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Health and Social Care Review

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The Independent Review of Health and Social Care concluded in April 2019 and was subsequently approved by Tynwald on the 21 May 2019 and with its recommendations are being taken forward by the Cabinet Office in conjunction with the Department of Health and Social Care, now Manx Care and Treasury.

Fundamental review of the Island's health and social care system

The main objective of the Review was to identify options on how to deliver and fund a modern, fit for purpose and sustainable health and care system for the Isle of Man.

Its Terms of Reference posed the following core questions:

  • What is currently being spent on health and care, is it sufficient and does it represent value for money?
  • What is the likely increase in funding required, projected to the end of the financial year 2035-36, and how might that be funded?
  • Is the current organisational model for the delivery of health and care to the Isle of Man population optimal, now and for the future?
  • Is the current health and care strategy still appropriate, or should it be amended and, if so, how? What obstacles have limited progress and how should they be overcome in the future?

Sir Jonathan’s Progress Report was presented to Tynwald on 15 January. This report was an update on the issues identified while examining this evolving and highly valued public service.

His Final Report to Tynwald, including 26 recommendations, has been published. The Review’s findings are summarised within the foreword and executive summary which have been pulled out into a separate downloadable document that is easier to digest. An easy read version of the final report has also been produced to make it more accessible to those with learning difficulties or disabilities.

Tynwald unanimously accepted the Review’s recommendations and required the Council of Ministers to implement them as a complete package.

The ideas, thoughts and concerns of all those that have contributed to the Review have been invaluable when putting together the final report and Sir Jonathan, and the Review Team, would like to thank you for your interest, contributions and for taking up the opportunity to help shape the future of the Island’s health and care system.

Please visit the Health and Care Transformation page for updates on the programme. 

Background to the review

In March 2018 the Government announced that a fundamental review of the Island’s health and social care system was going to take place led by Sir Jonathan Michael.

Sir Jonathan Michael has extensive board, managerial and clinical experience in healthcare across both the public and private sectors. He has significant experience of supporting hospitals and other healthcare providers and advising governments, health departments and regulators both in the UK and internationally. He was knighted in 2005 for services to the NHS.

The terms of reference for the review were established by the Council of Ministers and Sir Jonathan was tasked with setting out recommendations to address the current and long-term health and social care challenges facing the Isle of Man.

The review's work built on the Department’s Five-Year Health and Social Care Strategy as well as a number of other reports, including the work of the West Midlands Quality Review Service. The review sought to identify why other initiatives had not worked and in order to set out what is required to ensure that its recommendations are implemented.

The Department is currently working to its Service Delivery Plan, which aims to address a number of your comments and ideas from public engagement sessions in January 2016, including the following that are already being progressed:

  • Communication: publishing more on the Manx Care website, facilitating workshops on the future of residential and nursing care, working alongside Southern Community Initiatives around a Community Partnership pilot and working with residents and stakeholders through engagement events in the West

  • Care in the Community: plans to introduce far more locally delivered care from teams based in the community

  • Minimise waste: undertaking restructuring to reduce duplication and layers of management, including the formation of the Community Care Directorate, which combined four previous Divisions

  • Technology: roll-out of Patient Access (for GP appointments, prescriptions and test results), text message reminders for GP appointments instead of letters and instant update of patients' electronic records following out of hours GP consultations

Who was involved with the review

The Review was led by Sir Jonathan Michael and he had full editorial rights over the final report.

As outlined within the terms of reference, Sir Jonathan Michael was supported on Island by an Advisory Panel and a Secretariat working under his direction.

The Advisory Panel was made up of the following representatives:


  • Hospital Doctor Representatives
  • General Practitioner Representative
  • Hospital Nursing Representative 
  • Community Nursing Representative
  • Allied Health Professional Representative

Senior officers

  • Senior Health and Social Care Representative
  • Social Care Representative
  • Mental Health Representative
  • Public Health Representative

Political Representatives  

Third Sector Representative 

Business Sector Representative

Health Services Consultative Committee Representative 

Nobles' Patient Experience and Quality Committee Representative 

Private Care Representative 

Healthcare Review Secretariat Administrative lead 

Isle of Man Government Technology Services Representative 

The Advisory Panel was solely to provide advice to Sir Jonathan Michael in relation to the setup of services on the Island and guidance on any added complexities within the Island community. They were also key to ensuring that the views of all stakeholders were represented within the Review.   

The Secretariat team, which was independent of the Department of Health and Social Care, consisted of 4 people:

  • Head of Healthcare Review Secretariat
  • Healthcare Review Manager 
  • Healthcare Review Executive
  • Healthcare Review Officer 

Additionally, specialist support in relation to health economics and commissioning models and generalist support in transformation of healthcare services was provided by ASE Consulting Ltd/PPL Ltd.

Areas of health and social care (April 2019)

The Review applied to all areas of the health and care system:

  • Hospital care – including Noble’s Hospital, Ramsey and District Cottage Hospital and the ambulance and the air ambulance services

  • General Practitioners – including all GP practices and the Manx Emergency Doctor Service

  • Dentists – including those run by the Government (Central Community Health Centre) and those run privately

  • Mental Health – including acute community and mental health services for children, adolescents, adults and older people, Drug and Alcohol Team, Crisis Response and Home Treatment Team, the Memory Clinic, Next Step and Brunswick Gardens

  • Social services for adults and for children and families – including older people’s, vulnerable adults and disabilities social work teams, children and families social work team, adoption and fostering services

  • Therapies – including physiotherapy, occupational therapy, speech and language therapy, and dietitics

  • Community care – covers a vast array of services including:
    • Community nursing (health visiting, district nursing and school nursing)
    • Family planning
    • Podiatry services
    • Prison healthcare
    • Day services (for older people and people with a learning disability)
    • Reablement services
    • Home care
    • Learning disability residential and respite services 

  • Care homes – including residential and nursing care
    • the Department runs 3 care homes for older people and 3 care homes for people with dementia (the rest are provided privately)

  • Public Health – aims to protect and improve the health and wellbeing of the island’s whole population rather than treating the individual, including by improving lifestyles and our environment, and by championing approaches that support people taking responsibility for their own health and wellbeing

  • Off-Island care – including referrals to UK specialist hospitals and patient transfers

  • Third sector/charitable sector

Public engagement

Initially public engagement was focussed through an online ideas hub (open between 26 June and 7 August 2018), with suggestions also accepted by post, email, dedicated drop boxes, telephone and in person. More than 180 suggestions and 430 comments were submitted during the initial public engagement period. A report on these was presented to Sir Jonathan Michael and the Advisory Panel and was considered as part of the progress report laid before Tynwald in January 2019.

View suggestions

Open public workshops were held during September and October 2018 and a summary of the feedback from these was also presented to Sir Jonathan Michael and the Advisory Panel. The suggestions were considered, along with other research and engagement, and used to help shape some possible recommendations. These draft recommendations were shared with the public at workshops in January and February 2019, and further feedback was gained to inform the final recommendations.

All feedback received from the public was considered and transformed into evidence to inform the Final Report. 

We thank you for your interest, contributions and for taking up the opportunity to help shape the future of the Island’s health and care system.

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