Average costs for ambulance, A&E and crisis‑team services are unavailable because Manx Care does not use activity‑based costing.
Responding to a written question from Arbory, Castletown and Malew MHK Jason Moorhouse, Health and Social Care Minister Claire Christian said neither the Department nor Manx Care holds fixed unit‑level costs for the services requested.
She explained that Manx Care’s financial reporting is built around broad budget allocations rather than detailed tracking of the cost of individual activities.
The organisation does not currently use activity‑based costing (ABC), a methodology that assigns overheads and indirect costs to specific services.
Costs Vary
The Minister said this means the Department cannot accurately isolate the average cost of:
- A single ambulance response, where costs vary depending on staffing, response time, fuel, vehicle maintenance and the equipment or consumables used.
- A single A&E attendance, where costs depend on triage category, tests and treatment required, and the length of time a patient spends in the department.
- One hour of mental health crisis team support, which involves multidisciplinary staff time, administrative support and follow‑up work, none of which is currently costed on an hourly basis.
She added that the picture is further complicated by indirect costs held in other Departments’ budgets under Shared Service Agreements, making it difficult to calculate the full cost of individual activities.
Budget Parameters
Manx Care, she said, manages services within overall budget parameters and monitors spending by service area, but its current accounting systems are not designed to produce the specific unit‑cost figures requested by Mr Moorhouse.
However, the Minister confirmed that developing activity‑based costing is now a formal requirement.
The 2026/27 mandate and operating plan sets out a commitment under Priority 2(b), Cost of Care Transparency, to identify and cost a solution for ABC or an equivalent methodology, alongside improved patient‑level cost tracking.
Additional resource is expected to be mobilised through the Financial Recovery Plan during 2026/27 to develop a proposal for implementing ABC using both existing and planned systems.
The Minister said this work will support a more accurate understanding of the real cost of delivering health and care services across the island.
The full written answer can be found here.
