At the start of the 2024/25 financial year, Manx Care signed off a £19m cost improvement programme (CIP) to operate within the budget provided by Treasury and thereby achieve financial balance.
The majority of these schemes were transformational and recurrent, meaning their associated costs are permanently removed from the organisation, whilst also improving the efficiency of the organisation and positively impacting patient care.
After further risk and impact assessment and evaluation of those original cost saving schemes, the overall projected saving for this financial year was reduced to circa £12m, leaving a financial gap for Manx Care to address.
Manx Care has also incurred additional costs of £9m this year. This amount results from movement in the monthly spend rate (driven by increased demand), costs of off-Island care, the impact of high-cost care packages for individuals, and the increase in drug costs. The Manx Care Board’s view is that these costs, which align to individual patients and clients, are largely unavoidable if minimum standards are to be met.
To address the gap in the Cost Improvement Programme, an additional £5m of savings schemes have been identified and were signed off by the Manx Care Board in September 2024; these schemes are now in the process of being implemented. These are outlined below:
- Additional Executive scrutiny and sign-off for all bank and agency staff spend
Over and above what is already in place, further scrutiny is being placed on all agency placements to make sure only critical gaps are covered by bank and agency staff for the minimum period needed - Review all additional non-clinical programme activity (APA) for medical staff
Non-core medical additional programmed activity (APA) will be reduced as part of the job planning programme, eliminating inconsistency and duplication – this excludes direct patient-facing clinical time - Additional Executive scrutiny and sign-off for all recruitment
All non-essential recruitment has been paused immediately, and we are not covering vacancies with bank or agency staff - Pause non-mandatory training for staff
Where possible and appropriate, we are seeking to defer non-mandatory training into the next financial year - Implement outcome of productivity reviews
Recommendations from the reviews are being implemented in four of our services – Imaging, Pathology, Outpatients Department and Community Nursing. This should generate additional cost reduction and efficiencies not already included in the wider Cost Improvement Plan (CIP), with little to no reduction in patient-facing services. In some instances, we expect to be able to deliver more and better quality of care for the same cost - Additional scrutiny on planned UK NHS activity
Additional controls are being placed on planned appointments and procedures undertaken in UK hospitals. This includes a request for some NHS Trusts to delay some procedures into the new financial year where clinically safe and appropriate to do so. Additional focus is being placed on appointments and procedures to see whether they could be undertaken via video-appointment, or if investigations (such as scans or blood tests) could be done at Noble’s and the results sent to the UK hospital - Cool down planned activity
Elective activity in specific areas is being cooled down, to immediately reduce bank and agency spend with minimal patient impact (this represents an 18% reduction in elective theatre schedules). We have reduced the number of theatre lists by 5.5 per week in three specialties with the shortest waiting lists - Closure of Ramsey MIU at weekends
A decision was made to keep the Minor Injuries Unit at Ramsey and District Cottage Hospital closed at weekends to the end of the calendar year due to staffing issues - Temporary closure of Mental Health Recovery College
Manx Care is pausing this initiative for six months, and we will review the impact in the context of other mental health early intervention initiatives - Do not renew Kooth and Qwell Mental Health contracts
The pilot scheme came to an end, and we are pausing this initiative until a full assessment is completed - Withdraw out-of-hours social worker in adult social work
We have not ceased to take calls for adult social care out of hours, but have changed the arrangement so that the Executive on call will manage queries instead of a rota of adult social work staff. The rationale for this is that the expenditure on a separate rota was not justified by the demand
After some additional cost saving actions taken by Manx Care, a gap of circa £8m for 2024/25 remains, which remains subject to ongoing discussion between Manx Care and the DHSC.
We would like to thank our staff for their input and ongoing co-operation with these measures.
