Plans to reduce surgery lists will 'exacerbate' waiting lists

Isle of Man Medical Society says Manx Care decision will lead to people waiting longer

Planned changes by Manx Care to slash surgical lists will lead to people waiting longer to be treated, according to the Isle of Man Medical Society.

The healthcare body is reducing the number of elective theatre sessions by an average of 5.5 per week as a cost-cutting measure.

That means any surgery not classed as an emergency - covering anything from hip and knee replacements to tonsillectomies - could be delayed.

The society's President Elect, Dr Sean Crerand, and Chair, Dr Prakash Thiagarajan, have told Manx Radio it will 'exacerbate' an already significant backlog:

The Isle of Man Medical Society say they only discovered the move was taking place via Manx Radio's reporting this past weekend, with its last discussion with Manx Care on the topic taking place on 20 September.

The society subsequently raised its concerns in a letter to the Manx Care board, which has also been copied to the Department of Health and Social Care minister and the chief minister.

They asserted that: “Delaying or cancelling these surgeries will lead to prolonged suffering, increased morbidity, and potentially life and limb-threatening complications for those awaiting treatment and contrary to the minister for DHSC’s assertion that cancer procedures will not be affected, they will be, according to senior colleagues.

“Reducing elective surgery is not a cost saving but a deferred cost which in time will likely be higher because morbidity increases with time and so surgery becomes more challenging, adding to cost inflation and may form justification for further outsourcing to for-profit companies such as Synaptik.

“This will also increase demand on primary care appointments as patients seek treatment for symptoms while waiting for the surgery thus exacerbating the existing issues in access to general practitioner appointments.

“Furthermore the reduction in theatre lists will exacerbate the already significant backlog of elective surgeries, placing additional strain on our healthcare system.

“This backlog not only affects patients directly but also impacts the efficiency, skills-maintenance and morale of our medical staff, who are committed to providing the highest standard of care.”

Manx Radio invited Manx Care and the two ministers to respond.

Manx Care responded with the following statement: "In order to bring Manx Care into balance this financial year there is a need to focus on specific areas where spend can be reduced with immediate effect such as bank and agency expenditure, freezing of vacancies, purchasing of goods and services, off island commissioning etc. 

"As part of Manx Care’s financial recovery plan we have taken the decision to reduce the number of elective theatre lists by 5.5 lists per week for up to a maximum of six months in order to reduce expenditure on bank theatre and anaesthetic staff which are currently required due to a number of vacancies within both the theatre and anaesthetic teams.

"These reductions will be within ENT, general surgery and gynaecology. 

"Theatres and anaesthesia on average have been spending £84k per month on bank staff costs in the first four months of 24/25, although this has been reducing in both areas since August thanks to the appointment of new permanent staff, a trend that is likely to continue throughout the year. 

"Modelling has taken place within ENT, gynaecology and general surgery which indicates that based on the current waiting list position, the reductions in weekly list allocation will not cause those specialties to exceed the sustainable waiting list size.

"This is the number of people on the waiting list to maintain an 18 week wait between being added to the waiting list and being admitted for surgery.

"This approach means that the efforts that went into funding and delivering recovery and restoration phases 1 and 2 will not be wasted as the objective of the programme was to get waiting lists to the sustainable waiting list size on completion of the programme.

"In addition, after reviewing theatre productivity data, it has been identified that there are opportunities to improve theatre utilisation, particularly within general surgery and gynaecology, i.e. using the remaining lists more efficiently so that they can operate on the same number of patients in a reduced number of lists, thereby reducing the actual impact on patients.

"The weekly theatre planning meeting is leading on improving theatre utilisation by challenging surgeons to make the best use of the theatre list time allocated to them. 

"Manx Care has recently been successful in recruiting substantive anaesthetic and theatre staff who are planning to join Noble’s Hospital over the next few months.

"Appointing new substantive staff members to the organisation is a positive development.  

"Therefore as the requirement for additional bank cover reduces with the new permanent staff coming into post, the need to maintain these theatre lists reductions will be regularly reviewed as the opportunity to save will diminish and theatre lists will be reinstated accordingly.

"In the meantime the theatre team is taking a flexible approach to planning these reductions which will ensure that any urgent or cancer cases can be accommodated and any delays avoided wherever possible. 

"Manx Care appreciates that taking this action is not ideal but is committed to minimise the impact on patients, restoring the theatre lists as soon as possible and meeting the requirement of our financial recovery plan."

Meanwhile, Health and Social Care Minister Lawrie Hooper told Manx Radio: "As I am sure you are aware the Council of Ministers has made financial discipline a cornerstone of the Island Plan.

"Following a letter from the treasury minster outlining that Manx Care should enact its contingency plan to reduce expenditure and to try and come back within the allocated budget for the current financial year Manx Care have had to take operational decisions to try and achieve this.

"Manx Care and the DHSC have very recently presented to the Council of Ministers in respect of the financial pressures facing the health service, the decisions that will need to be made in order to achieve financial balance and the resulting impacts of those decisions. 

"The position in respect of the importance of financial balance was made clear to Manx Care by the chief minister and treasury minister.

"Whilst any significant changes to services would require changes to the mandate, which would require the approval of the DHSC and the Council of Ministers, the decisions taken to date rest within the operational sphere of Manx Care and I would suggest the best people to speak to about this would be Manx Care directly."

Manx Radio has also invited the Chief Minister to respond; but has not received a reply.