Manx Care - Sir Jonathan Michaels Report

[Ham_N_Eggs]

Well it has arrived.

Recommendation 1:
The Council of Ministers should formally adopt the principle that patients and service users are fully engaged in, and at the centre of, all aspects of planning and delivery of health and social care services.

Recommendation 2:
The setting of priorities and the development of policy in both health and social care should be separate from the delivery of services. A comprehensive governance and accountability framework should be established aligned to agreed standards and underpinned, where necessary, by legislation. 

A single public sector organisation, perhaps to be known as “Manx Care”, should be responsible for the delivery and/or commissioning from other providers of all required health and care services.

Recommendation 3: 
Services provided directly or indirectly by Manx Care should be inspected regularly by independent, external quality regulators, with a report to the Manx Care Board and to the DHSC.

Recommendation 4: 
A publicly available Annual Report from Manx Care should be provided to the DHSC and subsequently presented to Tynwald, summarising the delivery of the health and care services on the Island. 

Recommendation 5: 
A statutory duty of care (applicable to organisations and the individuals who deliver health or care services) should be agreed, implemented and maintained alongside the delivery of high value clinical governance, underpinned by legislation where necessary. The new statutory duty of care would include: 
 A duty of confidentiality;
 A duty to share information where appropriate to enable the delivery of safe optimal care; 
and
 A duty of candour – a responsibility to disclose where breaches of safety standards or harm to individuals have occurred.

Recommendation 6:
The Council of Ministers should mandate the DHSC, Treasury and the Cabinet Office to ensure implementation of the agreed Transformation Programme of health and care services as set out in this Report, led by the Chief Secretary. 

Recommendation 7: 
The Council of Ministers should receive a quarterly progress report on the Transformation Programme to understand the progress made and to identify any significant issues which need resolution. In addition, it is suggested that Tynwald should also receive an annual report on progress of the Transformation Programme. 

Recommendation 8: 
Primary and/or secondary legislation should be introduced as required, and included in the legislative programme as soon as possible, in order to form a modern, comprehensive legislative framework. 
This legislation should address weaknesses or gaps in the current system as well as enabling the implementation of the recommendations contained in this Report, such as any necessary legislation to establish Manx Care. 

Recommendation 9: 
The Public Health Directorate should be empowered to provide advice and guidance across Government, not solely to the DHSC. It should promote and co-ordinate health and wellbeing across the Island to help improve the quality of life and reduce the demand on health and care services in the future. All Departments should be required to factor public health guidance into policy setting and legislation. In order to facilitate this, the Public Health Directorate should be moved to a position in the Cabinet Office.

Recommendation 10: 
An on-going health and care needs assessment programme for the Isle of Man should be established and funded without delay. It is not possible to develop meaningful service delivery models and plans without establishing the current and future needs for health and care through this assessment. Many other recommendations in this report are predicated on the assumption that this programme will be established. The Public Health Directorate should be resourced to undertake the health and care needs assessment programme. 

Recommendation 11: 
A service-by-service review of health and care provision, in conjunction with the needs assessment and an analysis of care pathway design, should be undertaken to establish what services can, should or must be provided on and off-Island, against defined standards. Where services cannot be provided 
safely or deliver best value by Island-based providers, the default position should be to seek services from third parties for delivery on-Island whenever possible and off-Island where necessary.

Recommendation 12: 
Service by service integrated care pathways should be designed, agreed and delivered. These should encompass both on and off-Island components of clinical service models.

Recommendation 13: 
Manx Care should deliver an enhanced 24/7 emergency air bridge, allowing for patients to be stabilised locally and moved quickly and safely to contracted specialist centres.

Recommendation 14:

A single, integrated out-of-hours service should be established to provide care in an efficient and appropriate manner outside normal working hours.

Recommendation 15: 
The Isle of Man should establish a model for delivering primary care at scale, since further and deeper collaboration within primary care is necessary to deliver current services and provide additional local services.

Recommendation 16: 
The provision of social care should be considered as part of the current review of future funding of nursing and residential care with the intention of removing disincentives to people requiring care and support remaining in their home. This consideration should specifically include equalisation of the current threshold of financial assistance, a more flexible approach to funding to enable joint commissioning of broader care arrangements in the interests of the service user and provision of 24/7 social care access.

Recommendation 17: 
Increased funding should be linked to the achievement of annual efficiency targets. 

Recommendation 18: 
Additional transformational funding and dedicated specialist resources, including proven change leadership, are required to deliver the transformational recommendations for them to be implemented successfully.

Recommendation 19: 
Increases in funding for health and care services will be required to support the increased demands that will be placed on those services due to demographic changes, non-demographic changes and inflation.

Recommendation 20: 
Funding, based on agreed need, should, over time, move from the current annual budget allocation to a 3-5 years financial settlement for heath and care services for the Island.

Recommendation 21: 
Ensure data sharing protocols and arrangements are reviewed, agreed and implemented in accordance with the Information Commissioner’s regulations and guidance.

Recommendation 22: 
The development and delivery of the digital strategy should go further and faster to ensure the comprehensive capture, sharing and use of information. This would enable greater integration across the system, improved monitoring and enhanced delivery of quality and efficiency-related information.

Recommendation 23: 
A core data set is essential for the management and assessment of services and should be established without delay. 

Recommendation 24: 
The systematic capture of accurate data should be a priority for the Island’s health and care services 

Recommendation 25:
A fit for purpose workforce model needs to be developed to reflect the emerging needs of the new model of care. It should maximise the potential skills available within the workforce as well as the opportunity to recruit and retain high quality professionals. It will then increase the attractiveness of the Isle of Man as a career destination. 

Recommendation 26:
The Government should create a new, dedicated and skilled transformation programme group to oversee and support the implementation of the agreed Recommendations.

[James Hampton]

I see a lot of talk of increases in funding. 

I also see a lot of things that look quite similar to recommendations Dr Couch actually made in the past.

I’d love it to be a success. I fear it won’t be. 

[Rog]

Better find a money tree.

[The Duck of Atholl]

That's a fair old shopping list. I imagine that Couch felt overwhelmed by it when he saw the draft and has done 'the honourable thing' having viewed it as a failure on his part.

The proposal for'Manx Care' is particularly interesting.

The biggest problem will be getting a department which is resistant to change get behind it.

[The Duck of Atholl]

 

15 minutes ago, Rog said:

Better find a money tree.

It's possible but we would have to stop wasting money on being a living museum.

[NoTail]

51 minutes ago, The Duck of Atholl said:

 

It's possible but we would have to stop wasting money on being a living museum.

Agreed!

 If we could become a 21st century success story with a healthy, well educated and happy population then imagine the international interest we would get. Doctors,  politicians, economists and all sorts of professionals will be queuing to come over and find out our secret. First thing to do is stop wasting money on 19th century rubbish. 

[asitis]

17 minutes ago, NoTail said:

Agreed!

 If we could become a 21st century success story with a healthy, well educated and happy population then imagine the international interest we would get. Doctors,  politicians, economists and all sorts of professionals will be queuing to come over and find out our secret. First thing to do is stop wasting money on 19th century rubbish. 

I guess if you could persuade Tynpotwald and the depts in the CS, that the health service is a mahoosive vanity project, this report could fly !

[Neil Down]

In its current form, Recommendation 17 should kill it stone dead

[Non-Believer]

"Governance.....accountability..... candour"

Oh, and a 24/7 airbridge.

Lift the edge of the rug please.

[2112]

It’s good to see that that Sir Johnathon Samuels viewed DHSC in the report as having ‘a tactics acceptance of mediocrity and even failure’. This statement is true and could be applied to IOMG and the Civil Service. Resistance is encouraged and is futile and the rot starts at the HRH Chief Minister level  - who has presided over this nonsense since he was the previous Health Minister. 

[Neil Down]

1 hour ago, 2112 said:

It’s good to see that that Sir Johnathon Samuels viewed DHSC in the report as having ‘a tactics acceptance of mediocrity and even failure’. This statement is true and could be applied to IOMG and the Civil Service. Resistance is encouraged and is futile and the rot starts at the HRH Chief Minister level  - who has presided over this nonsense since he was the previous Health Minister. 

Couldn't the same be said about previous administrations?

[Galen]

The issues this report will face, I fear, will be the same as many other reports and initiatives in the past, which mainly come down to encroachment on selected medical fiefdoms, that prevent them doing 'what they want to do' rather than what should be done. That is not to tarnish all the medical profession, but historically some clinicians, have not been prepared to embrace change if it has not assisted their private work.

Another hurdle will be getting certain of our politicians to understand what is actually involved. While well-meaning, some of the implications of this report will, I believe, be beyond their comprehension and could be a possible threat to their re-election if the electorate is going to be inconvenienced or charged more - as, for example, proposed historical increases in prescription charges showed a few years ago.

However, we are where we are, and the Report, for those that read it all, shines a light into a dark corner of what many of the dedicated staff in the DHSC have been trying to change, but have been prevented from doing so, from above.

The odds the full implementation of this report I would put at pretty slim, with those that are implemented being the ones that (as often is the case) get the 'brownie points' for certain individuals.

[BallaDoc]

GP services come out of it pretty well, the main recommendations being that we should work more closely with other providers like nurses and pharmacists.  I don't have a problem with that.  What I would have liked to see more of in the report, but which of course is absent for political correctness reasons, is a request for the public to moderate their demands on the service.  Most people use it sensibly, but in primary care we spend a lot of time dealing with things like anxiety, difficulty sleeping and anger / irritability management which aren't really illnesses, requests for sick notes to access social security benefits by people who aren't really sick, anxious parents with kids with temperatures and rashes (this is a normal part of life - all kids get temperatures and rashes and we can't see every kid on the island who has a temperature or a rash) and so on.

It would also have been nice if the report had been published by Tynwald instead of Manx Radio!

[James Hampton]

28 minutes ago, BallaDoc said:

... in primary care we spend a lot of time dealing with things like anxiety, difficulty sleeping and anger / irritability management which aren't really illnesses, requests for sick notes to access social security benefits by people who aren't really sick, anxious parents with kids with temperatures and rashes (this is a normal part of life - all kids get temperatures and rashes and we can't see every kid on the island who has a temperature or a rash) and so on.

Doesn’t the report make suggestions for addressing some of those issues? There has to be some sort of filter - to separate genuine problems which can easily be dealt with at an early stage prior to escalation in severity (and so cost), from things which just need pointing to a chemist, education or similar.

As others have noted, and has been discussed in other threads, the problem seems to me to be that the public don’t appear to be giving politicians much support / pressure for following through on the more ‘difficult’ elements of reports like this, so there is a clear incentive to put it on the shelf with all the others, or simply cherry pick the easy bits. 

[Ham_N_Eggs]

44 minutes ago, BallaDoc said:

It would also have been nice if the report had been published by Tynwald instead of Manx Radio!

Presuming the Department got all excited and agreed to release it early. Tynwald order papers are usually published on Thursday lunchtime along with all associated reports and documents