More cuts to health services announced by Manx Care

Measures said to bring overspend down to £8m this year

Manx Care has today (10 October) announced it is in the process of implementing an additional £5 million worth of saving schemes.

If successful, the board says the measures will bring its overspend down to £8 million this financial year.

However, several of the 11 schemes outlined impact patient-facing services, from the Ramsey Minor Injuries unit to mental health contracts.

Siobhán Fletcher asked chief executive Teresa Cope to outline them:

At the start of the 2024/25 financial year, Manx Care signed off a £19 million cost improvement programme which aimed to achieve financial balance.

It saw an external specialist from the Mersey Internal Audit Agency brought in by Treasury in a bid to improve the body's 'financial oversight and governance'.

However, the board now says £12 million would have been a more 'realistic' goal.

It says it has incurred additional costs of £9 million due to the body's 'monthly spend rate' - fed by factors such as the cost of off-Island care, the impact of high-cost care packages for individuals, and the increase in drug costs.

The new schemes announced to save £5 million before the end of the current financial year are outlined below. 

RAMSEY MINOR INJURIES UNIT

Ramsey’s Minor Injuries Unit (MIU) will be closed at weekends until the end of the calendar year.

It has already been closed at weekends for a period of three months - from 6 July - due to staffing issues.

The advice to anyone with a minor injury or illness who would ordinarily have attended the MIU has been to attend the Emergency Department at Noble's Hospital instead, where a minor injuries service will be provided.

The Executive Director of Health Services for Manx Care, Oliver Radford, says the move will prevent £15,000 a month being spent on agency staff.

He confirmed the closure thus far meant six additional attendances per weekend at Noble's Hospital, and no added pressure on MEDS.

ELECTIVES

As already extensively reported, Manx Care is cutting elective surgeries to reduce reliance on bank and agency staff.

The number of elective theatre lists have been reduced by 5.5 lists per week for up to a maximum of six months.

It says this decision is being reviewed on a week-by-week basis.

UK HEALTHCARE

Elsewhere, Manx Care's tertiary partners in UK NHS Trusts are also being asked to 'slow down activity' for elective procedures in the final five months of the financial year.

This move could impact 215 patients who may see their planned procedure delayed.

This will impact so-called 'non time-critical' procedures such as hernia operations and other orthopaedic interventions.

Manx Care has confirmed this move will not impact children, cancer patients or neurology cases, and the UK hospitals contacted in this regard do not include the likes of Alder Hey or Clatterbridge.

Every request submitted to Patient Transfer is also being closely reviewed with a focus being placed on appointments and procedures which could actually take place on-Island (for example via video-appointment, or if investigations (such as scans or blood tests) could be done at Noble’s and the results sent to the UK hospital).

Mr Radford confirmed Manx Care is forecasted to spend £25.6 million on tertiary activity by the end of the year and the predicted overspend is currently £2.9 million.

MENTAL HEALTH RECOVERY COLLEGE

Two key early-intervention mental health services are set to be impacted by the measures announced today.

The Mental Health Recovery College initiative is to be paused for six months, with Manx Care saying it will 'review the impact in the context of other mental health early intervention initiatives'.

KOOTH AND QWELL

The Kooth and Qwell pilot scheme has come to an end, and Manx Care says it is pausing the initiative going forward 'until a full assessment is completed'.

Kooth is a free online E-Counselling service for children aged 11 to 17 years which was on offer to local residents since June 2019.

Managed in the UK by Xenzone, the service offers mental health services platforms for children and young people who are experiencing low-level anxiety, stress or depression.

Meanwhile, Qwell is a free online E-Counselling service for adults which was also offered to local residents since June 2019.

OUT-OF-HOURS SOCIAL WORKER

Elsewhere, Manx Care says it is 'changing the arrangement' going forwards with regards to out-of-hours social workers.

It will mean that the executive on-call will manage queries, instead of a rota of adult social work staff.

The health body says the rationale for this 'is that the expenditure on a separate rota was not justified by the demand'. 

The Board's Executive Director for Social Care, Tim O'Neill says that whilst the "safety of residents is paramount" the healthcare body "wasn't getting good value for money" via the current set-up.

EXECUTIVE SCRUTINY

Further scrutiny is going to be placed by the executive board 'on all agency placements' to ensure 'only critical gaps are covered by bank and agency staff for the minimum period needed'.

NON-CLINICAL PROGAMME ACTIVITY

The board has assessed direct clinical care versus additional programmed activity undertaken by its doctors and says going forward 'non-core medical additional programmed activity will be reduced' to eliminate 'inconsistency and duplication' – this excludes direct patient-facing clinical time.

Interim Medical Director Dr Marina Hudson says 44 programmed activities have been saved.

RECRUITMENT

All non-essential recruitment has been paused immediately, and Manx Care will not be covering vacancies with bank or agency staff.

TRAINING

Where 'possible and appropriate', the body is deferring 'non-mandatory training' into the next financial year.

PRODUCTIVITY REVIEWS

Recommendations from productivity reviews are being implemented in four of Manx Care's services – Imaging, Pathology, Outpatients Department and Community Nursing.

The board says this should 'generate additional cost reduction and efficiencies not already included in the wider cost improvement plan, with little to no reduction in patient-facing services'.

It says that in 'some instances, [it expects] to be able to deliver more and better quality of care for the same cost'.

CLOSELY MONITORED

The Manx Care board told Manx Radio all of the above decisions 'have been risk assessed and will be closely monitored'.

With regards to the remaining £8 million overspend, the board says it remains subject to ongoing discussion between Manx Care and the Department of Health and Social Care.

You can hear the full interview with Ms Cope in our latest Newscast: