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Health and Care Transformation

Introduction 

The Health and Care Transformation Programme is being delivered by the Cabinet Office in conjunction with the Department of Health and Social Care in order to deliver on the 26 recommendations set out in Sir Jonathan Michael’s Independent Review of the Isle of Man’s Health and Social Care System.

Background

Following Tynwald's approval of the Treasury Minister's motion on 16 January 2018, the Council of Ministers commissioned Sir Jonathan Michael to chair an independent review of health and social care on the Island.

In April 2019 the review's final report (GD 2019/0021) was completed and submitted to the Council of Ministers. The review's final report included a package of 26 recommendations to be implemented in order to achieve a financially and clinically sustainable, high quality health and care system for the Isle of Man. 

The Council of Ministers was in agreement with the findings of the final report and sought Tynwald approval for the package of recommendations to be accepted and implemented (GD 2019/022). 

On 21 May 2019, Tynwald voted unanimously to accept the package of recommendations and required the Council of Ministers to implement it. 

On 23 May 2019, the Council of Ministers issued a mandate to the DHSC, the Treasury and the Cabinet Office to ensure implementation of the review's final report's package of recommendations, led by the Chief Secretary and aligned to the principle that patients and service users are fully engaged in, and at the centre of, all aspects of planning and delivery of health and social care services.

These three Departments are now responsible to the Council of Ministers for delivering on the Transformation Programme required to deliver this package of recommendations. 

The Transformation Programme is being carried out by a dedicated team under the Chief Secretary within the Cabinet Office, working closely with the Department of Health and Social Care. 

Programme, Workstreams and Projects

As per the proposed structure, the Health and Care Transformation Programme is made up of 5 workstreams and 16 projects. Each project is designed to deliver on one or more of the independent report’s recommendations. Each workstream is designed to enable each project to effectively meet its objectives and maintain cross-working, linkages and dependencies within the Programme. The Programme, including its workstreams and projects, are currently being finalised and planned and are summarised below:

Workstream: Governance and Legislation

Project: Governance and Accountability Framework
Priority: Standard
Planning Lead: TBC
Description: Health and Care on the Island requires a consistent approach to Governance and Accountability. Sir Jonathan’s review identified the lack of this as being a significant inhibitor to the provision of consistent quality services.
This project will seek to implement a joined-up and structured approach to Governance and Accountability across all responsibilities and activities of DHSC including those which are delivered by other organisations including Manx Care, the third sector, private sector providers and off-Island providers, supported where necessary by legislation (though delivery of the legislation itself is covered elsewhere). 
The recommendations included the need for the introduction as part of the overall improvement of Clinical Governance of a statutory duty of care for all those delivering health and care services, including social care staff.
Linked recommendation: 2

Project: Improve Legislative Framework
Priority: High
Planning Lead: Nicola Igoea, Health and Care Transformation Manager
Description: The Final Report identified a number of areas where there are gaps in the law necessary to underpin a safe and responsible health and care service for the Isle of Man, for example around clinical governance and prescribing. In addition, some of the recommendations of the review will require legislative changes to enable their implementation, for example, new primary legislation will be required to establish Manx Care and amendments to legislation may be required following the decision on how to fund the increasing cost of the health and care service in the future. This project will determine the need for new or amended legislation and work with the necessary stakeholders to progress its introduction into statute.

The project will take an incremental approach to developing the revised legislative framework. As a result, the project has been split into three parts, as follows:

  • Part 1: A framework National Health and Care Bill to be the main piece of legislation for the Island’s National Health and Care Service and implement the majority of high level recommendations within the Report. Royal Assent is required for this Bill in February 2021 to ensure that Manx Care can be operational on 1 April 2021, which is a key delivery date for the Transformation Programme as a whole.
  • Part 2: As the Health and Care Service Bill will be a framework Bill, the majority of the substantive legislative detail will be in subordinate legislation. The project will progress the research work on the detail of the secondary legislation alongside the drafting of the Bill in order that the Bill is given context and therefore has meaning when being considered during public consultation and by Tynwald.
  • Part 3: The remaining legislative changes identified as gaps within the Final Report will need to be addressed separately, either after or alongside Parts 1 and 2.

Linked recommendations: 2 5 8 9 10

Project: Implement External Quality Regulation
Priority: Standard
Planning Lead: TBC
Description: The review found that there is a lack of comprehensive, consistent quality regulation across health and care services on the Island and that when inspectors do find fault, their recommendations are not consistently implemented. The current regulatory regime is not sufficiently robust to protect the public consistently and ensure that services are safe, relevant and of appropriate quality.
This project will implement appropriate, comprehensive external quality regulation across the full breadth of health and care services.
Linked recommendation: 3

Workstream: Model of Care

The first 3 projects in this workstream (Undertake Needs Assessment, Undertake Service-by-Service Review and Design and Implement Care Pathways) are closely related and interdependent projects that jointly consider what are the Island’s health and care needs, what is the optimum care pathway and what is the optimum service model. These projects will be closely aligned during delivery and activities will be subject to ongoing management by the Project Leads and Transformation Programme more broadly.

A Prioritisation Board will be set up to determine the order of services addressed by these three Projects. Once a priority is set, a joint team will be formed to deliver the initial ‘data dive’, service review and pathway design in parallel. This will be subject to a specific plan and scope defined by the Prioritisation Board and established during formal project initiation for each individual aspect. 

A series of pathfinder projects will also be used to develop and test the process for review and new service design. It is anticipated that the final list of pathfinder projects and immediate service reviews from the Prioritisation Board will include the most urgent of services to be reviewed and be composed of:

  • Diabetes
  • Cardiovascular
  • Up to three further large health conditions; and
  • Up to two small discrete service review projects

The common 'pathfinder' approach to be adopted across all three projects is shown in the diagram below:

Diagram - Programme, Workstreams and Projects

Project: Undertake Needs Assessment
Priority: High
Planning Lead: Madeleine Sayle, Senior Public Health Intelligence Analyst
Description: The objective of this project is to provide a baseline of health and care needs on the Isle of Man. It will be used to inform all service design, development and delivery processes as part of the Transformation Programme and beyond its delivery.

The desired outcomes of this Project are to deliver:

  • Improved understanding of need on the Isle of Man
  • Improved evidence-based service design
  • Greater proactivity in service delivery
  • The ability to ‘right size’ capacity in specific settings/for specific purposes (models of care)
  • An understanding of demand/need that is currently unmet and
  • A clear view of demand that drives the transformation of services

Linked recommendations: 10 11

Project: Undertake Service-by-Service Review
Priority: High
Planning Lead: ASE Consulting/Clair Barks, Head of Health and Care Transformation
Description: This project will deliver a service-by-service review of health and care provision on the Isle of Man to ensure that the most appropriate health and care services (clinically, operationally and financially) are provided in the most appropriate setting, whether on or off Island, and by the most appropriate person at the most appropriate time.

It is recognised that undertaking a service-by-service review is a significant task. Within the scope of the project are hundreds of individual services that provide individual elements of one or more care pathways.

The desired outcomes of the project are to deliver:

  • Improved patient and service user safety
  • Improved access to services
  • Increased service efficiency
  • Greater clarity surrounding the services offer and service user pathway consistency
  • Improved clinical outcome and
  • Improved Value for money

Linked recommendations: 11 13 16

Project: Design and Implement Care Pathways
Priority: High
Planning Lead: Claire Bader, Senior Healthcare Public Health Practitioner
Description: The objective of this project is to develop the process for delivering clear, evidence based, Isle of Man appropriate, person centred care pathways, through all five tiers of care, which enable the delivery of comprehensive integrated services.

The desired outcomes of the project are to deliver:

  • Improved well-being outcomes for individuals, particularly those with long-term conditions
  • Improved patient and service user voice and involvement in own care;
  • Greater consistency in services along care pathways
  • Improved joint collaboration between tiers of care with reduction in duplication
  • Greater financial efficiency through increased, appropriate care delivery in lower-cost settings
  • Greater General Practitioner (GP) oversight of patient journey
  • Improved alignment of ‘on’ and ‘off’ Island services to improve patient and service user experience and clinical outcomes and
  • Improved recognition and clarity of contribution to care by allied health and social care professionals

Linked recommendations: 11 12 13

Project: Implement Air Bridge
Priority: Standard
Planning Lead: TBC
Description: The project will enable the creation of an emergency air bridge; an aviation solution with comprehensive in-flight emergency and critical care facilities to transfer emergency cases to appropriate specialist centres. 
Linked recommendations: 11 12 13

Project: Implement Single integrated Out of Hours Service
Priority: Standard
Planning lead: TBC
Description: The project will enable the creation of a single centre of integrated out-of-hours emergency care on the Island.
Linked recommendations: 14

Project: Primary Care at Scale
Priority: Standard
Planning lead: TBC
Description: The project will determine the best means of achieving enhanced primary care at scale in general practice on the Isle of Man and deliver on the agreed means. It will also incorporate other aspects of primary care in order to maximise the benefits of the scale. 
Linked recommendations: 12 15

Workstream: Data

Project: Data, Information and Knowledge
Priority: High
Planning lead: Rebecca Rowley, Head of Research and Development
Description: This project is necessary to deliver a coordinated approach to:

  • specifying what data should be collected across the health and care system (from digital systems and or manual processes)
  • determining how that data should be collected, verified, aggregated, interrogated and reported
  • delivering the necessary changes to implement the specified changes

The focus must be on building a comprehensive dataset that is reliable and usable and in turn contributes to building information and in turn knowledge about the performance of the health and care system in the widest sense. 

To meet the Project objectives, tasks have been sorted into six main themes (quality, staff, systems, reporting, architecture and governance) and under two strands proceeding in parallel - ‘strategic’ and ‘tactical’:

  • Strand 1: Strategic will take a holistic and thorough ‘top-down’ view of data requirements across health and care on the Island and create an information strategy.
  • Strand 2: Tactical will adopt a ‘bottom up’ approach to focus on discrete areas sequentially to make the changes to data input and system configuration required to start the process of creating datasets throughout the DHSC.

Linked Recommendations: 21 22 23 24

Project: Digital Strategy
Priority: High
Planning lead: James Mayles, Programme Officer for GTS
Description: The review recognised that there is already significant progress being made in relation to improving digital services supporting health and care on the Island. 

Effective and flexible digital systems and reliable, shared information are both critical components of an integrated health and care system. This project will consider the existing Digital Strategy in detail and determine how that could be accelerated, re-shaped and expanded to support the wider transformation programme and will address four key areas:

  • 'in train' strategic projects (including gaps)
  • system replacements/upgrades
  • existing business initiatives
  • new digital enablers for Projects in the Transformation Programme

Linked recommendations: 22

Workstream: Funding

Project: New Funding Arrangements
Priority: Standard
Planning Lead: TBC
Description: This project will support changes in the amount of funding the Isle of Man’s health and social care system receives and will drive changes in the mechanisms through which funding is allocated to the system over time. 
Linked recommendations: 16 17 19 20

Workstream: Organisational Design

Project: Establish Arms-length Delivery of Health and Care Services
Priority: High
Planning Lead: ASE Consulting/Clair Barks, Head of Health and Care Transformation
Description: The project will establish the organisation to deliver health and care services (potentially called Manx Care - a single public sector body with responsibility for delivering and commissioning all health and care services on the Island) as an arm’s length body run by a Board appointed by Government and approved by Tynwald.

The outcomes of the Project are:

  • The establishment of Manx Care by April 2021 (but running in shadow form from September 2020)
  • A high level target operating model setting out clear roles and responsibilities for Manx Care and DHSC – the principle approach is for Manx Care to take the DHSC work and staff with some exceptions (such as Public Health, Regulation and Inspections Unit and areas of high level policy and strategy)
  • An agreed process for determining and notification (The Mandate) between DHSC and Manx Care of the services required and financial envelope within which the services are to be delivered from April 2021.

Recommendations: 2 4

Project: Transfer of Public Health Directorate to Cabinet Office
Priority: Standard  
Planning lead: TBC
Description: The aim of this project is to support the Public Health Directorate in working closely with other government departments and non-governmental bodies by transferring it to the Cabinet Office. This will enable the Public Health Directorate to better inform policy relevant to not only health and care, but also their wider areas that determine sound health such as housing, education, sport, employment, economy, transport and policing.
Recommendation: 9

Project: Workforce and Culture
Priority: Standard
Planning Lead: TBC
Description: The project will deliver a new workforce model which supports greater integrated/ multi-disciplinary working across health and care, and all agencies which determine the health of the population including education, housing, policing and fire services. 
Linked recommendation: 25

Transformation Political Board

A Health and Care Transformation Political Board has been established to provide political oversight of and accountability to the Council of Ministers for the implementation of the Transformation Programme. 

The Members of and Advisers to the Political Board are set out below: 

  • Hon David Ashford MHK (Chair), Minister for Health and Social Care 
    David Ashford MHK
  • Hon Alfred Cannan MHK, Minister for the Treasury
    Alfred Cannan MHK
  • Hon Chris Thomas MHK, Minister for Policy and Reform
     Chris Thomas MHK        
  • Mr Will Greenhow, Chief Secretary
    Will Greenhow
  • Mrs Angela Murray, Interim Chief Executive for the Department of Health and Social Care
  • Mr Caldric Randall, Chief Financial Officer, The Treasury
  • Sir Jonathan Michael, Independent Adviser
  • TBC, Health and Care Transformation Director
  • Mrs Clair Barks, Head of Health and Care Transformation

The Political Board has oversight of the transformation programme and will hold the Chief Secretary to account for the delivery of it. The Political Board will ensure the Transformation Programme has access to the resources required to transform the health and care system, including in relation to Human Resources and finances. The Board will assist in addressing issues or obstructions to the transformation and providing political guidance as required throughout the course of the Transformation Programme and in line with the principles and recommendations set out in the independent report. 

The Political Board will report to the Council of Ministers on a minimum quarterly basis and support the Council of Ministers in preparing a report for submission to Tynwald, and published, on an annual basis. 

The Political Board is currently meeting on a monthly basis.

Transformation Board

The Chief Secretary is accountable to the Political Board for the delivery of the Transformation Programme and has the support of a Board to monitor, manage and enable the work of the Transformation Programme at an operational level. 

The Members of and Advisers to the Board are set out below: 

  • Mr Will Greenhow, Chief Secretary (Chair) 

  • Mrs Angela Murray, Interim Chief Executive for the Department of Health and Social Care
  • Mr Caldric Randall, Chief Financial Officer
  • TBC, Health and Care Transformation Director

  • TBC, Clinical/Professional Transformation Lead
  • Mr John Quinn, Her Majesty's Attorney General
  • Mr Jon Callister, Executive Director for the Office of Human Resources
  • Mrs Clair Barks, Head of Health and Care Transformation
  • Mrs Liz Aelberry, Head of Corporate Communications

Transformation Programme Management Office

The Health and Care Transformation Director, appointed by and accountable to the Chief Secretary, will lead a dedicated team to establish, manage and monitor the transformation programme, including the work-streams that will be tasked with and accountable to the Health and Care Transformation Director for delivering on transformation programme.

The Members of the Transformation Programme Management Office are as follows:

John Spicer, Health and Care Transformation Director contact john.spicer@gov.im
TBC, Clinical/Professional Transformation Lead 
Clair Barks, Head of Health and Care Transformation contact: clair.barks@gov.im
Nicci Igoea, Health and Care Transformation Manager contact: nicola.igoea2@gov.im
TBC, Health and Care Transformation Programme Manager
Georgia Dobbins, Health and Care Transformation Executive contact: georgia.dobbins2@gov.im
TBC, Health and Care Transformation Officer

The Transformation Programme Management Office will report to the Board on a regular basis.

Contact

If you would like to contact the Transformation Programme Management Office, including if you want to contact any of the project leads or join a list of stakeholders in order to receive regular updates on the Transformation Programme, please contact us.

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