Clarity over Manx Care introducing charges for GP and A&E attendances

Thursday, 13 April 2023

We wish to respond to a media report yesterday (Wednesday 12 April 2023) which stated that ‘Manx Care recommends charges for GP appointments and A&E visits’. This is wholly inaccurate. We have not ‘recommended’ any such charges, and neither have we been approached by any media outlet for clarity around this position.

Before going any further, it’s important to clarify that Manx Care is not a privately owned company. It is a statutory board created by Isle of Man Government under the Manx Care Act 2021 to provide the operational delivery of health and statutory social care services on the Island. We are not a profit-making organisation.

In June 2022, Manx Care predicted an £8.7 million budget shortfall for the 2022/23 financial year. With a clear instruction from both Treasury and the Department for Health and Social Care (DHSC) that the organisation must live within its means, we were instructed to produce a list of potential mitigations in order to achieve financial balance. Many of these were difficult and unpalatable mitigations centred around pausing or reducing the provision of some services, looking at the feasibility of introducing parking charges at Noble’s Hospital, considering the potential for charging for face-to-face and home visit GP appointments or attendances at the Emergency Department (Noble’s) or Minor Injuries Unit (Ramsey) on a means tested basis, pausing operations on patients with a BMI in excess of 30 (where clinically appropriate to do so) and reviewing eligibility criteria for some services, for example Non-Emergency Patient Transfer. Such mitigations, whilst extreme and unpalatable, do exist in other jurisdictions and other health and care systems as means of controlling costs. The list of mitigations was reviewed by the Boards of both Manx Care and the DHSC, with Manx Care having the ultimate responsibility for any decision to implement these measures.

At a meeting held in early July, the Manx Care Board agreed that no mitigation involving charging patients for the provision of clinical services or appointments would be considered or recommended.

The Isle of Man’s Health and Social Care system under the DHSC has historically struggled to deliver services to a high standard, as evidenced by the many gaps in safety compliance and performance that Manx Care identified during its first year of operation. Many of these issues are the result of a combination of unresolved inefficiencies and significant underfunding of the system. As a result, it has almost continually failed to live within its budget and has required additional funding from Tynwald every year for the last seven years, of an average of £8 million per year.

This is the position that Manx Care inherited and, as an arm’s length organisation, our Board is committed to addressing this in conjunction with the DHSC.

As Health professionals we recognised that this represents particularly poor value for money for Manx Taxpayers. In an effort to bring this situation to an end, over the past two years Manx Care has worked hard to clearly identify and quantify the areas of the system that require improvement and investment, and also where savings could safely be made. In the 2022-23 financial year, our Cost Improvement Programme (CIP) has delivered savings in excess of £10 million, including cash-out savings of £7.4 million, much higher than our initial target of £4.3 million. Much of the work has been driving widespread quality improvements too rather than purely just financial benefits. We have also been successful in our efforts to recruit into substantive roles and lessen our reliance on costly agency and bank options.

Our financial plan identifies the areas of the system and the necessary amounts to address the major risks that still exist in terms of safety, governance, compliance and quality that have emerged, and which must be addressed as a matter of priority in order to provide the Island’s residents with a safe and satisfactory health and social care system. However, given that Manx Care has identified a funding gap of £40 million in the 2023-24 financial year between what it is mandated to do versus the funding envelope available to us, the significant financial challenges we continue to face mean we must continue to consider potential mitigations in order to live within our means and deliver a service to members of the public.   

It should be noted that the challenges that Manx Care faces also exist within health services globally and across the UK NHS. However, these are exacerbated by the Island environment in which we live. We are trying to do our best for the people of the Isle of Man working within the confines of our financial and staffing pressures whilst transforming the way that health and social care is delivered. The level of vitriol that has been directed towards the organisation’s colleagues, and in particular its senior leaders, over recent days as a result of media coverage is unacceptable, particularly when members of the public are making threats towards the lives of specific individuals. This will not be tolerated and will be reported to the Police.  

As an organisation we aim to be transparent and open about the challenges we face and the way we operate. We will continue to do this, and would invite members of the public who wish to discuss any headlines with us to contact us directly and have a conversation either face to face or on the phone based on accurate facts, rather than via social media.

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