Manx Care has 'fundamental issues' at arm's length

Manx Care was established "at arm's length" from government four years ago

There are "fundamental issues" with how Manx Care can operate independently from the Isle of Man's government, a review has found.

The report by the Mersey Internal Audit Agency was commissioned in June and will be debated in Tynwald next month.

Experts looked at the "arm's length" relationship between the Department of Health and Social Care (DHSC) and Manx Care.

Their report makes six key recommendations including a shift to longer-term funding models and the need for a more "unified approach" between Manx Care and the DHSC.

Manx Care was established in 2021 following a report from the former NHS Foundation Trust chief executive Sir Jonathan Michael.

After considering whether the island's healthcare provider should be reintegrated into the DHSC, the auditors concluded that it should not.

But the Mersey Internal Audit Agency found that while Manx Care was "the right model", its "ability to operate at truly arm's length is challenging".

'Levels of turnover'

The report said the "size and scale of the island, along with its governance and funding structures" had limited Manx Care's ability to "fully function as an independent arm's length body".

It identified four "fundamental issues" that were to blame: funding and strategy, core processes, governance, and communication and engagement.

The report found the DHSC faced staffing challenges, noting "significant levels of turnover" which affected its "stability, corporate memory... and consistency of approach".

It recommended recruiting permanent leaders and reducing the "high turnover" of interim staff.

It also called for the appointment of a government executive director "with overarching responsibility for all shared services' performance and delivery".

'Clear, shared vision'

Elsewhere, the review found current funding models were "one of the biggest challenges" faced by the DHSC, Manx Care, and government.

It said there had been a focus on reducing annual overspending rather than looking at "more strategic and longer-term" projects.

It called for a health and social care strategy that covered a 5-10 year period, as well as an assessment of the population's needs.

Instead of an annual budget focus, it called for a three-year plan "to support strategic planning, pathway development, and transformation".

The report also highlighted communication problems, with "siloed working" having "led to fragmented messaging and a lack of coordinated public communication".

It recommended that a "unified approach" be taken between DHSC, Manx Care, Treasury, and other departments to "support more effective decision-making, improve cultural alignment, and enhance confidence in the system".

It said it needed "a clear, shared vision for health and social care" that reflected the Island Plan and the population's true needs.

Health Minister Claire Christian said the review provided "an important opportunity to reflect on the current model, address particular issues and adapt appropriately".

Tynwald will debate the report's findings in December.