IOM DHSC & MANX CARE

[John Wright]

14 minutes ago, Boo Gay'n said:

Excellent post, thank you.

Re my highlight, surely this is what people want to hear?  I would vote for vision, investment and a long-term plan: but we are getting squillions pissed against the wall by our politicians to reduce waiting lists etc.  That is reactive and not strategic.

Politicians can be honest too about the reality of a bronze standard service, because it is still probably good enough.

But you’ve got to spend to bring the waiting lists, that have been allowed to develop, down, so that, hopefully you end up with establishment levels that can cope with the case load.

At the point off crisis health care was in, before and after pandemic, you’ve got to be reactive to the immediate problems, and proactive to ensure they don’t recur.

[Boo Gay'n]

50 minutes ago, John Wright said:

But you’ve got to spend to bring the waiting lists, that have been allowed to develop, down, so that, hopefully you end up with establishment levels that can cope with the case load.

At the point off crisis health care was in, before and after pandemic, you’ve got to be reactive to the immediate problems, and proactive to ensure they don’t recur.

You are probably right, as long as serious attention is paid at the same time to system problems.  Decisions about where to spend additional funding are political, rather than clinical.  In the memo included in last week's pack of documents for Tynwald, where the extra money for Manx Care was being requested, it says:

In response to the Mandate by DHSC, Manx Care plans to tackle three specialty areas which have the greatest volume of patients waiting for an inpatient procedure or a day case procedure. The specialty areas to be addressed are orthopaedics, general surgery and ophthalmology.

These may be the "specialty areas which have the greatest volume of patients waiting", but some form of political triage has been carried out, as we all know that there are other massive waiting lists.  Will the DHSC and/or Manx care simply keep going back for additional chunks of 18 million quid to deal with those others?

[John Wright]

14 minutes ago, Boo Gay'n said:

You are probably right, as long as serious attention is paid at the same time to system problems.  Decisions about where to spend additional funding are political, rather than clinical.  In the memo included in last week's pack of documents for Tynwald, where the extra money for Manx Care was being requested, it says:

In response to the Mandate by DHSC, Manx Care plans to tackle three specialty areas which have the greatest volume of patients waiting for an inpatient procedure or a day case procedure. The specialty areas to be addressed are orthopaedics, general surgery and ophthalmology.

These may be the "specialty areas which have the greatest volume of patients waiting", but some form of political triage has been carried out, as we all know that there are other massive waiting lists.  Will the DHSC and/or Manx care simply keep going back for additional chunks of 18 million quid to deal with those others?

Quite possibly, as and when they have the data, identified a service provider and negotiated a price. 

They’re engaged in a firefighting exercise, fingers in holes in dam. You identify the hottest spots or weakest points first. 

is that political?

I actually think Manx Care inherited a shit storm ( underfunded and underperforming service ), in the middle of a firestorm ( Covid - which exacerbated matters ). 

But I think they’re trying hard to fulfil their mandate and working through things item by item. And Tynwald are providing the funds.

Itll take 4-5 years before they get on top and have a sustainable plan.

No, I don’t like the commissioning/provider divide. And clearly it adds admin costs and costs of commissioning, tendering, setting targets, calibrating, measuring, regulating. But some of those things, the regulating are needed. The old monolith couldn’t deliver that.

[WTF]

waiting lists were shit long before covid turned up as the excuse for everything. 

[Apple]

On 10/25/2022 at 3:56 PM, John Wright said:

I actually think Manx Care inherited a shit storm ( underfunded and underperforming service ), in the middle of a firestorm ( Covid - which exacerbated matters ). 

But I think they’re trying hard to fulfil their mandate and working through things item by item. And Tynwald are providing the funds.

Itll take 4-5 years before they get on top and have a sustainable plan.

No, I don’t like the commissioning/provider divide. And clearly it adds admin costs and costs of commissioning, tendering, setting targets, calibrating, measuring, regulating. But some of those things, the regulating are needed. The old monolith couldn’t deliver that.

Agreed.

There are signs of change / progress reading through the Manx Care Board papers this month.

https://www.gov.im/about-the-government/statutory-boards/manx-care/board-meetings-2022/#accordion

There are still some trends that are not shifting yet and Rob Callister's letter expresses concerns in meeting this years mandate.

There is a lot on data / information and the details of the finances is very well laid out and more comprehensive than any we have seen before. 

[Boris Johnson]

When the old DHSS went to Tynwald asking to cover an "Overspend" there was lots of teeth sucking and grumping about giving them a far smaller sum of money.

Lots of grandstanding from our "Politicians" and statements of "NEVER AGAIN" They are wasting money etc etc etc 

How come now, we have a fancy named outfit (Manx Care for those a the back) "Running" THE HEALTH SERVICE" That it is okay to ask for over £20 million on top of your annual budget to make the health service work?

Just asking...... Forget Covid, it was terrible many years before that.

I have always been of the opinion that the IOM budget for the hospital etc is massively underfunded, so underfunded that there is zero chance of having enough money to make it a safe service from the islands low tax model.

As I have said before, turn Nobles into a stabilise, and send packing, hospital and let the proper docs/specialists in the UK do a proper job on you and your loved ones.

No offence aimed at Wrighty, he has been on island  a while but if you are a really cutting edge, good surgeon/ consultant, what the Actual F would you come here for?

Hint, the good ones don't come here, and when you talk to the good ones in the UK they laugh at the idea. It is a career killer.

I would, from prior experience at Nobles, sell my non mortgaged house and become homeless/ penny less before I let anyone at Nobles cut me open or try and fix a bone or any other part of me or my family.

Do not go there for anything other than a consultation, ask to be referred off island. It will save your life in many cases.

 

 

Edited October 29, 2022 by Boris Johnson

[forestboy]

9 minutes ago, Boris Johnson said:

When the old DHSS went to Tynwald asking to cover an "Overspend" there was lots of teeth sucking and grumping about giving them a far smaller sum of money.

Lots of grandstanding from our "Politicians" and statements of "NEVER AGAIN" They are wasting money etc etc etc 

How come now, we have a fancy named outfit (Manx Care for those a the back) "Running" THE HEALTH SERVICE" That it is okay to ask for over £20 million on top of your annual budget to make the health service work?

Just asking...... Forget Covid, it was terrible many years before that.

I have always been of the opinion that the IOM budget for the hospital etc is massively underfunded, so underfunded that there is zero chance of having enough money to make it a safe service from the islands low tax model.

As I have said before, turn Nobles into a stabilise, and send packing, hospital and let the proper docs/specialists in the UK do a proper job on you and your loved ones.

No offence aimed at Wrighty, he has been on island  a while but if you are a really cutting edge, good surgeon/ consultant, what the Actual F would you come here for?

Hint, the good ones don't come here, and when you talk to the good ones in the UK they laugh at the idea. It is a career killer.

I would, from prior experience at Nobles, sell my non mortgaged house and become homeless/ penny less before I let anyone at Nobles cut me open or try and fix a bone or any other part of me or my family.

Do not go there for anything other than a consultation, ask to be referred off island. It will save your life in many cases.

 

 

Bit over dramatic. 

[doc.fixit]

20 minutes ago, Boris Johnson said:

When the old DHSS went to Tynwald asking to cover an "Overspend" there was lots of teeth sucking and grumping about giving them a far smaller sum of money.

Lots of grandstanding from our "Politicians" and statements of "NEVER AGAIN" They are wasting money etc etc etc 

How come now, we have a fancy named outfit (Manx Care for those a the back) "Running" THE HEALTH SERVICE" That it is okay to ask for over £20 million on top of your annual budget to make the health service work?

Just asking...... Forget Covid, it was terrible many years before that.

I have always been of the opinion that the IOM budget for the hospital etc is massively underfunded, so underfunded that there is zero chance of having enough money to make it a safe service from the islands low tax model.

As I have said before, turn Nobles into a stabilise, and send packing, hospital and let the proper docs/specialists in the UK do a proper job on you and your loved ones.

No offence aimed at Wrighty, he has been on island  a while but if you are a really cutting edge, good surgeon/ consultant, what the Actual F would you come here for?

Hint, the good ones don't come here, and when you talk to the good ones in the UK they laugh at the idea. It is a career killer.

I would, from prior experience at Nobles, sell my non mortgaged house and become homeless/ penny less before I let anyone at Nobles cut me open or try and fix a bone or any other part of me or my family.

Do not go there for anything other than a consultation, ask to be referred off island. It will save your life in many cases.

 

 

Wrighty did a brilliant job on mrs doc's hip, Good job, good aftercare and brilliant long term too. No problems, no pain renewed ability to walk. Thanks Wrighty.

[Boris Johnson]

13 minutes ago, forestboy said:

Bit over dramatic. 

I don't think so, god help any family going there with something other than a minor health problem

[Apple]

41 minutes ago, Boris Johnson said:

As I have said before, turn Nobles into a stabilise, and send packing, hospital and let the proper docs/specialists in the UK do a proper job on you and your loved ones.

Too harsh but essentially that is what is in the offing. We can't afford everything and that is recognised in the financial report.

Medical staff though have not been kept in the loop it would seem by the BMA recommendations:

https://www.gov.im/media/1378149/159-bma-survey.pdf

but it seems they will be getting more information form. here on in.

A thought just occurred - how much time everyone will spend reading the papers and what the actual cost of that is. 

[wrighty]

5 hours ago, Boris Johnson said:

As I have said before, turn Nobles into a stabilise, and send packing, hospital and let the proper docs/specialists in the UK do a proper job on you and your loved ones.

No offence aimed at Wrighty, he has been on island  a while but if you are a really cutting edge, good surgeon/ consultant, what the Actual F would you come here for?

Hint, the good ones don't come here, and when you talk to the good ones in the UK they laugh at the idea. It is a career killer.

I would, from prior experience at Nobles, sell my non mortgaged house and become homeless/ penny less before I let anyone at Nobles cut me open or try and fix a bone or any other part of me or my family.

Do not go there for anything other than a consultation, ask to be referred off island. It will save your life in many cases.

No offence aimed at me perhaps, but you’ve done a pretty good job with that spectacularly ill-informed and inaccurate rubbish.

Send to ‘proper docs’ where? You are aware I suppose that the UK NHS is crumbling. The other day our regional trauma centre had 123 patients waiting for beds and a 25 hour wait to be seen in their ED. That’s good is it?

Why do people come here? Variety, quieter pace of life, ability to make positive contributions to the lives of many people, feeling more connected with your community… There’s more to life than a career in academic medicine. Plenty of good people come here. None of my former colleagues working at the ‘cutting edge’ in the UK are laughing at me. In fact they’re usually quite envious and wish they’d made a similar choice. 

Do you really think that everything, everywhere in the UK is great, and everything here is shit? Do you not watch the news and see the regular scandals in a variety of UK units? We have visitors routinely plead with us to treat them here and not send them back to their local hospital because of the horror stories they hear there. Consider joint replacements, something I know a bit about. We submit all our data to the National Joint Registry. We were recognised as one of the best hospitals for data quality in terms of timeliness and completeness. Our performance in terms of outcomes, including revision and death, is at or better than average in the main, and well within the expected norms in every factor. Not bad for a small rock in the middle if the Irish Sea. I could go on, but since you’ve already decided you’d rather be risking treatment across rather than here, there’s not much point. Best of luck with that idea to run services down to a ‘pack and send’ service next time the weather’s too bad to fly.

[WTF]

39 minutes ago, wrighty said:

 

 The other day our regional trauma centre had 123 patients waiting for beds and a 25 hour wait to be seen in their ED. That’s good is it?

 

A&E will be like airport arrival areas soon but instead of all the hire car booths there will be undertaker booths instead.

Edited October 29, 2022 by WTF

[hampsterkahn]

7 hours ago, Boris Johnson said:

When the old DHSS went to Tynwald asking to cover an "Overspend" there was lots of teeth sucking and grumping about giving them a far smaller sum of money.

Lots of grandstanding from our "Politicians" and statements of "NEVER AGAIN" They are wasting money etc etc etc 

How come now, we have a fancy named outfit (Manx Care for those a the back) "Running" THE HEALTH SERVICE" That it is okay to ask for over £20 million on top of your annual budget to make the health service work?

Just asking...... Forget Covid, it was terrible many years before that.

I have always been of the opinion that the IOM budget for the hospital etc is massively underfunded, so underfunded that there is zero chance of having enough money to make it a safe service from the islands low tax model.

As I have said before, turn Nobles into a stabilise, and send packing, hospital and let the proper docs/specialists in the UK do a proper job on you and your loved ones.

No offence aimed at Wrighty, he has been on island  a while but if you are a really cutting edge, good surgeon/ consultant, what the Actual F would you come here for?

Hint, the good ones don't come here, and when you talk to the good ones in the UK they laugh at the idea. It is a career killer.

I would, from prior experience at Nobles, sell my non mortgaged house and become homeless/ penny less before I let anyone at Nobles cut me open or try and fix a bone or any other part of me or my family.

Do not go there for anything other than a consultation, ask to be referred off island. It will save your life in many cases.

 

 

What an extraordinary and totally unwarranted  “blunderbuss “ attack on medical professionals who work here.

“ If you talk to the good ones in the UK they laugh at the idea.It is a career killer.” -Who are these “good ones”,?  “ They laughed ? How many did you manage to interview on this subject?

Several close members of my family have had truly outstanding treatment for serious conditions in Nobles, involving surgery, medical  and  ITU treatment by consultants and other staff who have all chosen to come and work here.

I am also aware that some of these professionals came here because of the less than ideal circumstances they encountered in their workplace in the UK NHS.

No one would deny we face some very serious problems in our Health Service.These certainly need to be urgently addressed - but it is unjust to carpet bomb with derogatory remarks  those  who are trying to keep things working.
 

 

[Jarndyce]

8 hours ago, Boris Johnson said:

I would, from prior experience at Nobles, sell my non mortgaged house and become homeless/ penny less before I let anyone at Nobles cut me open or try and fix a bone or any other part of me or my family.

Do not go there for anything other than a consultation, ask to be referred off island. It will save your life in many cases.

I trust you’ll have the courage of your convictions if you are ever unfortunate enough to be bleeding out in the back of an ambulance while the paramedics attempt to take you to Nobles to save your life.    I hope you’ll have the integrity to tell the medical staff what you think about them when you get there.

However, this is an anonymous forum: so no-one will be in a position to check whether you take your own fatuous advice when you or your family are next in need of urgent medical treatment.  

[asitis]

My experience of Nobles Hospital, for balance, is the service has been fine, the problems have been actually getting to see someone in the first instance !