Tynwald members have called for reform to the arrangements between the DHSC and Manx Care and a multi-year budget settlement.
The Mersey Internal Audit Agency (MIAA) report, commissioned by the DHSC, concluded the current arm’s-length model “is not working as intended.”
It presented four strategic options, ranging from maintaining the status quo to reintegrating Manx Care back into the department.
Moving the report, Health Minister Claire Christian said the report showed “several issues which are undermining the effectiveness of current governance arrangements”.
She advocated for a strengthened partnership model, saying it offered “greater clarity, improved accountability and enhanced integration”.
Funding
A central theme of the debate was the ongoing issue of funding.
The report identified the annual allocation model as “one of the biggest challenges”, a point strongly echoed by former minister Lawrie Hooper.
He argued: “If the government isn’t going to do that, don’t waste your time on anything else.”
Treasury Minister Dr Alex Allinson offered to collaborate but emphasised the need for trust: “I am very happy to work with the department on a multi year funding model, but there is that trust and accountability that has to be built in there.”
Chief Minister Alf Cannan questioned the affordability of long-term commitments, warning of “very serious questions” about future taxation or service funding.
He also doubted the Manx Care board’s effectiveness.
Mr Cannan said: “I mean, we shouldn’t be in here lecturing an organisation on its business performance if we’ve hired a professional board, one of the recommendations that Sir Jonathan Michael was to put in place this board, put in place an arm’s length body, give them the professionalism and the tools and the oversight they needed to push forward and yet.
“And yet, we’re still here in a position where we are talking about flaws in delivery, funding, models, strategic delivery people not looking ahead and just being sucked into the day to day problems, the same old issues that have been facing the organisation for some considerable time and period.”
Board
Several members, including Julie Edge supported proposals from the Isle of Man Medical Society for a restructured board with political representation.
Diane Kelsey MLC also noted the review recommended “consideration of political representation on the Manx care board”.
Speaker Juan Watterson urged action on long-identified fundamentals, stating: “It’s time to stop banging into the reefs before we founder all together.”
Ms Christian concluded by committing to return in February 2026 with a full response and implementation plan.