Manx Care

[Itsmeee]

DHSC has overspent its budget and had to beg for more for as long as I can remember 

[doc.fixit]

But as has been previously stated, how is the budget, the need and the spending reviewed and the years budget correlated to that review?...It isn't as far as I can see.

[finlo]

28 minutes ago, doc.fixit said:

But as has been previously stated, how is the budget, the need and the spending reviewed and the years budget correlated to that review?...It isn't as far as I can see.

 

[Non-Believer]

45 minutes ago, Itsmeee said:

DHSC has overspent its budget and had to beg for more for as long as I can remember 

Eddie Teare cut the Dept. budget 10-odd years ago and it's been cap-in-hand back to Tynwald virtually every year since.

[Apple]

40 minutes ago, doc.fixit said:

But as has been previously stated, how is the budget, the need and the spending reviewed and the years budget correlated to that review?...It isn't as far as I can see.

The budget was set by Alf in the annual budget speech as per normal presumably based on the business cases put forward by the Department. There have been service cuts already - e.g. didn't Crouch cut some none important children's surgery ?

Another method of staying ahead on costs will be of course the argument for higher prescription charges and / or possibly fees for seeing GP's, as that gets resurrected almost every year.

Privatisation  / means testing is an insidious process but one that usually doesn't produce the results everyone thinks it will, or indeed should.

[Sentience]

I still believe this is not a case of overspending, it is simply underfunding.

As the Islands population gets older we become more susceptable to a variety of illnesses. This is not a new problem, just a growing one, one we have known about for years.

With this knowledge, it amazes me that our so called 'caring government' have elected to attempt to reduce the funding for health care over the last few years, instead grudgingly agreeing to foot the bill of so called 'overspending'.

IOMG, wake up, smell the coffee, common sense should prevail. It doesn't go away by simply ignoring the facts.

SHOW you care.

[finlo]

1 minute ago, Sentience said:

I still believe this is not a case of overspending, it is simply underfunding.

As the Islands population gets older we become more susceptable to a variety of illnesses. This is not a new problem, just a growing one, one we have known about for years.

With this knowledge, it amazes me that our so called 'caring government' have elected to attempt to reduce the funding for health care over the last few years, instead grudgingly agreeing to foot the bill of so called 'overspending'.

IOMG, wake up, smell the coffee, common sense should prevail. It doesn't go away by simply ignoring the facts.

SHOW you care.

All they care about is their pension "entitlement"!

[Newbie]

8 hours ago, Sentience said:

I still believe this is not a case of overspending, it is simply underfunding.

There may be an element of underfunding, but how do you calculate what the 'correct' funding is. 

For 2019-20 (i.e. pre-pandemic) the IoM DHSC net expenditure was a little over 223 million, or around £2,600 per capita. The UK figure for 2019-20 was a little over 139 billion, or £2,140 per capita. Clearly, the UK NHS has funding problems, so I am not suggesting that their level of funding is correct, but the IoM has around 20% higher funding per capita.

The EU average is around €2,600 (or £2,200), although clearly there is a great variation in countries across the EU.

What is your evidence for saying that it is simply underfunding? To a certain extent, there is no real limit to the amount that could be spent on healthcare. It depends what level of service the public need/expect. What you cannot do is drive a Rolls Royce but expect to pay for a Mini.

[Apple]

28 minutes ago, Newbie said:

What you cannot do is drive a Rolls Royce but expect to pay for a Mini.

A comparison like this doesn't take into account all our extra costs due to our location. For some of the services we don't have - for instance mental health secure unit - we have to 'buy' for in the Uk. Same with some expensive Cancer diagnostics / treatment facilities - we have to pay for. Added to that of course is the costs of travel to and from the UK, which again is not cheap and the UK does not incur. There are more and probably better examples including perhaps Children's services. 

Arguably that is not a Rolls Royce service, but is pretty good given the capacity and expertise in some areas.

Other costs must include our retention and recruitment costs which is something we seem to struggle with. Getting the right people and having them on island and staying seems to be problematic. We spend more on prescription medications support I would venture. And so on...

Until we have that budget figure drilled down and see what spend per costs centre is then straightforward spend per capita costs comparison can only just start to inform us about the true costs and nature of the real health and social care costs here.

However I am certain it will be the first major debate of the New Year for the next Government. Manx Care will cost £20 million and the Government will want to see a return on that investment at some point. My first guess is that prescription charges will increase every year from then on, and not insubstantially. Means testing for health care is waiting in the wings I reckon. 

Edited April 6, 2021 by Apple

[Newbie]

29 minutes ago, Apple said:

A comparison like this doesn't take into account all our extra costs due to our location. For some of the services we don't have - for instance mental health secure unit - we have to 'buy' for in the Uk. Same with some expensive Cancer diagnostics / treatment facilities - we have to pay for. Added to that of course is the costs of travel to and from the UK, which again is not cheap and the UK does not incur. There are more and probably better examples including perhaps Children's services. 

Arguably that is not a Rolls Royce service, but is pretty good given the capacity and expertise in some areas.

Other costs must include our retention and recruitment costs which is something we seem to struggle with. Getting the right people and having them on island and staying seems to be problematic. We spend more on prescription medications support I would venture. And so on...

Until we have that budget figure drilled down and see what spend per costs centre is then straightforward spend per capita costs comparison can only just start to inform us about the true costs and nature of the real health and social care costs here.

However I am certain it will be the first major debate of the New Year for the next Government. Manx Care will cost £20 million and the Government will want to see a return on that investment at some point. My first guess is that prescription charges will increase every year from then on, and not insubstantially. Means testing for health care is waiting in the wings I reckon. 

I agree absolutely that there is a premium to pay when providing services at relatively small scale and in a location where many cases have to be sent away, so we should certainly expect to be spending more per capita, which we do to the tune of around 20% above per capita spend in the UK, and slightly less than that above per capita spend in the EU.

The question really is whether it is a matter of throwing more money at it (i.e. simply underfunding), or is it more complex than that. It is perfectly possible to be both underfunded to a degree and also inefficient at the same time.

Interestingly, the one part of the health service on the island that isn't funded at a higher level than the UK is General Practice. Of course, they don't have to deal with the costs associated with off island provision, and are insulated to a degree from the typically very high costs of the newest and most complex treatments, but nonetheless they don't overspend every year, and they still carry out around 90% of the face to face consultations whilst only spending around 10% of the money. The main difference is that they are not DHSC employees, they are independent contractors, running small businesses that have to be profitable in order to survive. We have seen on the island recently that they can go to the wall. All of the people responsible for running secondary care know that they cannot be allowed to fold, and that they will always be bailed out if they overspend.

[Dr. Grumpy]

2 hours ago, Newbie said:

There may be an element of underfunding, but how do you calculate what the 'correct' funding is. 

For 2019-20 (i.e. pre-pandemic) the IoM DHSC net expenditure was a little over 223 million, or around £2,600 per capita. The UK figure for 2019-20 was a little over 139 billion, or £2,140 per capita. Clearly, the UK NHS has funding problems, so I am not suggesting that their level of funding is correct, but the IoM has around 20% higher funding per capita.

The EU average is around €2,600 (or £2,200), although clearly there is a great variation in countries across the EU.

What is your evidence for saying that it is simply underfunding? To a certain extent, there is no real limit to the amount that could be spent on healthcare. It depends what level of service the public need/expect. What you cannot do is drive a Rolls Royce but expect to pay for a Mini.

Are you comparing apples with oranges here? It appears that you are comparing the per capita expenditure for Health in the UK with per capita expenditure for Health & Care here. Am I correct?

[Newbie]

1 hour ago, Dr. Grumpy said:

Are you comparing apples with oranges here? It appears that you are comparing the per capita expenditure for Health in the UK with per capita expenditure for Health & Care here. Am I correct?

I think it is fair to say that it is very difficult to be sure that comparisons are on a like for like basis! The UK figure relates to the UK DHSC so should include some Social Care, and certainly the NHS in UK funds a lot of social care when there is a health component. Local Authorities in the UK also pay for elements of social care, with the costs being offset by charges that they make for delivering it. I think the net cost to local authorities was somewhere in the region of £16 billion in 2019-20, but whether that covers the same, less or more services than are provided by the DHSC here is hard to know.

The point remains that we spend more on health and social care than the UK, and there may be very good reasons for that (geography, demographics etc). But it doesn't seem as simple as saying it is just underfunding and that if we keep throwing money at it the problem will be solved.

[Dr. Grumpy]

9 minutes ago, Newbie said:

I think it is fair to say that it is very difficult to be sure that comparisons are on a like for like basis! The UK figure relates to the UK DHSC so should include some Social Care, and certainly the NHS in UK funds a lot of social care when there is a health component. Local Authorities in the UK also pay for elements of social care, with the costs being offset by charges that they make for delivering it. I think the net cost to local authorities was somewhere in the region of £16 billion in 2019-20, but whether that covers the same, less or more services than are provided by the DHSC here is hard to know.

The point remains that we spend more on health and social care than the UK, and there may be very good reasons for that (geography, demographics etc). But it doesn't seem as simple as saying it is just underfunding and that if we keep throwing money at it the problem will be solved.

Not forgetting Public Health functions.... Still apples and oranges!

[Dr. Grumpy]

To make the health expenditure comparable, try with the GDP as the denominator: Here

[Newbie]

8 minutes ago, Dr. Grumpy said:

Not forgetting Public Health functions.... Still apples and oranges!

The IoM DHSC figures and the UK ones both include Public Health