Following a recent call for the Department of Health to be able to provide the average cost for each type of procedure undertaken at Noble’s Hospital, the Minister for Health, David Anderson MHK has outlined why the Isle of Man has not followed the same model as in England and why these costs are currently unavailable.
The Minister said:
'Naturally many aspects of the NHS in England and the Isle of Man are very similar. Our two national health care systems commenced on the same date in 1948. But there are as many differences as there are similarities. Over the past two decades the NHS in England has seen a huge transformation to create an internal market in order to make hospitals compete for business. This is because in England competitive commissioning – that is the purchasing of health care – is separate from the delivery of healthcare, such as receiving surgery in a hospital. A fortnight ago the UK Competition Commission turned down the merger of two NHS Trusts in Dorset because of the impact this would have on local competition between the Trusts. The reality is that the merit of such a system is largely irrelevant in the Isle of Man, where we have a single acute hospital in the form of Noble’s, which is not run on an English NHS Trust framework. There can be no internal market with cost centres and competitive tendering for services as there simply isn’t another acute hospital funded by the Isle of Man Government.
'In order to be able to maintain a comprehensive service on the Island for many procedures, we have to have sufficient volume so that clinicians can keep their skills up. This would be threatened if we created a system where Noble’s Hospital was in effect forced to compete with NHS Trusts in England solely on the basis of price. Taking into account the cost of patient travel, I think it highly unlikely that the majority of procedures undertaken by Noble’s Hospital could be provided cheaper in England, but the issue is we don’t have the data to hand to determine this, and we will need to look at how we can do better in this area going forward.
'It’s true that Medway, the main patient administration computer system at Noble’s Hospital is module based, and could be upgraded to enable us to collect the relevant data – the ability to expand the system is one of the reasons it was selected. However the Department has currently not diverted resources from clinical services to provide the infrastructure for an upgrade to IT systems and the resultant data collection and input. We need to consider the merits of the information systems on the market, review the capability and capacity of such, and the impact on resources for both headcount and budget. In order for us to do this, an initial external scoping review of a patient level information and costing system is due to commence shortly, to see if such a system is a viable option.
'The Department does have firm data for the most important international comparators such as life expectancy and overall costs. When comparing the cost of health services in terms of per capita expenditure the Island is well placed compared to most member countries of the Organisation for Economic Co-operation and Development. The average life expectancy in the Isle of Man when compared to cost of health services in terms of per capita expenditure is level with the UK. It would not be appropriate to compare costs per capita between health care costs on the Island and English Primary Care Trusts (PCTs). In addition to the Department carrying out similar health care activity to that delivered by an English PCT, it also acts as both a policy making and strategic entity like the equivalent UK Department of Health and NHS England. It is clear that at an observable level the Island’s health services are operating as efficiently as most.'
The Minister added:
'I know in relation to the possible funding of this system, mention has been made of the costs of refurbishment works at Crookall House, the Department’s Headquarters. The Department relocated from Markwell House in 2011, so as to free up space for Social Services and facilitate their move from Hillary House – which was rented accommodation. This move not only reduced costs for Government year on year, but enabled efficiencies through providing a centralised headquarters for the newly formed Department of Social Care. This decision is part of Government’s wider strategy to dispose of assets and reduce the amount spent on rented accommodation, which the Chief Minister has reported progress on recently.
'It will not escape anyone’s attention I’m sure, that Crookall House was designed and built in the 1930s as a Maternity Home and was only converted to office accommodation in the early 1990s when the new Jane Crookall Maternity Unit opened within the Noble’s Hospital site on Westmoreland Road. Since that original conversion 20 years ago, very little money has been spent on Crookall House and by modern standards the office accommodation is sub-standard. Whilst a new headquarters would be the Department’s preferred option, we have cut our cloth to meet the fiscal circumstances in which Government finds itself. It has been essential to ensure that the building offers the basic facilities required by staff, and minor refurbishment work such as painting and re-carpeting areas that have been left largely untouched for two decades, is not in my view unreasonable.'