IOM DHSC & MANX CARE

[Andy Onchan]

38 minutes ago, John Wright said:

The FoI answer is correct. But, as explained above, it doesn’t mean DoI as Nobles estate land owner/DHSC as occupier don’t have the power to stop access.

If your next door neighbours decided to access their back garden through your garden ( I know Mrs A wouldn’t object, she’s nice, but you would, you’re a bastard ) you’d stop them. I’d then ask you where was your right to stop them. You’d not be able to point to anything.

The FoI is an example of rubbish in rubbish out, or ask an unanswerable question and get a meaningless answer you can’t rely on principles.

😘 I love you too!

[John Wright]

5 minutes ago, littlebushy said:

Totally agree, it doesn't matter what the costs are, this is all about health care and it has to be a good news story!

I'm not sure that any of these were done by the local surgeons. However, what you have to factor into the equation was how many surgical theatres and lists were taken over by Synaptic and thus preventing our local surgeons from performing joint replacements, cataracts and hernia repairs when their job plans were for them to be operating. It would be interesting to know for example, how many cataracts have been performed by the Nobles Ophthalmologists for example.

The more interesting question, after two years of Synaptic, and after 2 years of new referrals, what do the waiting lists stand at now.

1. numbers of patients per speciality/procedure

2. actual weeks waiting per speciality/procedure

[John Wright]

6 minutes ago, Andy Onchan said:

😘 I love you too!

So, to what can you point in your lease, or deeds, that allows you to stop your trespassing neighbours.

So, if that FoI had been asked of you, what alternative response could you have given?

kisses.

[joebean]

2 hours ago, Roger Mexico said:

How good a news story it is if you examine the details is another matter as cissolt pointed out earlier:

The table they quoted comes from a fairly comprehensive report to Tynwald entitled Manx Care Restoration and Recovery - Phase Two Programme Summary and it's worth looking at that table in more detail:

Financially this has the signs of the sort of thing we've seen from DHSC/Manx Care before.  While individual items differ wildly from the figure given in the B[usiness] Case, miraculously the total spend just happens to match up with the estimated total exactly.  Only 0.01% under in this particular case.  No doubt they and the dumber politicians think that this proves how wonderfully efficient they are, but to the rest of us it just looks like they are fiddling the figures.

How they've done this is less certain.  Part of it may be in Support Services which will be supplied from the hospital budget.  If the whole project goes over they just bill less internally.  There's obviously also scope for using the contingency.  And the General Surgery figures are wildly out.  It's also possible they simply stopped treating people once the budget ran out, no matter what the need.

But because Manx Care/DHSC have prioritised making it look like there's a 'good story' over providing honest information, we can't really tell.  The worry is they may not know either or not care.

An apparent good news story then. It doesn’t really matter in politics whether it is actually good or not. If it can appear to be a good news story, a politician will want to put his/her name to it and present it to the media. If the subject matter cannot be presented as reflecting positively on the Department/Minister, it will not go to the media and the Minister will be distanced from it. Believe me, I have seen this many times. Truth, actual news and politics are not always in close partnership. 

[Ghost Ship]

4 hours ago, littlebushy said:

The other thing that isn't mentioned is the price per case. This equates to £5792 per case. 

Now a typical inpatient joint replacement in the UK costs around £13 000 fixed price but at most, this made up 582 of the 3156 cases listed above. The rest such as cataracts would cost an individual around £3000 and a lot of the minor operations, less than this. And of course, in a private hospital in the UK, each patient would be funding their bed, meals, theatre time, implant cost etc. all of this is already provided at Nobles. So the price per case should work out less than the eye watering £6k charged. On top of this, there is the economy of scale and the buying power of In excess of 3000 cases so whoever negotiated these costings in my opinion, should be held to account!

As someone whose career in the UK NHS started about the same time as the introduction of the internal market and who was also responsible for costing my trust's price tariff in the early 2000s, those figures in table 2a make very little sense.

In Ophthalmology how can an actual activity outturn 14% below target result in a "Finance" outturn 47% over target?

Ditto inpatient general surgery: activity 54% below target but "Finance" 55% over target.

Also on inpatient general surgey, there were only 50 procedures in 2022/23 for the Restoration and Recovery funding, yet there was £712,000 of "Finance" allocated (spent?) in that year.  That's over £14,000 per procedure...

I appreciate these figures are only trying to explain how the extra £18 million has been spent and its not a total costing of all Manx Care's activities, but I'd be thinking that those figures raise more questions that they answer.  

How come they appear to have spent 100% of the funds but only achieved 17%  83% of planned activity?

Ophthalmology returned to "Business as usual" in September 2023, after waiting lists hit target reduction in May.  But why had they overestimated the required target activity by so much?

 

[Edit:  Big whoopsie!  In the above I've deleted "only achieved 17%" and replaced it with the correct "only achieved 83%".  Even Manx Care aren't that bad!  Sorry...]

Edited June 5 by Ghost Ship

[Jarndyce]

. Deleted .

Edited June 5 by Jarndyce
Dull

[Dirty Buggane]

Because the whole thing is pure fantasy, designed to hoodwink mhk's and general public alike. BBB (bullshit  baffles brains)  🤥

[Andy Onchan]

15 minutes ago, Ghost Ship said:

As someone whose career in the UK NHS started about the same time as the introduction of the internal market and who was also responsible for costing my trust's price tariff in the early 2000s, those figures in table 2a make very little sense.

In Ophthalmology how can an actual activity outturn 14% below target result in a "Finance" outturn 47% over target?

Ditto inpatient general surgery: activity 54% below target but "Finance" 55% over target.

Also on inpatient general surgey, there were only 50 procedures in 2022/23 for the Restoration and Recovery funding, yet there was £712,000 of "Finance" allocated (spent?) in that year.  That's over £14,000 per procedure...

I appreciate these figures are only trying to explain how the extra £18 million has been spent and its not a total costing of all Manx Care's activities, but I'd be thinking that those figures raise more questions that they answer.  

How come they appear to have spent 100% of the funds but only achieved 17% of planned activity?

Ophthalmology returned to "Business as usual" in September 2023, after waiting lists hit target reduction in May.  But why had they overestimated the required target activity by so much?

The issue with the Ophthalmology numbers is that I suspect that the cost/activity (£1,897) will relate mostly to cataract surgery and for one eye only. As a comparison I had cataract surgery on both eyes at the same time in Liverpool and cost £2k for which the insurance company coughed up. Based on that I would suggest that the Synaptic charges for that procedure are not value for money.

[Roger Mexico]

3 hours ago, littlebushy said:

I'm not sure that any of these were done by the local surgeons. 

They were according to @wrighty:

For the avoidance of doubt, knee (and hip) replacement ops have been carried out by the orthopaedic surgeons who have all been working at Noble’s for over a decade, in some cases over two. The first patient to be done that the article mentions was one of mine. Synaptik are the company that provided the nursing staff to look after the ward, theatre staff, a therapist and an anaesthetist. They’ve been great, and our local patients who’ve been waiting far too long have benefited enormously from them being here. But it’s me and my colleagues who have been holding the knife and operating the power tools. And in case there is any further doubt over the headline’s use of the word ‘private’, we haven’t been paid extra to do this, and more importantly patients haven’t been charged - from the surgeons’ and patients’ perspectives this is just normal NHS work. 

Don't know about the other specialities though.

[Ghost Ship]

2 hours ago, Andy Onchan said:

The issue with the Ophthalmology numbers is that I suspect that the cost/activity (£1,897) will relate mostly to cataract surgery and for one eye only. As a comparison I had cataract surgery on both eyes at the same time in Liverpool and cost £2k for which the insurance company coughed up. Based on that I would suggest that the Synaptic charges for that procedure are not value for money.

You might be right, but I think my point is that the figures are so meaningless that you can't actually tell how much each procedure in the three specialties really cost (with respect to the extra £18m)

For example, with ophthalmology the business case planned activity over the two years was 2096 procedures and they had allocated £2,313,925 of the £18 million to it.  Yet despite (a) reducing the waiting list to the target level by May the second year, (b) returning to "Business as usual" for the last 7 months of the second year, and (c) reallocating "funds not spent on this speciality... to increase activity in the other two specialities", the "Finance" finally allocated to ophthalmology went up from £2,313,925 to £3,403,328 even though actual activity was only 1794 as opposed to planned 2096.

So the waiting list reduction target was met early, so they didn't need to spend any more of the £18m on ophthamology and - according to the report - used the remaining balance to fund orthopaedics and general surgery activity.  If that were true then the proper way to deal with it would be to transfer the unused "Finance" allocated to ophthalmology from ophthalmology over to the other two specialities to accurately reflect the increased costs of increased activity in those two specialties (if there was any...)

There is no logical explanation why ophthalmology "finance" went up by over £1 million in that time period despite activity stopping with 7 months left.  I suspect what they actually did was to keep the ophthalmology "finance" under that specialty even though it was no longer funding ophthalmology procedures and was actually funding additional orthopaedic and general surgery activity.

That of course is bonkers and no way to run a health service efficiently and effectively.  You'd never know the true cost of anything if you didn't move funding around to match where the activity was.

Or perhaps I've completely misunderstood what those tables are trying to show...

 

[NB - I have to acknowledge having to edit my previous post.  I'd wrongly said they'd spent 100% of the £18m but only achieved 17% activity.  That was wrong - it's 83% activity]

 

Edited June 5 by Ghost Ship

[littlebushy]

31 minutes ago, Roger Mexico said:

They were according to @wrighty:

For the avoidance of doubt, knee (and hip) replacement ops have been carried out by the orthopaedic surgeons who have all been working at Noble’s for over a decade, in some cases over two. The first patient to be done that the article mentions was one of mine. Synaptik are the company that provided the nursing staff to look after the ward, theatre staff, a therapist and an anaesthetist. They’ve been great, and our local patients who’ve been waiting far too long have benefited enormously from them being here. But it’s me and my colleagues who have been holding the knife and operating the power tools. And in case there is any further doubt over the headline’s use of the word ‘private’, we haven’t been paid extra to do this, and more importantly patients haven’t been charged - from the surgeons’ and patients’ perspectives this is just normal NHS work. 

Don't know about the other specialities though.

Thank you for this.

I have had a look on the National Joint Register https://surgeonprofile.njrcentre.org.uk/HospitalProfile?hospitalName=Nobles Hospital and there are 3 surgeons who do not appear to be substantive at Nobles, performing joint replacements at Nobles.

According to the data, between 1 April 2022 and 31 March 2023, there were 387 joint replacements performed at Nobles of which 191 of these were performed by the 4 substantive orthopaedic consultants at Nobles. Presumably the other 196 were performed by the other 3 surgeons (via Synaptik)

 

[wrighty]

34 minutes ago, littlebushy said:

Thank you for this.

I have had a look on the National Joint Register https://surgeonprofile.njrcentre.org.uk/HospitalProfile?hospitalName=Nobles Hospital and there are 3 surgeons who do not appear to be substantive at Nobles, performing joint replacements at Nobles.

According to the data, between 1 April 2022 and 31 March 2023, there were 387 joint replacements performed at Nobles of which 191 of these were performed by the 4 substantive orthopaedic consultants at Nobles. Presumably the other 196 were performed by the other 3 surgeons (via Synaptik)

 

@Roger Mexico quoted me without referencing the date. For clarity, the first phase of Synaptik assisted joint replacements were done by me, Crerand, Barker and Hutchinson. For second and subsequent phases Synaptik also brought a surgeon to provide additional capacity. They're Baird, Eslami and Nicol, and they operated at the same time as the 4 locals. There have been others since, but the scottish surgeons haven't all been great at inputting the data to the NJR (they don't use it in Scotland)  and we've had to do it retrospectively. From April 2022 Up to the end of 2023 we did 666 Joint replacements at Nobles. 

[cissolt]

5 hours ago, Roger Mexico said:

Quite.  That's an example of what I meant by it might not be as good a story as Hooper is proclaiming.  I'd add to your points that as well as all the costs already being covered by Nobles, many of the operations were done by Manx Care surgeons such as wrighty, so the amounts paid out look even more generous.  I'll try to examine the figures in more detail later.

The reduction in the waiting list is obviously a good thing.  But the fact they magically spent all the money and the majority of the operations and support being done by nobles does make you wonder just how much this whole thing has cost per operation.

[Albert Tatlock]

34 minutes ago, wrighty said:

@Roger Mexico quoted me without referencing the date. For clarity, the first phase of Synaptik assisted joint replacements were done by me, Crerand, Barker and Hutchinson. For second and subsequent phases Synaptik also brought a surgeon to provide additional capacity. They're Baird, Eslami and Nicol, and they operated at the same time as the 4 locals. There have been others since, but the scottish surgeons haven't all been great at inputting the data to the NJR (they don't use it in Scotland)  and we've had to do it retrospectively. From April 2022 Up to the end of 2023 we did 666 Joint replacements at Nobles. 

666 sounds a lot, I'm guessing many of them would be 2 per person...knees, hips etc.? So around 300-400 people?

No wonder it's so slow getting through Ronaldsway security 😀

[wrighty]

Just now, Albert Tatlock said:

666 sounds a lot, I'm guessing many of them would be 2 per person...knees, hips etc.? So around 300-400 people?

Haven't done that analysis. There will have been some having 2 or even 3 joints done in that time, but most will be just one. I'd guess 450-500 patients.