NHS Trusts forced Manx Care to backtrack on immediate surgery cuts, emails reveal

Health officials in England warned Manx Care its decision was inappropriate and urged a notice period to prevent disruption to patients

Manx Care attempted to halt all surgeries not classed as ‘emergency or trauma’ with immediate effect in late January, a series of emails sent by the health body has revealed.

It was only after NHS Trusts in England questioned the decision - asking whether Manx Care ‘fully understood the implications’, stating that it ‘did not feel it was appropriate’, and urging the organisation to reconsider - that the health body altered its approach.

The Trusts requested that Manx Care introduce a 'notice period' before enacting the cuts, allowing time for adjustments.

Details of the planned cuts only came to light when the former health minister leaked an embargoed press release, which had been recalled after the media was told it was no longer accurate.

Emails seen by Manx Radio between Manx Care and NHS Trusts in England highlight the urgency of the discussions, the resistance from NHS partners, and the back-and-forth that ultimately led to a revision of the proposed measures.

Financial pressures lead to surgery suspension plans

On 27 September 2024, Manx Care's Service Development Manager Kurt De Freitas wrote to The Walton Centre NHS Trust - the UK’s only specialist hospital dedicated to neurology, neurosurgery, spinal, and pain management services - warning that Manx Care’s expenditure on tertiary services was significantly exceeding budget projections.

The email stated that Manx Care had been ‘placed in financial turnaround by the Council of Ministers to achieve financial balance’ and was exploring options to slow activity for the remainder of the financial year.

Mr De Freitas requested a patient treatment list (PTL) to ‘understand and explore’ potential cost-saving measures.

By 9 January 2025, Manx Care’s Executive Director of Health Services, Oliver Radford, formally requested Liverpool University Hospitals NHS Foundation Trust (LUHFT) to delay treatment for patients categorised as P3 or P4 - those not in an active category - until the new financial year.

Under standard medical definitions:
•    Priority 1 (P1) – Emergency/trauma cases
•    Priority 2 (P2) – Urgent cases
•    Priority 3 (P3) – Cases to be completed as soon as possible
•    Priority 4 (P4) – Routine cases

Immediate suspension of non-emergency procedures proposed

On 16 January, Manx Care held a ‘Tertiary Forecasting’ meeting.

As a direct result, Mr De Freitas drafted a formal notice instructing NHS Trusts not to proceed with any non-P1 treatments for Isle of Man patients between 20 January and 31 March.

"If you do, we will not be in a position to pay the corresponding invoice," the notice warned.

On 20 January, Manx Care’s Director for Financial Recovery, Pete Shanahan, asked Mr De Freitas to send the directive. However, the decision quickly drew objections from NHS Trusts.

Later that same day, Alder Hey Children’s NHS Foundation Trust Associate Director Gary Wadeson responded:

On 21 January, LUHFT urged Manx Care to reconsider the suspension of all P2, P3, and P4 treatments and, at the very least, introduce a notice period:

Manx Care backs down under pressure

Later that same day, Mr Radford responded, clarifying that elective procedures, routine care, and non-urgent follow-up appointments should be deferred.

Acknowledging the concerns over appropriate notice, he extended the cut-off date to 1 February before restrictions would take effect.

However, in a separate email, Mr Radford also wrote, "Proceed based on clinical priority," prompting a blunt response from LUHFT that he should have included that in the initial notice:

Radford conceded the point, replying: