Manx Care

[Apple]

@Boo Gay'nI am not going to disagree. In some ways the case for non political involvement from here on in is made then. And given the waste in the last 5 / 6 years so much the better.

We have to ensure Manx Care is responsive to what the public requires. I think that can be done much more effectively than it has been in the past.

The methods and type of scrutiny have to be radically changed. Information and communications systems have to be significantly improved. Patient choice dialogue based on fact, openness and honesty has to be vastly enhanced. Clinical pathways need to be developed to reflect all of the this. 

All this of course now. against a background on post Covid outcomes.

But here is the rub. Make the changes above, engage with the right people, create a better attitude and atmosphere to deliver services in and use imagination in how and what and where the services can be delivered.

I believe now that there is enough scope for the island not to slavishly follow the UK model but has the chance to rewrite and develop a health and social care system that works much better.

I think we will have a good idea  if Manx Care are capable of leading that development by mid next year. I hope so as I have skin in the game. 

 

Edited July 29, 2021 by Apple
typo -I don;'t get paid for this ya know 😀

[John Wright]

At least the Manx Care board are taking serious initiatives to get the waiting lists down and to use spare, out of hours, theatre capacity.

NEWS RELEASE - 29 July 2021 

Manx Care has confirmed its plan to reduce waiting lists across nine clinical specialities.

It will use the services of two UK-based external companies – Medefer and 18 Week Support – to deliver around 12,500 virtual outpatient consultations and inpatient procedures between September 2021 and March 2022. The Treasury has approved a business case to provide £1.86m of additional funding to deliver this activity. The backlog in waiting lists is a long-standing issue on the Island, which has been exacerbated by Covid-19.  

Medefer provides a virtual outpatient service to NHS Trusts across the UK, employing a large number of medical Consultants with experience across a broad range of clinical specialisms. They’ll work with Consultants at Noble’s Hospital to identify patients who have been waiting the longest for a specialist appointment, and who are eligible for their medical consultation to be delivered virtually. These patients will then be referred to Medefer.

The Medefer Consultant will review the patient’s medical history and any relevant test results before conducting a detailed phone consultation with them. If any further tests are required, patients will have these on the Isle of Man. These will then be reviewed in a virtual follow-up appointment. The patient will then either be discharged under the care of their GP with a detailed treatment plan, or will be discharged back into the outpatient system for further follow-up appointments.

Medefer will focus on the provision of around 10,000 appointments across the specialities of:

Orthopaedics
ENT (Ear, Nose and Throat)
Gastroenterology
Cardiology
Respiratory medicine
Pain management 
Neurology
 

18 Week Support utilises a hospital’s surplus theatre capacity to deliver surgical procedures across a weekend period, and provides this service across a large number of UK NHS Trusts. A full clinical team from the company – including Consultants, Surgeons, Nurses and Theatre Practitioners – will travel to the Island to deliver around 2,500 Endoscopy and Cataract procedures at Noble’s. This will not impact on Manx Care’s core workforce, which is already working to capacity.    

Both Medefer and 18-Week Support are included in the Care Quality Commission’s (CQC) inspection regime and are used extensively across the UK NHS, particularly around the restoration and recovery of services as NHS Trusts work to reduce their own waiting list backlogs caused by the pandemic. Consultants from both companies will work closely with Manx Care’s Consultants to ensure patients receive a joined-up care pathway, with support available by Island-based teams as needed.  

Manx Care’s CEO, Teresa Cope, commented: “Addressing the long-standing waiting list challenge across our health and care service is a priority for Manx Care. It’s unacceptable that people are having to wait as long as they are for consultations and treatment. Utilising the services of Medefer and 18-Week Support will allow us to focus on reducing our waiting lists across nine clinical specialisms whilst implementing the changes we need to deliver that will allow us to provide a long-term, sustainable service here on-Island.   

“The Covid-19 pandemic has only exacerbated the pressure on waiting lists over the last 17 months, and the delivery of health and social care services more broadly. Like the UK NHS, which is investing over £5 billion into the recovery of health and care services following the pandemic, Manx Care has secured funding to address a significant proportion of our waiting list backlog which will be targeted at those who have been waiting the longest time for their outpatient appointment or procedure.”

[AlanShimmin]

This is great news and a positive development for the island. 

 

£1.86m well spent  

[Apple]

4 hours ago, AlanShimmin said:

£1.86m well spent  

Indeed it is. 

The arrangements sound a bit complex but should be achievable if everyone works to make it worth the investment. In view of the surgical waiting lists presumably these will be the very much the so routine procedures of the "lump and bump variety" but are important to those patients who have been waiting the longest. 

The communication pathways and the technology will play such a vital part of the initiatives success. It's the actual administration (access to records, letters, appointment arrangements etc) that will be essential in supporting to the whole process.

Alongside the recent Breast Care announcements of recruitment of a dedicated Surgeon and Specialist Nurse these initiatives are most welcome. A great start to Manx Care and one that should set the tone and the path for future optimism.

[Annoymouse]

Very welcome news, I haven’t been waiting as long as some but I hope I’ll be included in this.

[Andy Onchan]

13 hours ago, Apple said:

Indeed it is. 

The arrangements sound a bit complex but should be achievable if everyone works to make it worth the investment. In view of the surgical waiting lists presumably these will be the very much the so routine procedures of the "lump and bump variety" but are important to those patients who have been waiting the longest. 

The communication pathways and the technology will play such a vital part of the initiatives success. It's the actual administration (access to records, letters, appointment arrangements etc) that will be essential in supporting to the whole process.

Alongside the recent Breast Care announcements of recruitment of a dedicated Surgeon and Specialist Nurse these initiatives are most welcome. A great start to Manx Care and one that should set the tone and the path for future optimism.

Will the Breast Care dedicated surgeon (in particular) & Nurse both be resident positions, or visiting?

Edited July 30, 2021 by Andy Onchan

[Apple]

30 minutes ago, Andy Onchan said:

Will the Breast Care dedicated surgeon (in particular) & Nurse both be resident positions, or visiting?

Interesting question - it will depend on who we can attract. There is fierce competition for these posts in the UK.

I would think Manx Care are looking at permanent and resident positions. But we are at least now in the market. 

I have to add we have had these posts filled before here on the island by some excellent people. We let them go. It has been one of the the worst cases of succession planning / recruitment I have seen.

I welcome the recent announcements but we have lost some of the essentials and we need to catch up on those as well.

As I say, next year year we should know whether this was / is the right path for the island. 

[Andy Onchan]

12 minutes ago, Apple said:

Interesting question - it will depend on who we can attract. There is fierce competition for these posts in the UK.

I would think Manx Care are looking at permanent and resident positions. But we are at least now in the market. 

I have to add we have had these posts filled before here on the island by some excellent people. We let them go. It has been one of the the worst cases of succession planning / recruitment I have seen.

I welcome the recent announcements but we have lost some of the essentials and we need to catch up on those as well.

As I say, next year year we should know whether this was / is the right path for the island. 

OK. The reason for asking is: do the numbers of on-Island breast cancer cases warrant a resident surgeon? If so, that's worrying.

What's happening to Men's Care? I hear there are plenty of cases of prostate cancer on-island. Does specialist care for that already exist? I have a vested interest in asking the question having lost my brother to the horrible disease in December 2019. That puts me and my other brother (who's not an Island resident) at greater risk.

Edited July 30, 2021 by Andy Onchan

[wrighty]

5 minutes ago, Apple said:

Interesting question - it will depend on who we can attract. There is fierce competition for these posts in the UK.

I would think Manx Care are looking at permanent and resident positions. But we are at least now in the market. 

I have to add we have had these posts filled before here on the island by some excellent people. We let them go. It has been one of the the worst cases of succession planning / recruitment I have seen.

I welcome the recent announcements but we have lost some of the essentials and we need to catch up on those as well.

As I say, next year year we should know whether this was / is the right path for the island. 

We lack economy of scale.  Breast cancer is a multi-disciplinary specialty, and to do it properly requires surgery, radiology, pathology, chemotherapy, radiotherapy, and that's just the medical side of things.  In the UK most breast units will consist of a team of surgeons, which is considered best practice.  We don't have the numbers to justify that, so recruiting a single surgeon to be permanent and resident will likely prove impossible.  Ditto radiology, and the jobs market there is even worse with plenty of unfilled posts in the UK.

The model I think should be pursued is on-island diagnostics, but off-island major surgery in the form of reconstructions.  Alternatively a visiting service such that surgery done here is by surgeons who get to keep their skills up to date by working in a bigger unit.

You say it's been one of the worst cases of succession planning/recruitment you've seen.  Who's responsible for that would you say?

[finlo]

We could have one of those hospital ship's visit like other third world countries get!

[Apple]

1 hour ago, wrighty said:

You say it's been one of the worst cases of succession planning/recruitment you've seen.  Who's responsible for that would you say?

I wouldn't on a forum like this beyond what I have already posted previously.

There are different models to cover the Breast Care service and slot into a general surgical rota. There are people being paid an enormous amount of money now being paid to work out their own solutions. It just needs more imagination.

Without it we will end up with a part time Breast Care Consultant / visiting Consultant which is less then suitable in my view. 

From where I was watching it go pear shaped responsibility in my view lies with several and various senior medics and  managers groups / committees / teams mostly at Nobles / Crookall House and those who did not speak out about how badly it was going.  Many have gone now. Worth debating and happy to do so.

 

[wrighty]

13 minutes ago, Apple said:

 

There are different models to cover the Breast Care service and slot into a general surgical rota. 

Without it we will end up with a part time Breast Care Consultant / visiting Consultant which is less then suitable in my view. 

 

Having a breast surgeon that takes part in a general surgical rota is no longer a viable model.  Surgeons of all sorts are becoming more and more specialised, such that these days a newly qualified, fellowship trained breast surgeon is unlikely to be comfortable dealing with an emergency abdominal condition.  And that's what they need to be able to do on a general surgical rota.

So if you think a part-time or visiting model is less than suitable what do we have left?  We'd probably be better having a full-time breast surgeon seconded here from a suitable larger UK team, maybe two weeks on, two weeks off in rotation or something like that.  In that way we get a suitable surgeon and he or she is able to maintain expertise and connections.  It's not a particularly attractive way of working for the surgeon concerned though - many downsides and no benefits.

How do you think it should be?  I don't think there's a solution that combines the needs of everyone.

[Apple]

7 hours ago, wrighty said:

Having a breast surgeon that takes part in a general surgical rota is no longer a viable model.

I agree. 

 

7 hours ago, wrighty said:

We'd probably be better having a full-time breast surgeon seconded here from a suitable larger UK team, maybe two weeks on, two weeks off in rotation or something like that.  In that way we get a suitable surgeon and he or she is able to maintain expertise and connections. 

That sounds more realistic. IIRC there was to be a Breast Care Consultant who did something similar to that several years ago.  Now though it would depend on the current workload and what ongoing need and developments may be in the pipeline once the backlog has been stabilised. 

[Apple]

https://www.energyfm.net/cms/news_story_688779.html

A dedicated help line initiative to be welcomed as far as it goes. We could have dome with this a few years ago so why was it not introduced then ?

One of the worrying and frustrating issues for me and others (see above)   is trying to establish where in the process outpatient appointments / referrals are up to and whether they have been received, graded and put on the system.

All of that is outside of the patients view and sometimes several phone calls are needed to be made to establish what is going on. It's even more difficult if it involves appointments off island which again other posters have referred to.

More blue sky thinking is needed.

[Galen]

Looks as though Manx Care has upset the Information Commissioner

https://www.inforights.im/organisations/latest-news-updates/2021/sep/enforcement-notice-issued-to-manx-care/