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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 nine recommendations and two projects now completed. Each project is designed to fully or partially 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 


The project will address the gaps in the law as needed to underpin a safe and responsible health and care service for the Isle of Man, as highlighted in the Report. 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 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 and updating a number of other pieces of legislation. 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. While it has been progressing in tandem with Part 1 as far as possible, this Bill will require additional time to develop the policy.

  • Part 3: The remaining legislative changes identified as gaps by the Report will be addressed separately, either after or alongside 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.


  • Royal Assent for the Manx Care Act 2021 announced and in force in its entirety on 1 April 2021 following signature of Appointed Day Order

  • Duty of Candour Regulations public consultation completed and, following suitable consequential amendments, Regulations approved by Tynwald

  • Amendments to the Complaints secondary legislation to account for establishment of Manx Care approved by/laid before Tynwald

  • Ongoing development of the NHSCS Bill

  • Preparatory work for further interim Complaints Regulations ahead of NHSCS Bill

Aims for the next 12 months:

  • Deliver interim Complaints Regulations

  • Finalise approach to NHSCS Bill following impact of interim Complaints Regulations, identification of new policy leads and consideration of resourcing model

  • Continued development of the NHSCS Bill

Linked recommendations: 2 5 8 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 & Anup Rughani
Project Manager: Joshua Phillips


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 four strands of work:

  • Strand 1: Baselining and budget setting (January to August 2020)

    • High-level estimate of what ‘should’ health and care cost (based on benchmarking) and modelling how long it will take to get there, assuming different rates of efficiency improvements

    • Baseline spend of the DHSC and Manx Care from April 2021, and

    • Establish the opening funding budgets for the DHSC and Manx Care from April 2021

  • Strand 2: Future Funding (January 2020 to April 2022)

    • Funding model setting out what the requirement is going forward for the funding of health and care services post-2021/22

    • Range of options (from funding model) for the budget going forward depending on different rates of efficiency gains, funding requirement increases, and the budget starting points

    • Range of options for closing funding gap, and

    • Options appraisal and recommendations on finance-related policy decisions

  • Strand 3: Longer-term planning (July 2020 to April 2023)

    • Data set, whether new, existing or requiring improvement

    • Methodology to ensure efficiency saving opportunities are identified and realised

    • Reporting regime that uses activity-based costing, and

    • Identify and agree an implementation plan for the agreed sustainable model of funding

  • Strand 4: Implementation (April 2021 to September 2024)

    • Support Treasury, the DHSC and Manx Care to implement the agreed sustainable model of funding; to continuously improve the process and adapt it to take account of increased availability of information; and to realise a process in order for Manx Care to receive a three to five-year financial settlement linked to an obtainable efficiency target; and

    • Ensure a future model of activity can become outward facing, helping to improve understanding of health and care costs


  • Manx Care finance policy prepared, finalised and approved

  • Funding strategy completed, including what health and care should cost, estimated future funding gap and options around closing that gap

  • Revised future 8 year efficiency target profile for Manx Care and the DHSC approved, acknowledging this will need to be reviewed at least annually

  • Supporting the work of the Cost Improvement Programme team

  • Ongoing support provided to Manx Care, the DHSC and Treasury around budgets, efficiencies and benchmarking

  • DHSC and Manx Care 2021/22 opening budgets, including 1% efficiency target, sanctioned by Tynwald

  • Manx Care Financial Regulations prepared and subsequently issued by Treasury

  • Supporting the financial aspects of the Manx Care scheme of delegation

  • Accounting systems updated with the new Manx Care and DHSC structures

  • New Financial Regulations exemption process for Manx Care developed

  • High-level approach for developing options for future funding models and service models for residential and nursing care approved by Transformation Boards

  • Commence baselining and research for the nursing and residential care funding model

Aims for the next 12 months:

  • Continued support to the Cost Improvement Programme team to help enable the DHSC and Manx Care to achieve efficiency target

  • Refresh 8 year efficiency profile and agree 2022/23 mapped efficiency target

  • Patient level costing reporting framework defined

  • Interrogate financial aspects of service transformation (that require funding through the Programme) to ensure full costings/savings and benefits defined, monitored and delivered (or otherwise)

  • Continue and complete baselining, research, and high level options development for the home, nursing and residential care funding models

  • Detailed modelling, analysis, and options development for the funding model in order to prepare recommendations around home, nursing and residential care

Linked recommendation: 16 17 19 20  

Care Pathways and Service Delivery Transformation

The next 2 projects in this category (Care Pathways and Service Design Transformation and Undertake Needs Assessment) are closely related and interdependent that jointly consider what the Island’s health and care needs are, what the optimum care pathway is and what the optimum service model is. 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 series of pathfinder projects was used to develop and test the process for review and new service design. The initial focus for the pathfinder projects have covered the following areas:

  • Diabetes
  • Cardiovascular conditions (Cardiology, Vascular, Stroke)
  • Cancer
  • Children with Complex Needs (Children and Young People with Continuing Care Needs)
  • Autism
  • Eye care
  • Urgent and Emergency Integrated care

The common 'pathfinder' approach to be adopted is shown in the diagram below (note that 'Service Review' and 'Care Pathways' is now known as the 'Care Pathways and Service Delivery Transformation' Project):

Diagram - Programme, Workstreams and Projects

Project: Care Pathways and Service Delivery Transformation

Project Lead: Tracy Broom and Mellanie Patterson
Project Manager: Francesca DeHaven
Project Team: Claire Bader, Eve Bello and Bethan Cannell

The Undertake Service-by-Service Review and Design and Implement Care Pathways projects were merged to become the Care Pathways and Service Delivery Transformation project, while still working closely with the Undertake Needs Assessment project, in particular.


  • 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

  • Deliver a service-by-service review of health and care provision in 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.

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 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

  • 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

  • Improved value for money


  • All seven initial Pathfinder Final Reports have been completed and were approved by the DHSC Senior Management Team before 1 April 2021

  • Transition Plans have been completed for all seven initial Pathfinders

  • Governance and implementation planning sessions have taken place for Stroke, Cancer, Autism, Children and Young People with Continuing Care Needs, Diabetes, Cardiology and Vascular to enable implementation plans and business cases to be prepared

  • Next level of pathway preparation for Cancer services underway (for each tumour site)

  • Eye Care and Urgent and Emergency Integrated Care (EUIC) implementation continues with ideal pathways created, business cases for initial phases prepared and demand and capacity modelling underway

  • Proposal and associated business case for resources in Manx Care to ensure and coordinate implementation of service changes completed

  • Three month pilot for a new Minor Eye Conditions Service launched

  • Regular update newsletter launched and shared with project stakeholders and the public

  • Initial prioritisation framework (for implementation and for new service areas for review) prepared and under discussion with Manx Care

  • Approach towards implementation by Manx Care, with support as required, underway

  • Progressed the development of the model of care for domiciliary, residential and nursing care

Aims for the next 12 months:

  • Finalise prioritisation framework with Manx Care

  • Accelerate implementation for priority areas (EUIC and Eye Care)

  • Complete tumour site review and pathway development for Cancer Care

  • Complete implementation plans and associated business cases in order for service changes and new pathways to be delivered

  • Support the implementation of all pathfinder transition plans (in accordance with prioritisation framework), including cross cutting services

  • Undertake next stage pathway/service reviews, in accordance with prioritisation framework, including cross cutting services and incorporating HEMS and deliver agreed changes, led by Manx Care, as soon as practical

  • Continue baselining, research, and high level options development for the key potential service model changes in home nursing and residential care

  • Ongoing detailed modelling, analysis, and options development for the service model for home, nursing and residential care in order to prepare recommendations

  • Continued service user and staff engagement through workshops to identify and support the design of improvements to service

Linked recommendations: 11 12 13 16

Nursing and Residential Care

Work stream: Nursing and Residential Care

Transformation Lead: Denise Brock


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 objective of this project is to provide a baseline of health and care needs on the Isle of Man as part of a wider needs assessment programme for the population. It will be used to inform all service design, development and delivery processes as part of the 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

  • A clear view of demand that drives the transformation of services


  • Ongoing development of the detailed programme of population needs assessment process and resource

  • Initial scoping activities completed through a series of workshops to inform the detailed tasks and requirements

  • Isle of Man specific approach completed, based on best practice research informed the high level process design

  • Recruitment process for team initiated

  • Project placed on hold through March and April 2021 due to key resource being utilised by Public Health on the COVID-19 response

Aims for the next 12 months:

  • Create and embed the team to deliver the Project and ongoing programme

  • Complete preparation for full roll out of the needs assessment programme, including education, support and engagement across and outside of Government

  • Establish needs assessment programme cycle, processes, procedures and governance

  • Identify needs assessment topics for 2022/23 against criteria and prioritisation (to be agreed)

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:

  • 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 DHSC/Manx Care are implemented to maximise the benefits of such enhanced emergency air bridge service provision

  • Consider known and arising issues relating to the use, staffing and views of emergency air bridge and consider options to resolve them


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

  • Continued development of business case, including consultation and data gathering with the DHSC and (where possible and appropriate) off-Island Helicopter Air Ambulance service providers

  • Approach to securing Helicopter Emergency Medical Service (HEMS), supplier to bring immediate benefit and enable further service development agreed. HEMS is designed to not only transport patients quickly and more directly to where they need to receive their care but are also equipped and staffed to provide in-flight care that cannot always be accommodated on a fixed wing aircraft and not without taking clinical staff away from Noble’s Hospital

  • Publication of a Prior Information Notice 'PIN' to understand firm interest from off-Island HEMS providers

Aims for the next 12 months:

  • Complete initial analysis and staged approach development to deliver additional rotary wing transfer services

  • Contract supplier for initial six month trial and roll-out use of hospital to hospital transfer, including supporting contractual/commissioning arrangements with off-Island tertiary care providers

Linked recommendations: 11 12 13

Primary Care at Scale

Project: Primary Care at Scale

Project Lead: Charlotte Refsum
Project Manager: Pamela Crye
Project Team: Michael Hulbert & more members TBC


This project aims to co-design and implement a new strategy and model for Primary Care on the Isle of Man. Core to this strategy is the establishment of a model that allows Primary Care services to be delivered collaboratively and at scale, providing a sustainable, high-quality, and user-centred service. The Project will deliver the following outcomes across General Practice, dentistry, community optometry and community pharmacy:

  • A Primary Care system that delivers more effectively to its service users by being responsive, flexible, affordable and sustainable with a standardised approach in the services it offers

  • A key building block to delivering a wider integrated care model across the system

  • The ability to deliver Primary Care services collaboratively and at scale

  • Support the delivery of personalised care closer to home, delivering the right care, at the right time and in the right place

  • Reducing unnecessary spend in high cost settings in the system through more services being provided in a Primary Care setting

  • A more dynamic workforce to support the delivery of complex Primary Care services

  • Organisational resilience, professional support, enhanced leadership and management for those working within the system


  • Continued development of Primary Care at Scale Vision and Model of Care with stakeholders, which has been co-designed with clinicians, professionals, leadership and residents, to outline how patients will be cared for differently in the future to deliver the right care, at the right time, in the right place and by the right professional

  • Public and Third Party consultations completed, with responses shared on the Programme website

  • Delivered 1-2-1 interviews and workshops with members of the public on the developing Model of Care and Vision

  • Continued development of key service improvements:

    • Dermatology in Primary Care first iteration started
    • Planning and development of First Contact Practitioners prototype

    • Planning and development of Clinical Pharmacy prototype

    • Joint launch of a pilot of a Minor Eye Conditions Service for a period of three months (see Care Pathway and Service Delivery Transformation project above)

    • Primary Care at Scale Strategy developed with the DHSC, Manx Care and others prior to approval by Manx Care and Programme

Aims for the next 12 months:

  • Finalise Primary Care at Scale Strategy which outlines two key elements to deliver on the Primary Care at Scale aims and objectives. These elements are: 

    • The future Model of Care, which describes how patients will be supported differently in Primary Care and the outcomes that we will achieve in doing so

    • The future Primary Care at Scale Operating Model, which describes how the project will re-organise the system and work differently with Manx Care and Primary Care organisations to deliver this new model

    • Confirm full approach to Primary Care Development in terms of Leadership, Innovation and  Resilience and support delivery as required

    • Primary Care at Scale Detailed Integrated Model of Care agreed and initiated

    • Develop, with Manx Care, changes to Primary Care provision of services, enabling a shift from GP first to alternate, lower cost and more appropriate service provision

    • Further development of new services across general practice and optometry

    • Population Health Management Strategy launched

    • Scope, Objectives and Vision for Primary Care at Scale Phase 2 agreed

    • Long Term Delivery Plan for Primary Care at Scale agreed

Linked recommendations: 12 15

Information and Digital

Project: Information and Digital

Project Leads: Richard Wild
Project Manager: Neil Westwood

The Data, Information and Knowledge project and Digital Strategy project have been merged to create the Information and Digital project. 


The Report recognised that effective and flexible digital systems and reliable, shared information are both critical components of an integrated health and care system. This project aims to:

  • Improve the availability, accuracy and usability of data and information to inform decision making and to support the delivery of seamlessly integrated care pathways across all services and points of delivery

  • Deliver on the implementation of the agreed Information, Information Governance and Digital Strategies

  • Ensure that the digital systems are effective, flexible and reliable, to support an integrated health and care system

  • Collaboratively work with all other projects to identify needs and solutions that can be supported and/or accelerated through working together

  • Identifying 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, and delivering the necessary changes to implement the specified changes


  • Information Strategy, Information Governance Strategy and Digital Strategy completed and approved

  • Reporting Gap Analysis complete and recommended key performance indicators for first phase of Manx Care’s reporting against its Required Outcomes Framework and to the DHSC complete

  • Procurement of provision of Acute Clinical Coding system and structures commenced

  • Technical Transition of staff due to the split of the DHSC and Manx Care completed, including associated Memorandum of Understanding between redesigned DHSC, Manx Care and GTS

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

  • Data Warehouse specification development underway

  • Data Protection Impact Assessments, Records of Processing Activities, Data Sharing Agreements (DSAs) and Risk Registers for Manx Care and redesigned DHSC developed with full remediation plan prepared in order to improve the position for both organisations

  • Identification and consideration of existing DSAs in order to inform where gaps are required to be filled and/or improvements are required to existing arrangements

  • Significant support offered to enable clear understanding of existing position in relation to digital contracts in Manx Care in order to enable wider Programme deliverables to be achieved

Aims for the next 12 months:

  • Options analysis, informed by market soundings/PIN, to enable development and procurement for Manx Care Record

  • Complete review of current IT estate and options for Manx Care to refresh/renew all health and care systems, subsequent procurement and analysis, business cases, procurements, evaluation and commence implementation etc

  • Procure and implement system and service for Acute Clinical Coding system

  • Support addressing of action plans following DHSC and Manx Care DPIAs

  • Complete comprehensive refresh and implementation of fully compliant data sharing agreements between the DHSC, Manx Care and Public Health Directorate and wider parties as appropriate (including off Island providers of care)

  • Continued implementation of three agreed strategies including data capture, validation storage and exposure options

Linked Recommendations: 21 22 23 24

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


  • Staff induction, mandatory training and job advert documentation updated to reflect separation of DHSC and Manx Care

  • Continued development of First Leadership Academy Programme to be delivered in the autumn 2021

  • Duty of Candour training packages, operational procedure and communications completed

  • Options for online job performance appraisal for Manx Care staff developed

  • Listening Events initiated and adapted to continue during lockdown to support go-live on 1 April 2021 and continue thereafter in order to understand the views of Manx Care colleagues and key areas for change and improvement

  • First year plan and five year milestones developed

Aims for the next 12 months:

  • Launch and complete CARE   Workshops to improve managers’ visibility and create a sense of alignment/integration across the teams

  • Continuation of the listening programme to ensure focus on the right areas of improvement and to encourage open conversations

  • Drive culture change to ensure accountability, ownership and a shared vision of delivery standards and intent through individual care groups

  • Improve working environments

  • Review the current appraisal system/process for both clinical and non-clinical staff groups to prepare proposed future model

  • Analyse absence data to help inform strategies for improving absence rates

  • Complete revised, fit for purpose workforce models for first wave, including Women and Children, Social Care and Theatres

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

  • Initial agreement to 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 – with final amendment pending before formal agreement

  • Engagement with DHSC on preparations (including Provider Information Requests) once CQC SLA agreed

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

Aims for the next 12 months:

  • Completion of validation phase for inspections of relevant health and care services delivered/commissioned by Manx Care by CQC

  • Desktop review of relevant health and care services delivered/commissioned by Manx Care complete by CQC

  • Initial inspection of health and care services delivered/commissioned by Manx Care commenced (travel dependent)

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

Linked recommendation: 3

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

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