Tynwald has voted to approve Manx Care’s £19m overspend and £1.8m for endoscopy services.
While some members criticised the financial position of Manx Care, it was defended by others who said health funding remains below demand.
The supplementary vote, which covers the 2025-26 financial year, was passed by 19 votes to four in the House of Keys and six votes to none in the Legislative Council.
The revenue element includes Manx Care exceeding its allocated budget by £14.9m, driven by operational pressures, and the Department of Health and Social Care accruing £4.1m.
More than £12m of the pressure relates to maintaining safe staffing levels through bank and locum provisions.
Lightly
Health and Social Care Minister Claire Christian said the request was not made lightly.
“This is not a request that is made lightly, nor should it come as a surprise to honourable members,” she said.
“It reflects the position that has been consistently set out throughout the year, that our health and care system continues to face sustained structural pressures driven by real demand and the need to deliver safe statutory services.”
Ms Christian said Manx Care had delivered £9.9m of efficiencies through its cost improvement programme, exceeding the mandated target of 2%.
However, Tim Glover questioned why budgets were not being set to reflect reality.
“The question is not simply whether this funding is required, the question is why are we still setting budgets that do not reflect known reality?” he said.
“I think the court needs to reflect on what that tells us, because this is not about a single pressure point.
“We have the workforce cost, locum reliance in this year, demand from complex patients, and increased demand for off-island treatment. None of these are new.”
Demand
Ms Christian said the supplementary vote reflected genuine demand-led pressures.
“It covers expenditure already incurred in meeting real patient and service user need and ensuring that both Manx Care and the Department fulfil their statutory obligations,” she said.
Julie Edge raised concerns about the ability to achieve planned savings and again called for a forensic audit of Manx Care.
“We cannot continue to go down the road where we could possibly bankrupt the island because of healthcare,” she said.
“All we have done is continuously give more, because something’s not been met.”
Defended
Lawrie Hooper however rode in to defend Manx Care, saying the overspend had been predicted at the start of the financial year.
“We were told at the start of the year, the budget you’ve given us does not include all of these things,” he said.
“Manx Care were pretty clear about that, the minister was very clear about that.
“So at the end of the year the minister’s coming back to us and saying, you know, all those things that you didn’t include in the budget, you still asked us to do them, so we still did them, and they need paying for.”
Blame
Speaker Juan Watterson said he would not support the vote but said: “I’m not laying 100% of this blame at the door of either the department or Manx Care. This is a broken system.
“I won’t be supporting it today, not because I lay the blame at the minister’s door, but because I’m going to stop enabling a broken system.”
Former treasury minister Dr Alex Allinson said he would support the bid but called for greater responsibility from the Manx Care Board.
“I would like to see far more responsibility being put on the Manx Care Board, who are there specifically to look at the spending, to look at some of the pressures, and to do their job,” he said.
Ms Christian said work was under way to strengthen financial controls and reduce reliance on temporary staffing.
“This supplementary vote ensures that expenditure already incurred in delivering that care is properly authorised and transparently accounted for,” she said.
“It underpins our fundamental responsibility to the people of this island to ensure that whenever they need care, whether urgent, complex, or ongoing, it is available, it is safe and it is delivered with compassion, dignity and professionalism.”