IOM DHSC & MANX CARE

[Dr. Grumpy]

1 hour ago, Boo Gay'n said:

You may have spotted this elsewhere on MF, but the summary is that Sir Jonathan Michael was engaged to review the island's health and care system and sold us the diet version of England's Lansley 'reforms' just at the time that everyone across realised that they didn't really work.  This was all announced to hurrahs in Tynwald in 2019.  We will suffer the negative consequences for a generation unless, à la Truss, someone apologises for making a terrible mistake and reverses such a costly and ineffective experiment.

Yes, but the chances of that happening is similar to a snowball's chance in hell

[Dr. Grumpy]

The word on the street is that Noble's is more expensive, less safe and less productive since the advent of Manx Care (which costs about 4 Mill to run, separate from the operational budget for Noble's, allegedly). All failings are attributed to 'legacy issues' and the 'voyage of doscovery'

[Jarndyce]

45 minutes ago, Dr. Grumpy said:

All failings are attributed to 'legacy issues'

Well, they would say that, wouldn’t they?   My friends and former colleagues - some of whom have worked at the sharp end in Nobles for many years - are getting pretty sick of that line.

[Apple]

35 minutes ago, Dr. Grumpy said:

The word on the street is that Noble's is more expensive, less safe and less productive since the advent of Manx Care (which costs about 4 Mill to run, separate from the operational budget for Noble's, allegedly). All failings are attributed to 'legacy issues' and the 'voyage of doscovery'

I would agree with that. But the ball is rolling and now nothing can stop it. And it will be the community 'integrated' care services next. Politicians are excluded from comment - all been gagged I see. Still it has only been what 3 months without Tynwald and no questions arising from the CQC visits and latest reports. Not even about "feral medical staff".  Politicians in office, but not in authortiy. Embarrassing really. 

Interesting to see yesterday in Tynwald the temperature and comments between Hooper,Ashford and Callister. Blame games being played. If this is a sign to come then Callister will be under attack over every little thing that goes awry. 

Told there is a triumvirate structure being introduced in the care groups which tends to exclude many staff from the planning, strategic and operational business and communications apparently are a joke. Same model as the one broken in UK. Bring it on, get it done, then they can all go back home and we can all then just count the costs and moan about it later. A bit like the Prom really, or the flumes, or.....whatever.

[Omobono]

I was a patient at an orthopedic clinic   recently there was only one other patient , before me and I was there way ahead of my time , when I asked the nurse where everyone else was she replied ,  there are only a couple of patients today ,  even though there is a long waiting list   for surgery , there was a local consultant and an associate specialist  , a team of nurses and no patients , 

last time I went so see this surgeon  the clinic was bulging at the seams a new patient seen  every 10 minutes   so what  exactly is happening at Nobles ,  ,  in another medical   area  I have had 5  existing appointment date and time changes  in 3 months and my latest  next  appointment is in the New Year  something radically wrong with the system  I fear , 

never mind Rob will have all the answers !

[Boo Gay'n]

2 hours ago, Dr. Grumpy said:

The word on the street is that Noble's is more expensive, less safe and less productive since the advent of Manx Care (which costs about 4 Mill to run, separate from the operational budget for Noble's, allegedly). All failings are attributed to 'legacy issues' and the 'voyage of doscovery'

Can you explain more about these Noble's 'business as usual' costs and separate costs fro Manx Care?

[Dr. Grumpy]

3 hours ago, Omobono said:

I was a patient at an orthopedic clinic   recently there was only one other patient , before me and I was there way ahead of my time , when I asked the nurse where everyone else was she replied ,  there are only a couple of patients today ,  even though there is a long waiting list   for surgery , there was a local consultant and an associate specialist  , a team of nurses and no patients , 

last time I went so see this surgeon  the clinic was bulging at the seams a new patient seen  every 10 minutes   so what  exactly is happening at Nobles ,  ,  in another medical   area  I have had 5  existing appointment date and time changes  in 3 months and my latest  next  appointment is in the New Year  something radically wrong with the system  I fear , 

never mind Rob will have all the answers !

If I were less charitable, I'd say that patients are being removed from local services perhaps and handed over to private providers from across who may or may not have business connections with decisionmakers here, but I won't.

Above entirely my suspicion. Wrighty whom I respect assures me that this is incorrect. So I stand corrected. Please disregard the above.

Edited October 19, 2022 by Dr. Grumpy
Factual correction

[Dr. Grumpy]

6 minutes ago, Boo Gay'n said:

Can you explain more about these Noble's 'business as usual' costs and separate costs fro Manx Care?

I could, but may end up silenced. All the information is available in the public domain, so google's your friend

[Boo Gay'n]

30 minutes ago, Dr. Grumpy said:

I could, but may end up silenced. All the information is available in the public domain, so google's your friend

In the March Tynwald (page 695), Hooper, replying to Thomas said -

"The Minister: There were some comments there around scepticism and I acknowledge those. I acknowledge the concerns the public have around having heard the same message year in, year out, for seven years at least from various Health Ministers. That is the whole purpose of professionalising the management of health and care via the Manx Care model. It is the whole purpose of separating delivery from strategy: to get amateur politicians out of some of those very operational decisions that need to be made. I would challenge some of the things he said, however. The Transformation Programme, for example, has never been revenue funded. That exists entirely separate to the healthcare budget and is a dedicated transformation fund that exists that Tynwald approved. I know the Hon. Member is aware of this, so that actually does not factor into any of the issues around overspending, not directly at any rate. Of the additional cost of Manx Care management, £3½ million was what this Hon. Court agreed and approved at the outset and, as I said, Manx Care have already managed to save £1.7 million in their first year of operation. So should this continue, and I have no reason to suspect it will not, and if they do start hitting their CIP targets – again, I have no reason to suspect that they will not be able to do this – you will see more savings than the management structure is costing. That was the whole purpose again of professionalising the system."

The savings claimed were from the total budget of over a quarter of a billion squid, not the Manx Care additional management cost.

Reading Hooper's main speech, asking for 10 million more, and his replies to questions gives you a headache - they were so obviously designed to deploy smoke and mirrors about what, if anything, was being achieved that could be called positive.

[snowman]

Apologies if this information is already posted. It's from Rob Callister and contains some eye watering figures in relation to current wait times and targets.  Even the targets remain lengthy in some areas after the recovery phase ..

 

 

 

£18.3M FOR RESTORATION & RECOVERY PHASE 2

I enclose a copy of my full statement in Tynwald yesterday relating to the £18.3 million to undertake 3,800 surgical procedures over the next few months, which will improve the quality of life for many within our Manx community. 
 
Thank you Mr President,

Our ‘Island Plan’ has an objective to “address how waiting times and access to health and social care services can be improved as a priority” - and this motion for consideration here today directly supports that goal.

Manx Care inherited a significant waiting list backlog across all inpatient, day-case and outpatient specialties.

These waiting lists were prolonged by the impact of Covid-19 with most specialties reporting more than a 52 week wait for both inpatient surgeries and outpatient appointments.

I’m sure that many of us in this honourable Court have been contacted by concerned constituents who have had to wait far too long for appointments, which are seriously affecting their quality of life.

If Tynwald agrees here today to vote through the funding, around 3,800 surgical procedures will be completed over the course of the next few months.

As the new Health and Social Care Minister

I fully acknowledge the excellent work already undertaken…. and the success we have already seen in some specialities.

Funding of £1.8m was previously agreed by Treasury for the Restoration and Recovery Phase 1, which addressed some of the Covid-19 backlog, along with providing virtual hospital outpatient appointments across certain specialities.

Mr President

I confirm that 458 endoscopy procedures were completed in phase 1, which eliminated that waiting list.

We also completed 356 cataract operations with patients returning home on the same day.

Further funding of £908,400 was also agreed to fund hip and knee surgery, and this work started on Island in April and delivered 115 operations.

To date we have invested £2.7m to undertake 929 individual procedures, which will help improve the quality of life for many members from within our community.

In support of the “Island Plan” objective, and as part of their Mandate, Manx Care are required to address waiting times to levels comparable with other health and care systems…

….and to improve waiting times across services, with the ultimate target of an 18 week “Referral to Treatment time” (known as RTT).

Therefore this next phase of the programme, Restoration and Recovery Phase 2 plans to address the backlog in the three areas that have the largest numbers of patients waiting for an inpatient or day case procedure.

These are orthopaedics, general surgery and ophthalmology.

The aforementioned specialties are also those that have been targeted in the UK by NHS England.

With this plan, waiting list numbers as at the end of 2022/23 would be reduced by 2,200 cases across the three specialities.

This should bring the waiting list sizes to a level that should enable patients on the Orthopaedic, Ophthalmology and General Surgery inpatient waiting list to have average RTT waiting times of around 52 weeks… which includes the outpatient element of the pathway.

At present, the average waiting times for day cases across the 3 specialities is about 85 weeks.

Treasury and Council of Ministers has approved interim funding of £5m, which has allowed the work to begin in October.

If we are unable to secure the necessary funding here today, the department will need to give immediate notice to end the work in 8 weeks’ time, meaning that no further Restoration and Recovery activity work can take place after December.

If Tynwald approves the funding then we anticipate completion of the work in quarter 1 of the new financial year subject to winter pressures, human capacity and supply chain pressures ect.
 
Mr President

As for the cost - I fully understand that £18.3 million is a lot of money.

However, the plan addresses a legacy of issue, which means that waiting lists have unfortunately grown to beyond what can be considered safe.

The financial governance for this project is robust given the blend of independent provider and internal resources providing services … 
and a contingency of £2m is inclusive of the £18.3m to address any rise in costs associated with consumables and equipment.  

Following delivery of these procedures, we expect the waiting lists in 3 defined areas to be reduced significantly….
…and the quality of life for many within our community will be enhanced.

In Orthopaedics the current average waiting time for in-patient and day case is 46 weeks and that is expected to reduce to just 4 weeks, with the numbers waiting being reduced from 669 to 100.

In General Surgery the current average waiting time for in-patient and day case is 43 weeks and that is expected to reduce to just 3 weeks, with 554 people being removed from the waiting list, leaving just 60 patients awaiting for treatment at the end of the programme.
In Ophthalmology the current average waiting time for in-patient and day case is 58 weeks and that is expected to be reduced to 18 weeks at the end of the programme.

The number of people waiting is forecast to reduce from 1,359 to 300

To summarise Mr President,

The Island Plan has made a clear commitment to reduce our historic waiting list backlog and this funding is critical, in order to help deliver against that commitment.

Failure to address these backlogs will undoubtedly have a detrimental effect on a patients’ condition in the longer term.

It could also create even greater cost pressures in the future due to the increased complexity and risks around conditions that have worsened whilst on the waiting list.

Addressing the waiting list position quickly also has an economic benefit to the wider community, and the economy.

The proposed model of using external resources to support Manx Care’s teams to deliver additional activity over and above business as usual on-Island is already proving successful as I have already outlined.

Edited October 19, 2022 by snowman

[Apple]

35 minutes ago, Boo Gay'n said:

The Transformation Programme, for example, has never been revenue funded. That exists entirely separate to the healthcare budget and is a dedicated transformation fund that exists that Tynwald approved. I know the Hon. Member is aware of this, so that actually does not factor into any of the issues around overspending, not directly at any rate.

I hear this has been suspended due to lack of funds.

Separate issue but what is happening in the Neo natal unit ? Nurses not happy I'm told.

[Boris Johnson]

17 hours ago, snowman said:

Apologies if this information is already posted. It's from Rob Callister and contains some eye watering figures in relation to current wait times and targets.  Even the targets remain lengthy in some areas after the recovery phase ..

 

 

 

£18.3M FOR RESTORATION & RECOVERY PHASE 2

I enclose a copy of my full statement in Tynwald yesterday relating to the £18.3 million to undertake 3,800 surgical procedures over the next few months, which will improve the quality of life for many within our Manx community. 
 
Thank you Mr President,

Our ‘Island Plan’ has an objective to “address how waiting times and access to health and social care services can be improved as a priority” - and this motion for consideration here today directly supports that goal.

Manx Care inherited a significant waiting list backlog across all inpatient, day-case and outpatient specialties.

These waiting lists were prolonged by the impact of Covid-19 with most specialties reporting more than a 52 week wait for both inpatient surgeries and outpatient appointments.

I’m sure that many of us in this honourable Court have been contacted by concerned constituents who have had to wait far too long for appointments, which are seriously affecting their quality of life.

If Tynwald agrees here today to vote through the funding, around 3,800 surgical procedures will be completed over the course of the next few months.

As the new Health and Social Care Minister

I fully acknowledge the excellent work already undertaken…. and the success we have already seen in some specialities.

Funding of £1.8m was previously agreed by Treasury for the Restoration and Recovery Phase 1, which addressed some of the Covid-19 backlog, along with providing virtual hospital outpatient appointments across certain specialities.

Mr President

I confirm that 458 endoscopy procedures were completed in phase 1, which eliminated that waiting list.

We also completed 356 cataract operations with patients returning home on the same day.

Further funding of £908,400 was also agreed to fund hip and knee surgery, and this work started on Island in April and delivered 115 operations.

To date we have invested £2.7m to undertake 929 individual procedures, which will help improve the quality of life for many members from within our community.

In support of the “Island Plan” objective, and as part of their Mandate, Manx Care are required to address waiting times to levels comparable with other health and care systems…

….and to improve waiting times across services, with the ultimate target of an 18 week “Referral to Treatment time” (known as RTT).

Therefore this next phase of the programme, Restoration and Recovery Phase 2 plans to address the backlog in the three areas that have the largest numbers of patients waiting for an inpatient or day case procedure.

These are orthopaedics, general surgery and ophthalmology.

The aforementioned specialties are also those that have been targeted in the UK by NHS England.

With this plan, waiting list numbers as at the end of 2022/23 would be reduced by 2,200 cases across the three specialities.

This should bring the waiting list sizes to a level that should enable patients on the Orthopaedic, Ophthalmology and General Surgery inpatient waiting list to have average RTT waiting times of around 52 weeks… which includes the outpatient element of the pathway.

At present, the average waiting times for day cases across the 3 specialities is about 85 weeks.

Treasury and Council of Ministers has approved interim funding of £5m, which has allowed the work to begin in October.

If we are unable to secure the necessary funding here today, the department will need to give immediate notice to end the work in 8 weeks’ time, meaning that no further Restoration and Recovery activity work can take place after December.

If Tynwald approves the funding then we anticipate completion of the work in quarter 1 of the new financial year subject to winter pressures, human capacity and supply chain pressures ect.
 
Mr President

As for the cost - I fully understand that £18.3 million is a lot of money.

However, the plan addresses a legacy of issue, which means that waiting lists have unfortunately grown to beyond what can be considered safe.

The financial governance for this project is robust given the blend of independent provider and internal resources providing services … 
and a contingency of £2m is inclusive of the £18.3m to address any rise in costs associated with consumables and equipment.  

Following delivery of these procedures, we expect the waiting lists in 3 defined areas to be reduced significantly….
…and the quality of life for many within our community will be enhanced.

In Orthopaedics the current average waiting time for in-patient and day case is 46 weeks and that is expected to reduce to just 4 weeks, with the numbers waiting being reduced from 669 to 100.

In General Surgery the current average waiting time for in-patient and day case is 43 weeks and that is expected to reduce to just 3 weeks, with 554 people being removed from the waiting list, leaving just 60 patients awaiting for treatment at the end of the programme.
In Ophthalmology the current average waiting time for in-patient and day case is 58 weeks and that is expected to be reduced to 18 weeks at the end of the programme.

The number of people waiting is forecast to reduce from 1,359 to 300

To summarise Mr President,

The Island Plan has made a clear commitment to reduce our historic waiting list backlog and this funding is critical, in order to help deliver against that commitment.

Failure to address these backlogs will undoubtedly have a detrimental effect on a patients’ condition in the longer term.

It could also create even greater cost pressures in the future due to the increased complexity and risks around conditions that have worsened whilst on the waiting list.

Addressing the waiting list position quickly also has an economic benefit to the wider community, and the economy.

The proposed model of using external resources to support Manx Care’s teams to deliver additional activity over and above business as usual on-Island is already proving successful as I have already outlined.

That all sound good, very good.

Just one question, are there any connections between Manx Care peeps and the providers of these catch up services?

 

 

Edited October 20, 2022 by Boris Johnson

[wrighty]

1 hour ago, Omobono said:

I was a patient at an orthopedic clinic   recently there was only one other patient , before me and I was there way ahead of my time , when I asked the nurse where everyone else was she replied ,  there are only a couple of patients today ,  even though there is a long waiting list   for surgery , there was a local consultant and an associate specialist  , a team of nurses and no patients , 

last time I went so see this surgeon  the clinic was bulging at the seams a new patient seen  every 10 minutes   so what  exactly is happening at Nobles ,  ,  in another medical   area  I have had 5  existing appointment date and time changes  in 3 months and my latest  next  appointment is in the New Year  something radically wrong with the system  I fear , 

never mind Rob will have all the answers !

 

1 hour ago, Dr. Grumpy said:

If I were less charitable, I'd say that patients are being removed from local services perhaps and handed over to private providers from across who may or may not have business connections with decisionmakers here, but I won't

Clinics do sometimes seem quiet. There are loads of possible reasons for this. You only need a couple of patient cancellations or DNAs and you find yourself sitting around doing nothing for half an hour. We no longer overbook clinics regularly. Covid put paid to packed waiting rooms and so clinic schedules were adjusted accordingly. As per BOA guidelines we allow 20 minutes for a new patient. And the clinics at Ramsey cannot cope with the numbers that the ones at Noble’s used to - space is an issue. 
 

Ideally a clinic should seem quiet to a patient - turn up on time, get seen straight away, have enough time in clinic, and go just before the next patient turns up 20 minutes later. 
 

@Dr. Grumpysorry, your insinuation is wrong. Anything that’s been done with external providers has been in addition to our usual services. Synaptik have been working with us in Noble’s to both enable us to work at capacity, and provide additional lists. Medefer have been used for outpatient triage and telephone consultations, but I’m not sure they’ve done anything yet. If they have however it will be in addition to, and not instead of local services. 

[Boris Johnson]

4 minutes ago, wrighty said:

 

Clinics do sometimes seem quiet. There are loads of possible reasons for this. You only need a couple of patient cancellations or DNAs and you find yourself sitting around doing nothing for half an hour. We no longer overbook clinics regularly. Covid put paid to packed waiting rooms and so clinic schedules were adjusted accordingly. As per BOA guidelines we allow 20 minutes for a new patient. And the clinics at Ramsey cannot cope with the numbers that the ones at Noble’s used to - space is an issue. 
 

Ideally a clinic should seem quiet to a patient - turn up on time, get seen straight away, have enough time in clinic, and go just before the next patient turns up 20 minutes later. 
 

@Dr. Grumpysorry, your insinuation is wrong. Anything that’s been done with external providers has been in addition to our usual services. Synaptik have been working with us in Noble’s to both enable us to work at capacity, and provide additional lists. Medefer have been used for outpatient triage and telephone consultations, but I’m not sure they’ve done anything yet. If they have however it will be in addition to, and not instead of local services. 

You should then go back to overbooking.

Nobles is a disgrace.

 

[wrighty]

7 minutes ago, Boris Johnson said:

You should then go back to overbooking.

Nobles is a disgrace.

 

Really. And if everyone does turn up should we send people away, or should the staff stay on late? And what if it’s a morning clinic. Run into the afternoon and inconvenience the next clinic?

It is very easy for outsiders to shout the odds and say everything is shit, but the reality is that when you’re dealing with people it’s nigh on impossible to predict in advance how long everything takes.