Programme and Projects

Project: Improve Legislative Framework
Status: Amber - Delivery appears feasible overall but significant issues exist requiring management attention

Project Lead: Nicola Igoea
Project Manager: Gary Perkins
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.

This 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: The Manx Care Bill to establish Manx Care and implement some of the high level recommendations within the review. Royal Assent is intended in February 2021 to ensure that Manx Care can be operational in April 2021;
• 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 and updating a number of other pieces of legislation. The Project will deliver this Bill and subsequent pieces of secondary legislation, to more readily enable it to remain modern and, while it will progress in tandem with Part 1, it will take additional time to develop the policy so it is currently anticipated that it will enter the branches of Tynwald in 2021.
• Part 3: The remaining legislative changes identified as gaps by the Review will be addressed separately, either after or alongside Parts 1 and 2.

Linked recommendations: 2 5 8 9 10

Project: Establish Manx Care
Status: Amber - Delivery appears feasible overall but significant issues exist requiring management attention

Project Lead: Mark Cox
Project Manager: Bryan Moyer
Description: 

This Project will create a new organisation 'Manx Care' with responsibility for delivering all 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. This will facilitate the separation of the strategic planning and policy making, which will be retained by the DHSC, from the delivery of services by Manx Care – which was a key recommendation of Sir Jonathan Michael’s 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 roles and responsibilities for Manx Care and 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 social care services for the Island from April 2021.

Linked Recommendations: 2 4

Project: Governance and Accountability Framework
Status: Amber - Delivery appears feasible overall but significant issues exist requiring management attention

Project Lead: Simon Morioka
Project Manager: Gary Williams
Description:

This Project will create a clear and systematic governance and accountability framework, covering DHSC, Manx Care and associated government functions. This will be supported by an active engagement programme, to ensure that the outcomes are embedded across the health and care system at all levels.
The Project will deliver a comprehensive Corporate Governance Framework and a Clinical and Care Governance Framework covering all health and care services (including quality and risk management) the relationship to areas such external regulation.

Key objectives include:

1. Ensure clear accountability for operational delivery and transformation, with a 'golden thread' linking policy and strategy to day-to-day improvements in outcomes;
2. Provide transparency around quality, performance and finances across all associated health and care services;
3. Embed continuous improvement and proactively addressing risks and issues wherever they are present in our health and care system;
4. Develop integrated working, built around the needs of individuals and communities;
5. Create greater consistency and accountability for corporate, financial, clinical, care and quality reporting and monitoring across the System;
6. Ensure that future corporate and clinical and care governance are fully aligned, system-wide, with active representation and involvement of patients and service users;
7. Achieve improved efficiency by increased transparency and clarity.

Linked recommendation: 2

Project: New Funding Arrangements
Status: Green - Delivery is on track

Project Lead: Toby Irving
Project Manager: Gary Williams
Description: 

The aim of this project is to achieve a health and care system which plans for the future, which 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 DHSC and Manx Care from April 2021, and
  • Establish the opening funding budgets for 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, 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 cost 

Linked recommendation: 16 17 19 20  

Project: Transfer of Public Health Directorate to Cabinet Office
Status:  Amber - Delivery appears feasible overall but significant issues exist requiring management attention

Project Lead: Matt Stevens
Project Manager: Katy Murray
Description: 

The aim of this Project is to enable the Public Health Directorate to comprehensively fulfil its advisory and guidance function to the entirety of the Isle of Man Government through the transfer to the Cabinet Office.  Phase one of the project focused on the transfer of the Directorate (now complete) and phase two will embed the transition.

The transfer of the Directorate to the Cabinet Office will:

• Improve the Directorate’s ability to advise policy makers across Government, thereby providing for greater delivery of public health policy through other public sector organisations;
• Mature the Directorate’s capability of collecting data from across Government;
• Support improved focus on public health and better outcomes in relation to policy making across Government;
• Support Government as a whole to address the wider determinants and influences of health;
• Encourage a greater focus on health and wellbeing across the Island;
• Facilitate better access to services amongst vulnerable/seldom-heard-from groups;
• Enable better outcomes for the Isle of Man population; and
• Improve clinical effectiveness, cost effectiveness and value for money in health and care service delivery.

With effect from 1 April 2020, the Public Health Directorate now sits within the Cabinet Office.

Linked recommendation: 9

The first 3 projects in this category (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
• Cancer
• Eye Care
• Integrated Urgent Care
• Children with Complex Needs
• Autism

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

Project: Design and Implement Care Pathways
Status: Green - Delivery is on track

Project Lead: Claire Bader
Project Manager: Katy Murray
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: Undertake Needs Assessment
Status:  Green - Delivery is on track

Project Lead: Madeleine Sayle
Project Manager: Katy Murray
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
Status:  Green - Delivery is on track

Project Lead: Jon Green
Project Manager: Katy Murray
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: Implement Air Bridge
Status:  Green - Delivery is on track

Project Lead: TBC
Project Manager: Gary Perkins
Description: To deliver an enhanced air bridge service that meets the needs of the Isle of Man citizens and compliments and builds upon the current fixed wing provision for air ambulance transfers. This Project will:

• Identify the appropriate type(s) of air bridge services required to meet the changing needs of emergency air transfers to agreed off-Island providers of care.
• 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.

Linked recommendations: 11 12 13

Project: Primary Care at Scale
Status:  Amber - Delivery appears feasible overall but significant issues exist requiring management attention

Project Lead: David Segal
Project Manager: Pamela Crye
Description: The Project will co-design and implement a new strategy and model for Primary Care on the Isle of Man. Core to this strategy will be the establishment of a model that allows Primary Care services to be delivered collaboratively and at scale, providing a sustainable, high quality, service user-centred service.

The Project will deliver the following outcomes:

1. 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;
2. A key building block to delivering a wider integrated care model across the system;
3. The ability to deliver Primary Care services collaboratively and at scale;
4. Support the delivery of personalised care closer to home, delivering the right care, at the right time and in the right place;
5. Reducing unnecessary spend in high cost settings in the system through more services being provided in a Primary Care setting;
6. A more dynamic workforce to support the delivery of complex Primary Care services;
7. Organisational resilience, professional support, enhanced leadership and management for those working within the system.

Linked recommendations: 12 15

Project: Data, Information and Knowledge
Status: Amber - Delivery appears feasible overall but significant issues exist requiring management attention

Project Manager: Peter Leahy
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
Status:  Green - Delivery is on track

Project Manager: Peter Leahy
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

Project: Workforce and Culture
Status: Green - Delivery is on track

Project Lead: Clare Conie
Project Manager: Gary Williams
Description: This 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 the current DHSC and then DHSC and Manx Care, when formed:

1. Deliver a workforce audit that accurately reflects the current culture of the DHSC and can be used as the basis for recommendations for the future for DHSC/Manx Care staff.
2. Identify and reprioritise all organisational development, design and cultural initiatives that have taken place or recommended to date
3. Assess to what extent the DHSC workforce is skilled and capable of providing the services the people of the Isle of Man require via a workforce skills audit. 
4. 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. 
5. Develop tools for ensuring that all staff in DHSC/Manx Care are participating in a value-laden appraisal process.
6. Design and implement a strategic employee engagement programme that seeks to improve employee morale, engagement and confidence in DHSC/Manx Care.
7. Design and introduce a framework for promoting and delivering integrated working across DHSC/Manx Care 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. 
8. Introduce a systematic approach to coping with and managing change that incorporates the implementation of a continuous improvement framework.
9. Introduce a modern and values-driven internal communication framework and guidance that promotes openness, transparency and clear messaging.
10. Design and implement a recruitment strategy that addresses issues with recruiting and retaining skilled workers across the health and care system.
11. Develop a focus on responsiveness, quality and delivery.

Linked recommendation: 25

Project: Implement External Quality Regulation
Status:  Amber - Delivery appears feasible overall but significant issues exist requiring management attention

Project Lead: Gary Perkins
Description: This Project will ensure that rather than an ad-hoc approach to inspection of services, there is a consistent, independent and systematic approach to the inspection of all services across health and care on the Isle of Man to 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:

1. A systemic, robust approach to the independent inspection of the quality of provision of all health and care services;
2. A defined set of quality standards for health and care services that encourage services to improve outcomes and engage in continuous improvement rather than a simplistic tick box approach or an approach that only aspires to deliver a safe service rather than a great service;
3. Means for identification of any issues in the quality of care which need to be addressed by the organisations delivering care;
4. Means for remediation plan (with timescale) for rectification of issues identified.
5. An agreed process and responsibility for successful implementation of remediation plans; and
6. Measurable improvements in care against a defined baseline.

Linked recommendation: 3