A report into the structure of arrangements between the DHSC and Manx Care has effectively ruled out scrapping the organisation.
The governance review, conducted by the Mersey Internal Audit Agency, concludes that while the current arm’s-length model is not operating as intended, there is “little appetite to return to the previous model”.
It found that Manx Care as a delivery model is “the right model” but faces significant challenges due to the island’s size and governance structures.
However, this review has not explored the wider public mood for the future of healthcare on the island.
Issues
The review identifies fundamental issues across funding, strategy, governance, and communication.
A key finding is that the Department of Health and Social Care’s (DHSC) own structure and governance “does not meet ministerial needs” for holding Manx Care to account.
Significant staff turnover has impacted the DHSC’s “stability, corporate memory, [and] consistency of approach.”
The current annual funding model is described as “one of the biggest challenges”, forcing a focus on reducing overspends rather than enabling “a more strategic and longer-term focus”.
The report says: “Without change, the current method will lead to continued overspends and will perpetuate the cycle of mistrust.”
Viable
Two viable options for reform are presented.
Option 2 involves the full implementation of the 2019 Sir Jonathan Michael review, reinforcing the separation between the DHSC and Manx Care.
Option 3 proposes a “strengthened partnership” with closer collaboration and shared governance. The report notes that in the given environment, “Option 3 is viewed as the most viable option”.
Regardless of the path chosen, the review stresses that fundamental challenges must be addressed, including developing a five to 10 year strategy underpinned by a three-year financial settlement and defining a clear shared service model.
The report concludes that the final decision on the future structure of the island’s health and social care system rests with the government, which is only partly true as it would be up to the will of Tynwald.