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Programme and Projects

The Transformation Programme has put in place the foundations necessary to deliver successfully on the recommendations of the Final Report.

The 26 recommendations from the Report will be delivered by the Programme Management Office (TPMO) through one or more of the projects, with thirteen recommendations and two projects now completed. Each project is designed fully or partially to address one or more of the recommendations from the Report. This section provides a brief overview of each project, progress made to date and what the project will look like moving forward.

Improve Legislative Framework

Project: Improve Legislative Framework

Project Lead: Nicola Igoea
Project Manager: Pamela Crye 


Recommendation 8 from the Sir Jonathan Michael Report states that:

'Primary and/or secondary legislation should be introduced as required, and included in the legislative programme as soon as possible, in order to form a modern, comprehensive legislative framework. This legislation should address weaknesses or gaps in the current system as well as enabling the implementation of the recommendations contained in this Report, such as any necessary legislation to establish Manx Care'.

The project will address the gaps in the law needed to underpin a safe and responsible health and care service for the Isle of Man, as highlighted in the Review. This project will determine the need for new or amended legislation, and work with the relevant stakeholders to take forward its introduction into statute. With an incremental approach to developing the revised legislative framework, the project was split into three parts:

  • Part 1: The Manx Care Act 2021 came into force in its entirety on 1 April 2021, establishing Manx Care and implementing some of the high-level recommendations within the Report, including a duty of candour and a duty to share information. Additionally, secondary legislation was prepared and laid before/approved by Tynwald as required to enable the establishment of Manx Care.

  • Part 2: A framework National Health and Social Care Services Bill (known as the 'Reform Bill') will be the main piece of legislation for the Island’s national health and care service, consolidating the National Health Service Act 2001, National Health and Social Care Act 2016 and Social Services Act 2011. The project will deliver this Bill and subsequent pieces of secondary legislation to create a modern framework that can be more readily kept up to date.

  • Part 3: The remaining legislative changes identified as gaps by the Report will be addressed separately, after Parts 1 and 2, along with any other new areas identified as required through the wider work of the Programme not otherwise enabled prior to this phase.

Complaints Regulations: In April 2021, the Department of Health and Social Care was required by Tynwald to review its Complaints Regulations and return to November 2021 Tynwald with updated Regulations. The Department was asked to include a clear procedure for handling complaints at the local resolution stage (where the service was provided) and at the independent review stage. The Transformation Programme is supporting the Department with these interim Complaints Regulations alongside Part 2 of the Project. 


  • Royal Assent for the Manx Care Act 2021 announced and in force in its entirety on 1 April 2021

  • Duty of Candour Regulations approved by Tynwald and in force on 1 April 2021

  • Amendments to the Complaints Regulations to account for establishment of Manx Care approved by/laid before Tynwald and in force from 1 April 2021

  • Ongoing development of the policy for the Reform Bill

  • Complaints Regulations redrafted

  • Key stakeholder consultation and public consultation on Interim Complaints Regulations

  • Feedback from the consultation is being incorporated into the final Interim Complaints Regulations

  • Consultation report on Interim Complaints Regulations issued

Aims for the next 12 months:

  • Deliver Interim Complaints Regulations by July 2022

  • Continued development of the policy for the Reform Bill

  • Consultation on prioritised policy areas under the Reform Bill

Main recommendation: 8

Linked recommendations: 2 5 9 10

Establish and Embed Governance and Accountability Framework

Project: Establish and Embed Governance and Accountability Framework

Project Lead: TBC
Project Manager: TBC


The project aims to create a clear and systematic governance and accountability framework, covering the DHSC, Manx Care and associated Government functions.

The project aims to deliver a comprehensive corporate governance framework and a clinical and care governance framework covering all health and care services (including quality and risk management) as well as the relationship to areas such as external regulation. Key objectives include:

  • Support the implementation and embedding of a fully comprehensive Clinical and Care Governance Framework for Manx Care

  • Ensure clear accountability for operational delivery, with a 'golden thread' linking policy and strategy to day-to-day improvements in outcomes

  • Provide transparency around quality, performance and finances across all associated health and care services

  • Embed continuous improvement and proactively address risks and issues in our health and care system

  • Ensure that future corporate and clinical and care governance frameworks are fully aligned, system-wide, with active representation and involvement of patients and service users


  • Detailed mapping of interfaces between Manx Care, DHSC, Treasury, Public Health complete

  • Best practice model of clinical and care governance developed

  • Corporate governance and accountability models, including related Terms of Reference and roles and accountabilities, for Manx Care Board and Health and Care Partnership Board completed

  • Best practice Duty of Candour procedure developed for implementation using existing processes and systems

  • Delivery of governance induction for new Manx Care Non-Executive Members

  • Co-development, with Manx Care patient safety and quality leads, of the new Duty of Candour operational policy, covering all care settings

  • Configuration of Datix incident reporting system to record and report on Duty of Candour incidents

  • Development of supporting training specification to support roll-out of Duty of Candour

  • Manx Care complaints processes updated in line with new Regulations

  • Baseline analysis completed of all existing Clinical and Care Governance policies – to be progressed by Manx Care (with support from the project if required)

  • Supporting the development of the DHSC proposed assurance framework for future health and care services

Aims for the next 12 months:

  • Baseline of current clinical and care governance procedures and policies established across all care settings and priority areas for development identified

  • Support development of governance arrangements between the DHSC and Manx Care during first year’s establishment, ensuring model remains true to the Report

  • Embedding Corporate and Clinical and Care Governance Framework

Linked recommendation: 2

New Funding Arrangements

Project: New Funding Arrangements

Project Lead: Bevan Boyle and Anup Rughani
Project Manager: Rachael Harrison


The aim of this project is to achieve a health and care system that plans for the future, is affordable, financially sustainable, and delivered to an agreed set of standards, contracts and mandate through six strands of work.  The development of the funding model for the Nursing and Residential Care work is also being delivered by this project in conjunction with the Care Pathways and Service Delivery project.


Strand 1: System wide Efficiencies

Whilst Manx Care and DHSC will continue to be responsible for the delivery of efficiencies against the agreed 8-year profile, the project will conduct a high-level benchmarking exercise to identify areas where there are opportunities for productivity improvement.  Outputs of this will feed Manx Care, DHSC and other projects (outside of New Funding Arrangements) within the Health and Care Transformation Programme to inform system-wide initiatives and changes to be put in place.

Strand 2: New Funding Formula

The focus of this work strand is to outline the requirements and develop an implementation plan for the proposed 3-5 year funding approach. This will include an assessment of the various options available, outlining key areas of data requirements and the development of a business case to support the approval and subsequent implementation of the agreed funding formula.

Strand 3: System Funding Model

This work strand will develop and introduce a dynamic funding model that covers the entire health and care system. The model will be a single version of the truth that determines the financial baseline of health and care today whilst also forecasting post-transformation financial projections for the next five years through scenario and efficiency planning. This will be built on the foundations of the model used to develop the final report. 

Strand 4: Activity Based Costing

Through the system financial model, this work strand will develop activity based costing across the health and care system to support the ongoing transformation across all projects within the Health and Care Transformation Programme and ongoingbenchmarking to help Manx Care and DHSC.  Activity-based costing compares the cost for each activity within the health and care system with its actual consumption.

Strand 5: Management Information

There are two elements to increasing transparency in costs and wider management information. This first part covers management information across the system, including both financial and non-financial information, as well as internal and external reporting requirements. This work strand will recommend a reporting framework to outline flows of management information across the health and care system. This will include a high level overview of the structure and contents of reporting at various levels.

Strand 6: Nursing and Residential

The New Funding Arrangements project will provide projections for the net funding position for Nursing and Residential Care to outline the ‘do nothing’ position.  It will also model the financial impacts of the six existing options, and any further options outlined around changes to the Nursing and Residential Care funding model, working closely with others, including the Care Pathways and Service Delivery Transformation project to enable options, a decision and implementation of a new funding model and model of care for residential and nursing care.

Aims for the next 12 months:

Strand 1: System wide Efficiencies

  • High-level review of the incentives and disincentives within GP contracting and Social Care benefits system
  • Summary report outlining modelling outputs and assessment of 3-5 options to close funding gap

Strand 2: New Funding Formula

  • Complete high-level business case for preferred funding formula

Strand 3: System Funding Model

  • Formal hand over of system model

Strand 4: Activity Based Costing

  • Summary report outlining proposed framework and roadmap for development of a long term systematic approach to activity-based costing for acute and non-acute settings

Strand 5: Management Information

  • Summary report outlining proposed framework for management information

Strand 6: Nursing and Residential

  • Detailed modelling, analysis, and option recommendations around home, nursing and residential care.


Linked recommendation: 16 17 19 20 

Care Pathways and Service Delivery Transformation

Project: Care Pathways and Service Delivery Transformation
Project Lead: Tracy Broom and Mellanie Patterson
Project Manager: Francesca DeHaven


Our team looks at how we currently deliver services to patients and where and how we could improve this.  We do this by reviewing care pathways - so what are care pathways?

A care pathway is a series of “things” that happen to a group of patients over a period of time.  Sometimes, people refer to it as a patient journey, where people needing health or care services move between different teams responsible for care delivery.

Our aim is to design care pathways that are appropriate for the Island, joined up, coordinated, best value, based on best practice (for example evidence and research) and deliver quality outcomes and experiences for our community. 

When we look at a care pathway we would include care that starts for example with a visit to your GP and then may involve calling an ambulance, a visit to the Emergency Department, the Minor Injuries Unit or being admitted to a ward and your hospital stay.  The pathway will also look at care after discharge, when back in your home, this may involve a visit from a community nurse or social worker.  Many pathways will also include what happens when patients need transfer off Island, for a specialist review, and how care is coordinated between the professionals involved when you return to the Island.

As we can’t do this for the whole of our health and care system at the same time, due to the volume of services provided on the Island, we need to do the reviews in clusters. We are guided by Manx Care on the priority of services they would like us to review. 


In Phase 1 we looked at 9 service areas and mapped out how we currently provided health and care, found out how others provided this (international best practice) and then described, at a high level, what an ideal pathway for the Isle of Man community might look like.

These 9 areas were: Cardiology, Vascular, Stroke, Diabetes, Children & Young People with Continuing Care Needs (CYPCCN), Autism, Cancer, Eye Care and Urgent and Emergency Integrated Care (UEIC)

The process was inclusive, with health and care staff and the Third Sector (voluntary and charity staff) attending sessions and working together to identify and agree issues and opportunities.  People who use the services (i.e. patients and carers) were involved through surveys, workshops and individual meetings.

Phase 2 (our current work) started in autumn 2021 when our work was re-prioritised by Manx Care and we were asked to look at 3 areas in more detail; these areas were Urgent and Emergency Integrated Care (UEIC), Eye Care and Cancer. 

For UEIC and Eye Care, the teams reviewed the Phase 1 pathways (post-Covid) and began to agree the detail of possible solutions, moving then into planning how to make this happen.  For Cancer, we were asked to break down the pathway into 12 tumour site pathways.  The work for all 3 pathways will be summarised into business cases, which will include activity numbers and costs.

UEIC and Eye Care is now nearly completed and we hope will move to implementation (i.e. making the changes) by summer 2022.  Cancer is making good progress and it’s likely that services will change when the 12 business cases are approved.

For the 6 areas not prioritised in Phase 2:

  • We grouped diabetes, cardiology, vascular and stroke and, working with Public Health, reviewed national screening services provided elsewhere.  The purpose of screening is to find people in the community who are at higher risk of a health problem or a condition, so that an early treatment or intervention can be offered.  The main outcome of this work is a proposal for a national Diabetic Retinopathy Screening programme for the Island.

  • Children with Continuing Care Needs (CYPCCN) – the team are reviewing and updating the outputs of the Phase 1 work and moving towards an ideal pathway for the Isle of Man, with the business case due mid-April 2022.

  • Autism is awaiting the outcome of the DHSC led National Autism Strategy (underway).  As autism is not only supported by health and care services, the decision was taken to wait until the strategy was completed to make sure we are all coordinated in our approach.

Our other current work includes linking with the New Funding Project, looking at options for the long term sustainability of Nursing and Residential Care and Service Sustainability Reviews where we are looking at the activity data for our surgical service delivery across all specialities.

Aims for the next 12 months:

We are currently working with Manx Care to agree the next care pathways to review; these will commence May 2022 onwards.  They are likely to include continuation of UEIC (detailed planning of the next two phases), conclusion of the Cancer tumour pathways (due to complete in late summer) and new care pathways on diabetes, cardiology and stroke.

We also want to get out and meet with our community to talk about the changes.  We will be working with Manx Care to plan a number of sessions where we will be available to talk about the care pathway work and answer any questions you may have.

Nursing and Residential Care

Work stream: Nursing and Residential Care

Project Lead: TBC


As a stream of work sitting between the Care Pathways and Service Delivery Transformation project and the New Funding project, this work considers the service and funding models for nursing and residential care to ensure that the provision of social care satisfies the island’s future requirements and is also financially sustainable.

The work seeks to ensure that:

  • the nursing and residential care service model is informed by international research to secure better care and keep people well at home  for longer

  • nursing and residential care is adequately funded, financially sustainable and satisfies future demand

The Care Pathways and Service Delivery Transformation Project is responsible for:

  • Conducting an evaluation of the international provision of care of the elderly with the focus on domiciliary, residential and nursing care provisions and criteria/thresholds and producing best practice variants based on research and international delivery

  • Considering any increased demand for use of domiciliary support in the home for people to stay independent for longer and the cost associated with this

  • Understanding the impact on length of stay (and therefore cost impact) in residential and/or nursing care due to increased domiciliary support

  • Understanding impediments – benefit rules, payment rules on charging for social care, availability of resources to deliver, including within the third sector (paid for or otherwise)

  • Considering the housing stock available to enable supported living and options to fund more if required

The New Funding Arrangements Project is responsible for:

  • Understanding of current spend on services and the forecasted future need and spend on services if no actions are taken

  • Modelling the future funding gap and analysis of how this gap might be closed

  • Detailing the financial modelling around impact

  • Supporting the service model review and assessing immediate and future financial impact of different service models

  • Aligning with the wider health and care service funding model

  • Final options and recommendations development of future funding models

  • Considering the low tax economy, inheritance expectations and the long-term implications of the proposed changes


  • Baselined current cost of, and numbers in, nursing and residential care, including projections for funding requirements for the next 20 years

  • Gained an understanding of the nursing and residential care market and completed best practice research

  • Worked with stakeholders to understand the current system and fully identify issues and barriers being experienced by all

  • Completed public engagement sessions (2018), gaining public feedback on improvements to the current system, and votes on which funding models were preferred

  • Identified six possible options for nursing and residential care:

    • Modified Manx offer, threshold and cap, asset protection guarantee, free personal care provision (Scottish model), hypothecated tax (social insurance model), mixed (Jersey model) with high level pros and cons to each

    • Each of these options has been financially modelled to understand the sustainability of the option

  • Contracted KPMG to provide specialist skills and knowledge to support the delivery of the project

  • Identified a range of initiatives that would support keeping people well at home for longer

  • Developed design principles to set the blueprint for proposed changes to the future operating model

Aims for the next 12 months:

  • More detailed analysis of options and feasibility to take place
  • Shortlist of options to be selected by transformation board in April 2022
  • Further public consultation on the updated options
  • Recommendations to be put in front of Tynwald by April 2023

Undertake Needs Assessment

Project: Undertake Needs Assessment
Project Lead: Madeleine Sayle
Project Manager: Laura Garcia-Fierro


The purpose of the Undertake Needs Assessment project is looking at the process for conducting a programme of health and care needs assessments which will look at the current and future health and wellbeing needs of the local population to inform and guide the planning and commissioning of health, well-being and social care services.  

The programme should consider the needs arising from all the factors that impact the local population including economic, education, housing and environmental factors (Wider Determinants of Health), this is best achieved by Joint Strategic Needs Assessment (JSNA).  

A JSNA is the first step in a process which leads to the agreement of strategic objectives, the delivery of those objectives through an implementation plan and finally a mechanism for holding all partners to account for delivery.  A JSNA is the single agreed picture of need and is essential for joint strategic planning based on the identification of the most important areas for action, all underpinned by core data sets and evidence based research. 

The intention is that the process will reflect the changing need in how health and care services are to be delivered in the future, from institution led to a whole systems approach that’s largely preventative and looks at wider determinants of health in communities.  It should be population-focused and with the aim of “Health in All Policies” becoming the ‘norm’ across all Isle of Man Government Departments.

The desired outcomes of this Project are to deliver:

  • Improved understanding of need on the Isle of Man
  • Improved evidence-based service design
  • Whole system approach to designing services around place rather than through individual services
  • 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
  • A clear view of demand that drives the transformation of services


  • Needs Assessment Team has been fully recruited
  • Initial scoping work with the Strategy Board has been completed with chapters for the first two years of Needs Assessment work identified
    • Starting Well / Developing Well 
    • Ageing Well
    • Best practice research work commenced alongside data analysis to evidence the demand/need that is currently unmet
      • Needs Assessment Work Programme to Launch in April 2022

Aims for the next 12 months:

  • Implementation of the needs assessment programme cycle, processes, procedures and governance
  • Ongoing work around needs assessment education, support and engagement across and outside of Government
  • Identify needs assessment topics for 2023/24 against criteria and prioritisation
  • Annual report to be produced on work completed 2022/23 

Linked recommendations: 10, 11

Enhanced Emergency Air Bridge

Project: Enhanced Emergency Air Bridge

Project Manager: Joshua Phillips
Business Analyst: Nigel Hart


To deliver an enhanced air bridge service that meets the needs of the Isle of Man citizens and complements and builds upon the current fixed-wing provision for air ambulance transfers. The project will:

  • Deliver a service which aims to take patients who are seriously ill or who have suffered a major trauma from the Isle of Man directly to the UK for emergency medical treatment.
  • Identify the appropriate type(s) of air bridge services required to meet the changing needs of emergency air transfers to agreed providers of care off-Island
  • Create a business case for the provision of such services
  • Support the procurement of the agreed services
  • Outline the implementation plan for the procured services
  • Ensure the necessary business process changes within Manx Care are implemented to maximise the benefits of procured services
  • Consider known and arising issues relating to the use, staffing and views of emergency air bridge and consider options to resolve them


  • Initial analysis conducted with Manx Care to outline the feasibility of establishing an enhanced emergency air bridge, that being a modern solution (potentially using helicopters, fixed wing aircraft or both).
  • Following recommendations to the Health and Care Transformation Board, and agreement was made to partner with the Great North Air Ambulance Service (GNAAS) to provide a Helicopter Emergency Medical Service (HEMS) for an initial trial period of six months and then up to five years.
  • GNAAS have now registered on as a charity and corporation on the Island, in order to operate.
  • A contract has been signed between the Great North Air Ambulance Service (GNAAS) and Manx Care.
  • Helicopter Emergency Medical Service (HEMS) trial live as of 14 March 2022 and will end 14 September 2022.

Aims for the next 12 months:

  • Now the service is live as a trial, the project has prepared a methodology to capture and review each mission. This will be an ongoing review that will help inform the decision to extend the service. 
  • The project is also working with Manx Care and The Great North Air Ambulance to assess functionality of the activation processes and whether there are aspects of the relationship or the delivery of the Services that either Party could improve or how such improvement might be implemented.
  • If the trial is successful, the project will support Manx Care in extending the HEMS service into business as usual in September 2022.

Linked recommendations: 11 12 13

Primary Care at Scale

Project: Primary Care at Scale

Project Lead: Charlotte Refsum
Project Manager: Pamela Crye


This project is responsible for the delivery of Recommendation 15 of the Final Report following Sir Jonathan Michael’s Independent Review of the Isle of Man Health and Care system

Recommendation 15 states that:

'the Isle of Man should establish a model for delivering Primary Care at scale, since further and deeper collaboration within Primary Care is necessary to deliver current services and provide additional local services.' 

The project will also need to consider Recommendation 12, which states that:

'service by service integrated care pathways should be designed, agreed and delivered. These should encompass both on and off-Island components of clinical service models.' (Working with Care Pathways and stakeholders to develop new ways of working and care pathways.)

Primary Care at Scale is a multidisciplinary team based approach to support patient centred initial health and care interventions based on the needs of the person, providing a holistic primary care for the whole population. The multidisciplinary team will include a broad set of professionals, such as GPs, first contact practitioners (e.g. specialist physiotherapists, associated physicians, and community prescribers).  

The At Scale model will create an integrated model across all elements of Primary Care, maximising benefits through operating at scale while also ensuring a personalised patient-centric care model.  Working with existing programmes and building on work already done e.g. Wellbeing Partnerships.

At Scale GP services will be delivered through a Primary Care Network. This will build upon the Isle of Man Primary Care Network (IOMPCN), which has been established to work collaboratively to enhance the level of services provided in Primary Care. Commissioning of dentistry, optometry and community pharmacy will also encourage partnership working.

The main objective of this project is:

  • To provide equity of access and services across the Island for patients by GPs, community pharmacy, optometrists and dentists through new and enhanced models of service. Main elements to this are:

    • Supporting the delivery of a more personalised Model of Care that has the patient at the centre (how patients will be supported differently in Primary Care)

    • Co-design and implementing the optimal strategy and Operating Model to deliver Primary Care services collaboratively and at scale on the Island (how the system will operate differently within and between Manx Care and Primary Care organisations)

Right care, in the right place, at the right time, in the most affordable way


A baseline strategy has been developed, building on UK and global evidence and initial co-design. The baseline strategy was agreed by Manx Care in May 2021.

The project is progressing:

  • Building out the strategy in more detail with key stakeholders

  • Ongoing co-design and development of the high level target operating model for all providers (GPs, Pharmacists, Opticians and Dentists)

  • Developing approaches for key requirements for Primary Care to deliver at Scale (Leadership development; Population Health Management/Risk stratification)

  • Supporting mobilisation of prototypes (iterative implementations e.g. First Contact Practitioners)

Aims for the next 12 months:

  • Development and approval of an outline business case for the target operating model

  • Completion of co-design of the detailed target operating model

  • Development and approval of the detailed target operating model and implementation plan

Linked recommendations: 12 8 11 21 22 25

Workforce and Culture

Project: Workforce and Culture

Project Lead: Louise Quayle
Project Manager: Julie Colquitt
Project Team: Louise Jones, Kate Rotheroe and Holly Ball


The project aims to introduce a new workforce model which enables the joint optimisation of the social/people and technical/process elements of culture that create a high performing organisation. The project will deliver the following objectives for Manx Care:

  • Deliver a workforce audit that accurately reflects the current culture and can be used as the basis for recommendations for the future for staff

  • Identify and reprioritise all organisational development, design and cultural initiatives that have taken place or recommended to date

  • Conduct a workforce skills audit to assess the extent to which the workforce is skilled and capable of providing the services the people of the Isle of Man require

  • Develop skills, career paths and Continuous Development Programmes for all professions, grades and bands across the organisation, including new and emerging disciplines, that enable staff to work at the top of their licence and be empowering and successful leaders 

  • Develop tools for ensuring that all staff are participating in a value driven appraisal process

  • Design and implement a strategic employee engagement programme that seeks to improve employee morale, engagement and confidence

  • Design and introduce a framework for promoting and delivering integrated working that includes multi-disciplinary and shadow working as well as working across sites and teams in order to support the vision for the model of care 

  • Introduce a modern and values-driven internal communication framework and guidance that promotes openness, transparency and clear messaging

  • Design and implement a recruitment strategy that addresses issues with recruiting and retaining skilled workers across the health and care system


  • Engagement with workforce at all levels 
  • Supporting the First Leadership Academy Programme which commenced autumn 2021 
  • Values Workshops ‘Back to Basics’ 
  • Appraisal/PDP Review 
  • Cultural assessments and local action plans 
  • Team of the month award 
  • Building relationships with key stakeholders 
  • CARE values review & recommendations 
  • Designed Change Coach Programme 
  • Research on psychological safety 
  • Wellbeing offering & promotion of 
  • Agreed methodology to Workforce Planning/Modelling 
  • Research for an Equality, Diversity & Inclusion programme 
  • Listening & signposting for support 
  • Research for an Equality, Diversity & Inclusion programme 
  • Surveying – analysing & recommending

Aims for the next 12 months:

  • Workforce Planning/Modelling (Theatres underway, pending agreement on priority order for rest of organisation – proposed Social Care, Midwifery Services, Paediatrics, Integrated Primary Care Services). PCAS & Pathways. 
  • Equality, Diversity & Inclusion Programme (Terms of Reference agreed for forum, procuring specialist advice from consultant in this field, ELT rep agreed, first focus group held). 
  • Staff Space funding/committee – progressing with procuring items to improve/create staff comfort areas in Ramsey Cottage, Central Community Health Centre and Noble’s staff restaurant. 
  • Develop a systematic change management programme – research phase, all about “systems thinking”. 
  • Psychological Safety Programme – workshop development complete, waiting for sign-off, pilot with ELT, roll out to Manx Care. 
  • Target sickness absence reduction – wellbeing opportunities (increase promotion and engagement where possible), Activ8 business case, investigating wellbeing apps, mental health support for staff etc. 
  • Launching and embedding refreshed CARE values – April 2022. Key is to embed! Give the organisation the tools to do this. 
  • Recruitment strategy actions – Closely working with TAS and Manx Care BP on Exit Interview process, values-based recruitment, improving retention of staff and supporting staff who relocate to the Island. 
  • PDP/Appraisal system – focus groups held, recommendations/options paper drafted, pending information on IOMG-wide approach and review of MPTC appraisal trial. 
  • Leadership & Management teams – working with the ELT and Care Group leaders/managers to provide opportunities/guidance in terms of visibility, executive development programmes, training, undertaking Insights/MBTI.

Linked recommendation: 25

Implement External Quality Regulation

Project: Implement External Quality Regulation

Project Manager: Joshua Phillips


This project will ensure that there is a consistent, independent and systematic approach to the inspection of all health and care services delivered or commissioned by Manx Care. It will set out an agreed set of standards as well as a rigorous process to understand, critically assess and act on the findings. The project will deliver the following outcomes:

  • A systemic, robust approach to the independent inspection of the quality of provision of all health and care services

  • A defined set of quality standards for health and care services that encourage services to improve outcomes and engage in continuous improvement

  • Means for identification of any issues in the quality of care which need to be addressed by the organisations delivering care

  • Means for remediation plan (with timescale) to rectify any issues identified

  • An agreed process and responsibility for successful implementation of remediation plans and

  • Enable measurable improvements in care against a defined baseline


  • This project was slowed down during the first wave of COVID-19 to limit strain on limited DHSC resources – activity resumed once the strain reduced

  • Finalised Service Level Agreement (and related arrangements) between the DHSC and Care Quality Commission (CQC) to inspect the majority of health and care services mandated to Manx Care

  • Completed validation phase for inspections of relevant health and care services delivered/commissioned by Manx Care by CQC. This gave a greater understanding of the Island’s provision of health and care services, the challenges we face on the Island, in addition to the expectations of DHSC and CQC for a much smoother running of later inspection phases and the delivery of high quality inspections which fulfil our needs.

  • Identified reporting format

  • Progressed work to identify appropriate and willing alternate providers of services for services out of CQC scope

Aims for the next 12 months:

  • CQC to deliver initial inspection of health and care services delivered/commissioned by Manx Care within scope (Adult Social Care, Primary Care and Hospital)

  • Identify, procure and enable the establishment of other inspector(s) beyond CQC to undertake baseline assessment of service

Linked recommendation: 3

For more information, visit the DHSC’s website with which the Health and Care Transformation Programme are working collaboratively.

Establish Manx Care

Project: Establish Manx Care


The project has created a new organisation, 'Manx Care', with responsibility for delivering all national health and care services on the Island as a public sector arm’s length body, run by a Board appointed by Government and approved by Tynwald. Establishing Manx Care has facilitated the separation of the strategic planning and policy making, to be retained by the DHSC, from the delivery of services by Manx Care – which was a key recommendation of the Report.

The outcomes of the project include:

  • The establishment of Manx Care in April 2021 following a period of running in shadow form

  • A high-level target operating model setting out clear functions and responsibilities for Manx Care and the DHSC, and the boundaries and interfaces with other parts of the system

  • A formal agreement (the 'Mandate') that will set out the DHSC’s objectives, expectations and budget for Manx Care’s delivery of health and care services for the Island from April 2021

Progress from June 2020 to May 2021:

  • Manx Care Non-Executive Chair, Andrew Foster started 7 September 2020

  • Manx Care Chief Executive, Teresa Cope started 1 December 2020

  • Five Manx Care Non-Executive Board Members appointed: Ms Sarah Pinch, Ms Katie Kapernaros, Ms Vanessa Walker, Mr Nigel Wood and Mr Andrew Guy

  • System Target Operating Model - completed

  • DHSC Mandate to Manx Care developed along with associated supporting documentation:
    • the Overview Document: required by legislation and to be published (after the first two financial years of operation an Operating Plan is required) setting out Manx Care’s response to the Mandate – finalised and submitted from Manx Care to the DHSC

    • the Operating Framework: this has been drafted and will contain some of the detail required to support the DHSC and Manx Care’s working relationship that was originally envisaged to be contained within the Mandate

    • the Manx Care Operational Independence – Position Paper: sets out Manx Care’s independence from government (autonomy) – finalised

    • the Supporting the Work of Elected Members Paper: sets out the manner in which Manx Care will support politicians – finalised

  • Manx Care logo selected by Manx Care staff and approved by Council of Ministers, trademarking application submitted and branding guidelines designed and rolled out

  • Signage at Manx Care locations changed from DHSC to Manx Care

  • Relevant contracts were automatically novated from the DHSC to Manx Care (under the Manx Care Act 2021) and recorded suppliers were notified

  • Approach to ensuring compliance in terms of commissioning and contracts approved and to be progressed by Manx Care

  • Shared Service Agreements developed as working documents between Manx Care and the respective Shared Services it is mandated by the DHSC to use – some have been agreed and some work remains to finalise others

  • Preparing and coordinating redesigned DHSC and Manx Care recruitment in relation to newly required roles

  • Staff briefings, supporting material and formal written notification to all staff to confirm their new organisation

  • Formal transfer of Public Service Commission (PSC) and non-PSC staff from the DHSC to Manx Care

  • Registration of all relevant Manx Care provided services with Registration and Inspection Unit underway and on track for completion

  • Finalisation of legal documentation around Manx Care’s use of buildings and assets owned or previously used by the DHSC

  • Manx Care and redesigned DHSC websites updated to reflect creation of the two organisations

  • Public engagement and communication around the creation of Manx Care

  • Closure of final tasks and deliverables, including outstanding issues and any new issues identified after go-live

  • Final handover to TPMO, redesigned DHSC and Manx Care to ensure completion of outstanding tasks and monitoring of benefits

  • Reconstitution of the Individual Funding Request Panel (IFRP) and Clinical Recommendations Committee (CRC) progressed to be concluded with the DHSC, Manx Care and Public Health with Programme support after project closure

  • Project closure following successful handover

Linked Recommendations: 2 4

Transfer of Public Health Directorate to Cabinet Office

Project: Transfer of Public Health Directorate to Cabinet Office


The aim of this project was to enable the Public Health Directorate to comprehensively fulfil its advisory and guidance function to the whole of the Isle of Man Government through the transfer to the Cabinet Office.  Phase one of the project transferred the Directorate and phase two embedded the transition.  This work included:

  • Complete (two) Transfer of Functions Order(s) to move the Public Health Directorate from the DHSC to the Cabinet Office - completed

  • Secure suitable reporting and governance arrangements reflecting the Directorate’s position within the Cabinet Office - completed

  • Transfer the Directorate staff and current funding to being stationed with the Cabinet Office from the DHSC (administratively and, if necessary, physically) - completed

  • Ensure the Directorate’s current functions, generally and also specifically in relation to the DHSC/Manx Care, are maintained when in its new position in the Cabinet Office, including ensuring that appropriate lines of sight, accountability and responsibility are in place for those public health programmes that will be delivered by Manx Care - completed

  • Determine and implement the means/route to enable the Directorate to provide the guidance and advice to the entirety of the Isle of Man Government going forward - completed


  • Completed transition of all personnel, information technology and finance deliverables

  • Mapping of Public Health functions completed

  • Second Transfer of Functions Order laid before Tynwald in December 2020

  • Delegation under Government Departments Act complete

  • Data Privacy Impact Assessment (DPIA), including risk register, Records of Processing Activities and DPIA Report, completed

  • Handover of remaining activities to Public Health (including the ongoing support of data processing and servicing for Quit4U), TPMO (including Memorandum of Understanding with the DHSC) and Information and Digital project (including Data Sharing Agreements)

  • Project closed

Linked recommendation: 9

Information Governance

Project Lead: Patrick Mwondela

Project Manager: Neil Westwood


This project aims to achieve GDPR compliance for Manx Care, the DHSC and the Public Health Directorate to secure the foundations for a sustainable information governance framework. The Project aims to assess current compliance, determine what the future Information Governance model should look like and implement it.


  • Scoped an outline approach to achieving GDPR compliance

  • Formed an Advisory Board to provide oversight and guidance

  • Established the Transformation team to undertake the work, including an Information Governance Project Lead, Project Manager and additional information governance specialists from KPMG

Aims for the next 12 months:

  • Establish information governance framework

  • Identify and train resource

  • Baseline compliance

  • Inform work plan of continual improvement

  • Identify and establish digital support where applicable

  • Review and refresh all existing IG/DP artefacts

Manx Care Record

Project Lead: Robin O’Connor (interim)

Project Manager: Neil Westwood


This strand aims to implement the Manx Care Record, a single overarching digital care record that provides appropriate staff from all parts of health and care with access key data from each relevant system used in the delivery of care. This will improve efficiency and enable the provision of higher quality services.

This project will therefore ensure that digital systems used are effective, flexible and reliable, to support an integrated health and care system.


  • Completed high level aims for the Manx Care Record and published Prior Information Notice (PIN) to inform options analysis before progressing

  • Identified the suitable team that will be required for this project

  • Established the Manx Care Record Advisory Board for guidance and oversight

  • Commissioned and completed the options analysis and report

  • Commenced recruitment activity

Aims for the next 12 months:

  • Consider recommendations of options appraisal undertaken by the Programme’s consultancy partner, KPMG

  • Outline business case, funding approach and output based specification

  • Define procurement and commercial strategies

  • Award contract 

Data and Business Intelligence

Project Lead: Richard Wild

Project Manager: Neil Westwood


This project will develop the systematic and accurate capture of information in a core data set. This will hold all data held by Manx Care to aid efficiency, automation, reporting and, by extension, informed decision making. The project will start work imminently with a new partner, bringing a strategic solution to clinical coding – this is where information collected about patients during hospital appointments, time on the wards and surgical procedures is translated into a widely recognised coding system.

Other work includes establishing:

  • Integrated Performance Report Metrics

  • Current Pathfinder Metrics, i.e. metrics to support development of new models for treatment pathways, eg. Cancer, autism, cardiovascular

  • Public Health Outcome Metrics to inform population needs assessment

  • Care Quality Commission Metrics

  • Operational Reporting Metrics to support and monitor above


  • Established a foundation of a Business Intelligence function

  • Identified and commenced recruitment of resource required to accelerate transformation of the BI function

  • Established Core Data Set v1.0

  • Developed automated integrated performance report

  • Commenced delivery of public health outcome framework data 

Aims for the next 12 months:

  • Address reports for Cancer Pathway and reporting for the Care Quality Commission (CQC)

  • Commence strategic delivery of coding and data improvement (clinical coding)

  • Publish data dictionary for data set approved recommended solution data warehouse and commence delivery

  • Make available Health Outcome Framework (HOF) Reporting

  • Establish the core data set (v2.0)
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