IOM DHSC & MANX CARE

[Jarndyce]

57 minutes ago, John Wright said:

Clearly anything approved by NICE can be given to Manx patients receiving treatment in English hospitals.

Actually, no.   NICE recommendations don’t have the legal status here that they have in England.   So, unless funding is available, there is no legal obligation to provide them.

57 minutes ago, John Wright said:

So, are they saying that there were some things you could be prescribed and given in England that couldn’t previously be prescribed and given here?

Yes.   Unless there’s been a recent policy change, this is still the case.   However, in principle, if funding has not been approved for use in IOM, then it shouldn’t be prescribed and used on a Manx patient in England, as funding may not be available through the tertiary care budget.   Very frustrating for the English prescribers and the patients.

57 minutes ago, John Wright said:

And how does that translate to the ability to actually safely administer here?

Nothing to do with safety, as a rule (your own case notwithstanding) - and everything to do with funding approval.

Edited November 14, 2022 by Jarndyce
Addition for clarity

[Apple]

8 minutes ago, Jarndyce said:

However, in principle, if funding has not been approved for use in IOM, then it shouldn’t be prescribed and used on a Manx patient in England, as funding may not be available through the tertiary care budget.  

sad then to hear the system is still the same. So what is the process for seeking budgetary approval.? Does it go to DHSC Minister or can Manx care make the decision? 

Edited November 14, 2022 by Apple
slight adjustment to wording but meaning stays the same, I think

[Jarndyce]

7 minutes ago, Apple said:

But surely approved Cancer treatments should have priority.

They do.   Hence my earlier query - plenty of other treatments for life-limiting conditions have NICE approval in England, but no funding or approval in the island.   

[Jarndyce]

3 minutes ago, Apple said:

sad then not hear the system is still the same

There were plans afoot to approve all NICE treatments here - but it would depend on Treasury approval since funding is key.   I have no idea whether this is happening/is under active discussion/has been binned as too expensive.   Wrighty might have some insight?   Or a DHSC minister or political member might be reading these pages? 🤔

[Jarndyce]

11 minutes ago, Apple said:

So what is the process for seeking budgetary approval.? Does it go to DHSC Minister or can Manx care make the decision?

Couldn’t say…I am out of the loop!

Edited November 14, 2022 by Jarndyce
Addition for clarity

[Roger Mexico]

21 minutes ago, Jarndyce said:

There were plans afoot to approve all NICE treatments here - but it would depend on Treasury approval since funding is key.   I have no idea whether this is happening/is under active discussion/has been binned as too expensive.   Wrighty might have some insight?   Or a DHSC minister or political member might be reading these pages? 🤔

Well something was announced and discussed a few months back.  Though in an obscure way.  But everything's so tied up in bureaucracy (made worse by the DHSC/Manx Care split) that whether it can happen is another matter.

[buncha wankas]

6 hours ago, John Wright said:

It didn't bin them or ban them as such, and the hospital management systems weren't good at picking up what was private and then billing for use of imaging, consulting rooms, operating theatres, staff, private beds, drugs, etc.

Truth is it ran at a loss, and was subsidised by the tax payer. So money has been saved, not lost.

Facilities were outdated and DHSC decided to:

1. Update the Private patient ward and consulting room suite

2. Invite a private operator to tender to run it

1. Has been completed. The facilities couldn't have been used with the work going on. As the process for 2 was started Covid came along and the private beds were repurposed for a time. I think that tenders to operate have been invited again but I don't think it has the critical mass to really interest a UK private hospital operator

Not actually true as Manx care put loss incurred buy closing private as 800k lost income.   So it couldn’t have been subsidised by tax payer, sounds like we lost millions.

don’t believe everything they tell you. 

[John Wright]

41 minutes ago, Jarndyce said:

Actually, no.   NICE recommendations don’t have the legal status here that they have in England.   So, unless funding is available, there is no legal obligation to provide them.

I think we are at cross purposes here. I’m talking about a Manx Patient being treated as an inpatient in, or receiving outpatient treatment, physically  delivered in a hospital in England. Not someone being under the care of an English consultant or clinic and trying to get the reccomended drugs prescribed here.  Your answer to my question seems to suggest the English prescriber has to phone IoM to check if he can? 
 

it’ll be too late, it’ll have been given and does anybody here go through the bill from English Trust to Manx Care, with that type of fine toothed comb.

41 minutes ago, Jarndyce said:

Yes.   Unless there’s been a recent policy change, this is still the case.   However, in principle, if funding has not been approved for use in IOM, then it shouldn’t be prescribed and used on a Manx patient in England, as funding may not be available through the tertiary care budget.   Very frustrating for the English prescribers and the patients.

So, you’re answering my question yes, but then going back to the issue of prescribing, dispensing and administering in England.

41 minutes ago, Jarndyce said:

Nothing to do with safety, as a rule (your own case notwithstanding) - and everything to do with funding approval.

I think you’ve missed the point. There may be things that are prescribable and approved in IoM where we don’t have either the equipment or training or protocols to safely administer.  So nothing to do with funding. 

I was being given Arsenic Trioxide. Pharmacy was really iffy about making it up, and, because of the potential cardiac risk, nurses were not happy about physically administering without a delivery protocol designed around the ability or limitations of pharmacy and some training.

[Jarndyce]

13 minutes ago, Roger Mexico said:

everything's so tied up in bureaucracy (made worse by the DHSC/Manx Care split)

Notwithstanding my being out of the loop (see above), my guess is that it would go like this:

DHSC is responsible for policy, so they would decide on a policy to fund NICE treatments.

Before implementing the policy, they would have get Treasury approval for the funding required - past, current, “best guess” future and contingency funding.

If Treasury say yes, DHSC go to Manx Care and say “this is the policy, here’s the cash, now we’re commissioning you to go and make it happen”.

If Treasury say no, DHSC put the policy back in the box until public pressure changes the Treasury view.

[John Wright]

21 minutes ago, buncha wankas said:

Not actually true as Manx care put loss incurred buy closing private as 800k lost income.   So it couldn’t have been subsidised by tax payer, sounds like we lost millions.

don’t believe everything they tell you. 

Ashford said closing the private wing would save DHSC £200,000 a year

https://www.iomtoday.co.im/news/health/suspension-of-private-medical-care-at-nobles-223944

And wrighty explained in detail

https://www.manxforums.com/forums/index.php?/topic/63929-private-medical-care-terminated-at-nobles/&do=findComment&comment=1298358
 

I think you’re quoting the loss that Manx Care is notionally losing by not using Ward 19. But it wouldn’t have been able to use it for lots of 2021/22 when it was repurposed due to covid. And I suspect that’s the budgeted figure for income from a successful tender, which hasn’t happened, so it’s not actual.

[Jarndyce]

7 minutes ago, John Wright said:

I think we are at cross purposes here

Fair enough - apologies for any confusion.

[WTF]

2 hours ago, John Wright said:

 

 

So, are they saying that there were some things you could be prescribed and given in England that couldn’t previously be prescribed and given here?

 

perhaps on a financial level rather than a medical one ?  

[Boo Gay'n]

1 hour ago, buncha wankas said:

Not actually true as Manx care put loss incurred buy closing private as 800k lost income.   So it couldn’t have been subsidised by tax payer, sounds like we lost millions.

don’t believe everything they tell you. 

Oh, you naive pup!  Income and expenditure accounts show if you have a profit or loss.

I think that JW said earlier that they had no real idea what was being spent to generate the income.

[buncha wankas]

1 hour ago, John Wright said:

Ashford said closing the private wing would save DHSC £200,000 a year

https://www.iomtoday.co.im/news/health/suspension-of-private-medical-care-at-nobles-223944

And wrighty explained in detail

https://www.manxforums.com/forums/index.php?/topic/63929-private-medical-care-terminated-at-nobles/&do=findComment&comment=1298358
 

I think you’re quoting the loss that Manx Care is notionally losing by not using Ward 19. But it wouldn’t have been able to use it for lots of 2021/22 when it was repurposed due to covid. And I suspect that’s the budgeted figure for income from a successful tender, which hasn’t happened, so it’s not actual.

The Private Patients was making plenty of revenue before it was closed.  You suspect budgeted figure?  There was no tender so the revenue is actual loss from previous revenue earned. 

[John Wright]

6 minutes ago, buncha wankas said:

The Private Patients was making plenty of revenue before it was closed.  You suspect budgeted figure?  There was no tender so the revenue is actual loss from previous revenue earned. 

But expenditure exceeded the revenue. PPU was just a hotel with nursing, plus some consulting rooms they rented out. Most revenue from private care at Nobles went to consultants, surgeons, anaesthetists.

And, as wrighty explained 4 years ago, most things billable,  and therefore revenue,  went to Treasury, not DHSC, but DHSC paid all the costs like staff, heat, light, power, maintenance.