IOM DHSC & MANX CARE

[Jarndyce]

4 minutes ago, Roger Mexico said:

However one thing we can be sure of is that no matter how much the bureaucracy has expanded, the number of clinical directors is likely to be small compared to total number of doctors on the Island,

Indeed.   One Clinical Director per clinical division at Nobles - not sure how many of these there are these days, but I’d suggest no more than five or six.   Responsible for the clinical management of the divisions - roughly following the UK job description above.   And presumably reporting to the board via the Medical Director.

[wrighty]

31 minutes ago, Jarndyce said:

Indeed.   One Clinical Director per clinical division at Nobles - not sure how many of these there are these days, but I’d suggest no more than five or six.   Responsible for the clinical management of the divisions - roughly following the UK job description above.   And presumably reporting to the board via the Medical Director.

They're care groups here, not divisions (which sounds, well, divisive rather than cohesive).  Some care groups cover multiple departments/directorates/divisions and may have more than one CD.

There are CDs in Surgical, Medical, Women's and Children's, Theatre/ICU/Anaesthetics, ED, Support Services.  That makes 6.  There are other, broadly equivalent roles, and I haven't factored in psychiatry or primary care (because they're outside of the hospital services).  It is unclear to me who the CDs are expressing support for Teresa and the board, but it's probably the 6 I listed there as a starting point.

[Utah 01]

18 hours ago, cissolt said:

they are spending more money and delivering less services.

You've been catching up on W1A again.

[Roger Mexico]

The iomtoday piece rightly concentrates on cancelled elective procedures, but the context it came out in is very odd.  It was part of a reply to a Written Question that Julie Edge had asked on 5 September and which was produced, as usual, at the very last minute on the 26th.  So if this was "pre-budget posturing" as someone understandably suspected, it was rather secretive posturing.

Edge had asked: 

How many theatre operating sessions have been cancelled in each clinical specialty in each year since the Manx Care Board was created; in each case a) what was the reason; b) whether the cancellation affected elective treatment; and c) whether the cancellation affected the delivery of treatment for cancer; and what plans there are to reduce theatre operating sessions in the 2024/25 financial year.

and in reply got a number of interesting tables and statements of which more later.  But what caused the attention is the final two paragraphs:

From mid-September 2024, Manx Care are reducing the number of elective theatre lists by 5.5 per week (on average), a reduction from 30 to 24.5, as part of their plan to recover the overspend and is intended to save an estimated £220,000 in the latter six months of the financial year.

Cancellations have been selected within the General Surgery, ENT and Gynaecology specialties which currently have the lowest waiting lists for inpatient and daycase surgery. Manx Care appreciates this will extend waiting lists within these specialties and operational systems are in place within the Access and Capacity team to ensure that any urgent or cancer procedures are not affected by these reductions.

So it looks like they are reducing the number of elective operations by more than 18% so as to 'save' a pretty small amount of money in Manx Care terms, even ignoring the fact that those bumped down the list may develop further expensive needs due to their non-treatment.

[doc.fixit]

It seems as though there is a problem with consultants too. I had an appointment in August for my regular 6 months lung check up. a week before it was due I got a letter saying the appointment was cancelled and I would get another asap. I haven't yet got one so I phoned to be told I was on the list but the consultant was on indefinite leave due to illness and they couldn't give any indication when I would get my appointment.

[Non-Believer]

1 hour ago, Roger Mexico said:

The iomtoday piece rightly concentrates on cancelled elective procedures, but the context it came out in is very odd.  It was part of a reply to a Written Question that Julie Edge had asked on 5 September and which was produced, as usual, at the very last minute on the 26th.  So if this was "pre-budget posturing" as someone understandably suspected, it was rather secretive posturing.

Edge had asked: 

How many theatre operating sessions have been cancelled in each clinical specialty in each year since the Manx Care Board was created; in each case a) what was the reason; b) whether the cancellation affected elective treatment; and c) whether the cancellation affected the delivery of treatment for cancer; and what plans there are to reduce theatre operating sessions in the 2024/25 financial year.

and in reply got a number of interesting tables and statements of which more later.  But what caused the attention is the final two paragraphs:

From mid-September 2024, Manx Care are reducing the number of elective theatre lists by 5.5 per week (on average), a reduction from 30 to 24.5, as part of their plan to recover the overspend and is intended to save an estimated £220,000 in the latter six months of the financial year.

Cancellations have been selected within the General Surgery, ENT and Gynaecology specialties which currently have the lowest waiting lists for inpatient and daycase surgery. Manx Care appreciates this will extend waiting lists within these specialties and operational systems are in place within the Access and Capacity team to ensure that any urgent or cancer procedures are not affected by these reductions.

So it looks like they are reducing the number of elective operations by more than 18% so as to 'save' a pretty small amount of money in Manx Care terms, even ignoring the fact that those bumped down the list may develop further expensive needs due to their non-treatment.

All very encouraging for prospective new residents, not.

Which would also prove Ashford and the Housing and Communities Committee to be on the right track.

[cissolt]

3 hours ago, Roger Mexico said:

The iomtoday piece rightly concentrates on cancelled elective procedures, but the context it came out in is very odd.  It was part of a reply to a Written Question that Julie Edge had asked on 5 September and which was produced, as usual, at the very last minute on the 26th.  So if this was "pre-budget posturing" as someone understandably suspected, it was rather secretive posturing.

Edge had asked: 

How many theatre operating sessions have been cancelled in each clinical specialty in each year since the Manx Care Board was created; in each case a) what was the reason; b) whether the cancellation affected elective treatment; and c) whether the cancellation affected the delivery of treatment for cancer; and what plans there are to reduce theatre operating sessions in the 2024/25 financial year.

and in reply got a number of interesting tables and statements of which more later.  But what caused the attention is the final two paragraphs:

From mid-September 2024, Manx Care are reducing the number of elective theatre lists by 5.5 per week (on average), a reduction from 30 to 24.5, as part of their plan to recover the overspend and is intended to save an estimated £220,000 in the latter six months of the financial year.

Cancellations have been selected within the General Surgery, ENT and Gynaecology specialties which currently have the lowest waiting lists for inpatient and daycase surgery. Manx Care appreciates this will extend waiting lists within these specialties and operational systems are in place within the Access and Capacity team to ensure that any urgent or cancer procedures are not affected by these reductions.

So it looks like they are reducing the number of elective operations by more than 18% so as to 'save' a pretty small amount of money in Manx Care terms, even ignoring the fact that those bumped down the list may develop further expensive needs due to their non-treatment.

How does the reduction actually save money? Does this mean less staff are required who aren't on full time contracts?

[Roger Mexico]

1 hour ago, cissolt said:

How does the reduction actually save money? Does this mean less staff are required who aren't on full time contracts?

Well presumably every operation has some marginal costs - staff you might be bank/agency/on overtime, consumables such as anaesthetics and so on.  But I would expect overheads to dominate any real costing. 

Whether that has been done is another matter.  They say "Each year there are 2080 operating sessions available" and the table shows that "to date" 880 have been used, leaving 1200 slots.  If as they also say "From mid-September 2024, Manx Care are reducing the number of elective theatre lists by 5.5 per week (on average), a reduction from 30 to 24.5".  Apply 5.5/30 to that 1200 and you get 220 cancelled operations/unused slots.  As they reckon this "is intended to save an estimated £220,000" it works out as a suspiciously round £1000 per operation.  

Now these sort of costings are never easy and never exact, but that doesn't mean that the best possible attempt shouldn't be made.  Whether it has been more than a finger in the air here is another matter.  There's certainly evidence of a rather careless attitude elsewhere in the answer.  For example:

but the 24/25 figure is derived from 44 cancelled up to date (see table 4) so the percentage is actually 44/880 ie 5%, which rather spoils their story of the percentages decreasing.

[Jarndyce]

6 hours ago, wrighty said:

They're care groups here, not divisions

You say potato...

[cissolt]

Haven't seen this one mentioned yet.  Feels like a poorly worded question by Mr Wanneburgh and a poorly answered one from DHSS.

The net contribution can't be accurately calculated if they don't include all relevant expense, staff etc...

How much lower is the real figure I wonder?

If it was making 500,000 a year for the hospital, why have they allowed it to remain closed since 2019? 

 

 

[Roger Mexico]

28 minutes ago, cissolt said:

Haven't seen this one mentioned yet.  Feels like a poorly worded question by Mr Wanneburgh and a poorly answered one from DHSS.

The net contribution can't be accurately calculated if they don't include all relevant expense, staff etc...

How much lower is the real figure I wonder?

If it was making 500,000 a year for the hospital, why have they allowed it to remain closed since 2019? 

The Private Patient Unit was always notorious for things not being costed properly and not being charged out.  It was never clear whether this was incompetence or whether certain consultants expected certain things to be forgotten about.  Certainly, as the reply rather surprisingly admits, the systems simply either didn't exist or were never used. So it could have been that rather than the PPU subsidising the NHS, it was the other way round.

It explains why there wasn't much enthusiasm to get the unit running again 

[Kopek]

6 hours ago, doc.fixit said:

I got a letter saying the appointment was cancelled and I would get another asap.

A GP once advised me, that for the best of health..... 'stay away from Doctors'!!!

Hope your situation continues to improve, best of luck to you.

[Kopek]

If the p-rivatepatients unit were easier to find it would make tons more money??? Very poor signage from Ballafletcher end!!!

Being used for the RSV jab and covid booster, Flu jabs next!!! So it's out of use for months yet?

Does the 220k saving include ongoing costs which cannot be saved???

[Andy Onchan]

2 hours ago, Roger Mexico said:

The Private Patient Unit was always notorious for things not being costed properly and not being charged out.  It was never clear whether this was incompetence or whether certain consultants expected certain things to be forgotten about.  Certainly, as the reply rather surprisingly admits, the systems simply either didn't exist or were never used. So it could have been that rather than the PPU subsidising the NHS, it was the other way round.

It explains why there wasn't much enthusiasm to get the unit running again 

In which case they probably saved a bunch of money.

[Jarndyce]

DHSC Minister Hooper, responding to MR on the planned theatre list reductions:
 

"Whilst any significant changes to services would require changes to the mandate, which would require the approval of the DHSC and the Council of Ministers, the decisions taken to date rest within the operational sphere of Manx Care and I would suggest the best people to speak to about this would be Manx Care directly."

…or, if you prefer, “don’t ask me, nothing to do with me, guv…”