time to kill the experiment of arms-length healthcare dead an interesting proposition for voters.
The Budget next month will set out what Manx Care’s budget is, what it will spend is a different matter, but either way, expect a health minister to utter the immortal words “please Tynwald, we want some more”.
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