Health Minister Eddie Teare warned late last year that his department was heading for a budget overspend of between £7m to £9m this financial year.

And that's even before the DHSS is hit by the squeeze on government spending following the VAT crisis, which will see £80m-90m lost in Customs revenue next year and up to £140m in subsequent years.

Tynwald will be asked next week to approve the transfer of £8.5 million from general revenues to plug the shortfall.

Health chiefs say the overspend is due to increased medical activity at Noble's Hospital, more patient referrals to the UK, higher unemployment, more expensive drugs, increased number of children in care and reduced National Health Insurance receipts.

The DHSS is the biggest-spending department with a net budget of £246.7m.

In November Tynwald voted for a one per cent increase in National Insurance employees' contribution to try to shore up the health service's budget deficit. The increase wil come into force in April.

The Health Minister has said the £7m a year from the NI rise would be ring-fenced for health — but he conceded that even with this extra money, it would be difficult to maintain frontline services.

Following the UK's raid on the government's VAT revenues, Mr Teare instructed managers to look at proposals for making cost-savings of 10 per cent right across the DHSS.

He said with 60 per cent of his department's costs going on wages, a reduction in staff numbers was being considered. But he said this would be by natural turnover, with some vacancies not being filled.
Wards were closed at Noble's Hospital over the festive period — in a move designed to save money.

And further temporary ward closures have not been ruled out as government departments face an unprecedented spending squeeze.

WHAT DO YOU THINK?
Send your comments to newsviews@newsiom.co.im

YOUR COMMENTS

Given all the recent publicity re the DHSS is it any surprise to anybody that they have overspent. What is a worry though is the amount £8.5. have the powers that be no idea on budget restraints. The latest fiasco with regards to the winter fuel supplement caps it all.
PEEJAY

PEEJAY, would you rather people get turned away for operations/treatment then? I am sure you would change your tune if you required medical assistance when DHSS became overspent. Your comments never fail to cause me despair. You really seem to have no idea how the government works, you just sit behind your PC picking fault with all the different departments, their leaders and all the MHKS, if you think you know how to run a Government or dept. then step up to the plate! You have absolutely know idea how the budget bidding process works or the fact that all depts bid for what they need but is not always possible to forecast for anything. Try removing the McCains homefry from your shoulder and be more positive!
AMUSED (!) CIVIL SERVANT

Strangely enough I don't recall posting anything about turning patients away. I am aghast at the way this inept government operate. We are paying for the mistakes of others, people who do not have the required skills to run government departments. Budgeting is not rocket science. You know what you want, you build a little in for emergencies then apply for your money. You then operate within those restraints. As for your suggestion to step up to the plate, I am not that naïve to think I could change anything. It would need a complete removal of all deadwood in there for that to happen. One person would be spitting in the wind.
PEEJAY

Sir, I read with concern that the DHSS is in the red again. While some expenses such as increased activity, increased need for transfers to the mainland and the need for expensive new drugs are inevitable, a huge amount of waste also goes on with the department. The Isle of Man has more NHS managers per head of population than anywhere in the developed world and they, along with their support staff are a huge drain on the budget. A small island such as ours certainly does not need so many layers of management. I'll give you an example of an ordinary nurse's management: She is managed by a team leader, who is managed by a deputy ward manager, who is managed by a ward manager, who is managed by a directorate manager, who is managed by the director of nursing, who is managed by the hopital manager, who is managed by the director of health strategy, who in turn is managed by the chief and deputy chief executive! In the UK, a similar sized population will have less that half the NHS managers we have. Another major drain on our finances is maintaining the Ramsey cottage hospital. Until our politicians tackle the above, the overspends will continue.
A NOBLE'S EMPLOYEE

Peejay seems to be SUCH an expert on all Island matters - so he or she should stand at the next election get in and sort the mess out ..
The Island would benifit from such an all round expert .. The said Peejay person might even do it for free and REALY save some money ..
MR IM CROSSTOO

Mr Teare certainly got the poision chalice when he took on the DHSS!
In the short term Tynwald surly has to agree to bail out the dept.
After that a radical review needs to be undertaken by the person heading up the dept. they need to be competent, fair and reasonable and a little ruthless, not a 'yes person' (Note the correct use of PC!) like most Civil Servants. So that rules out ET! Staffing accounts for some 60% of cost, a private enterprise would look at this first, government on the other hand would not. There are individuals in the DHSS who are habitually 'off sick' some spend in excess of half the working year sick, which excludes the average 7-9 weeks leave per annum.
There is a 'capability' proceedure which is in place to address these individuals but this is rarely applied. It needs to be. a few years back the 'Agenda for change' was introduced, which in effect meant that staff had to write thier own job descriptions (padded out of course) with the outcome that some staff increased thier wage by up to 100%, some higher management earn more than MHKs in the region of £70-90k.
These should be reviewd by an independent (uk) body to evaluate the 'real' allowable increase should fairly be applied to the top earners. The admin side of the DHSS is top heavy, this needs cutting back. better tendering for contracts of all types need introducing.
Consultants should be charged for the use of theatres, staff, drugs and implements; at present they are not. Rumour has it that one locum (who seems to be permanent) earnt close to £1m last year. Staff morale is a major problem (see sicness above also) and needs to be addressed.
Government is dictating cuts in fees on a wide spectrum of services, private companies are on reduced working weeks, it therefore follows that this should be considered for medical agencies, locums (who seem permanent)and possibly consultants too. Again rumour has it that some of these consultants and locums have not paid tax or NI in the IOM, this needs investigating and proscecutions made. Generally the DHSS needs new blood at the top and needs to be run as a large private company is, ie. comercially and economically.
T TASH

Well said PEEJAY, I agree with both your posts. Overspends can happen but £8.5M is not an overspend, it is a case of mismanagement and would result in responsible parties dismal in the private sector. The commenting "Civil Servant" has proven your point about deadwood, my guess is the poster should be working and not surfing the net. The government needs to wake up to the fact that revenue will fall by over 200 million pounds in the next two years! A very simple way to start saving money is to make the civil servants work more efficiently, this can be achieved by restricting internet access to only a very small minority that actually need it to carry out their role. The cap in hand times are over as the soup bowl is almost empty.
OLIVER TWIST

Mr I M Crosstoo, if you are going to highlight particular words, at least have the decency to spell them correctly. If you had bothered to read my post you would realise why it would make no difference at all if I were elected or not. A later thread by a Nobles employee explains everything. I wonder if Mr Amused (!) Civil Servant is amongst the several layers of so called management.
PEEJAY

The DHSS has more than just the hospital(s) to deal with. The fact that Mr Teare forecast the overspend shows that the budget was on the low side in the first place. This is less than 3.5% of the total - I think they should be congratulated on estimating it so close. My wife has spent the last 12 months going through the treatment for breast cancer - surgery (twice), chemotherapy and radiotherapy at Clatterbridge. Without exception, the hospitals and their staff were excellent. 30 years ago, I had a car accident which entailed long treatment both here and in Liverpool. In each case, I reckon we easily cost the service our own entire working life's NI contributions and we are more than grateful. No health service can accurately forecast for every contingency. Anyone remember the swine-flu panic hardly a year ago? You could hardly forecast that. The post from the hospital staff member explaining the management system shows it may well be over-managed. This seems to be common in every public service where they don't dare to get anything wrong in this libelous society. I'd rather see the DHSS spend the extra 3.5% than leave people untreated if ill or dumped in the street when old, unemployed or disabled.
MK

Whilst I do not disagree with the Nobles Employee's views re management structure within the DHSS, I do take issue with the comments re Ramsey Cottage Hospital. Has this person ever been there? I myself was very grateful to be able to use the Minor Injuries Unit facilities Ramsey has to offer yesterday morning after suffering a very nasty cut to my hand requiring medical attention. Had the Mountain Road been shut yet again, Cronk y Voddy shut because of snow and the Coast Road out of action due to an accident and someone needed emergency treatment, what then? The people in the North are very grateful to have such a service, particularly the elderly and for those who do not drive. I note the writer did not suggest the relatively new Southern Area facilities which are now similar to what Ramsey has be also closed.
MARY BREW

I have been told by a number of nursing staff that if you are booked to work a bank holiday or Sunday and then call in sick you still get paid double time, and if you go on holiday you still get an average of the overtime worked leading up to that date ? If this is true this is madness, can anyone confirm or have I been told this to wind me up. If your sick or on holiday you should get basic pay, not double time ! Reward those that actually turn up to work.
FRED

Very well said Nobles Employee and T Tash. It is clear that the DHSS is a complete shambles and the points you raise should be thoroughly investigated. No doubt the Council of Ministers will champing at the bit to investigate your points, Or perhaps not. If Mr Cannan, Mr Houghton or Mr Karran bring it before the keys (very few others would), the block vote of the Council of Ministers will scupper any attempted investigation. On a personal note, this huge deficit could be the reason that my last five consecutive DHSS appointments (two ophthalmology, one diabetes clinic and one dentist) have been cancelled, one of which I did not find out about until I presented myself for the appointment only to be told "oh did you not get a letter?!!!!!
VERY CONCERNED MANXMAN

I agree with 'a nobles employee' the levels of management in the IoM DHSS are crazy. Year on year various Ministers of Health have instructed the DHSS minions to 'make savings' cutting mere pennies from areas that desperately needed them and yet completely missing the point over huge areas of rampant spending. The biggest costs in any health department are always the human resources so start looking in areas that matter - at the crazy numbers of managers twiddling their pens trying to save a few pounds. I recall a few years ago someone flagged to DHSS that the Consultants were doing private work on hospital time in hospital theatres - this has still not been truly addressed by the very people who are meant to be managing the system!
SADDENED EX DHSS EMPLOYEE

The DHSS is responsible for more than the health service. I don't think any of us begrudge money being spent on people who are ill, it's inefficiency on the Social Services side that winds people up. What no-one seems to have commented on is that in his proposals for the reorganisation of Government the Chief Minister is proposing to give more responsibilities, including public sector housing, to this department which every year demonstrates itself incapable of managing a budget. And he seems to think that will be a way to save money. Incredible!
PEEWEE

The Hospital is very top heavy. It is also a pity that the further up the chain people travel, the less they do.The less well they do it.The more out of touch they are. Once within the top level, they are joining an executive club whose members look out for each other. I don't know if anyone remembers the A4C process of job descriptions and profiling, but it was no accident that this was steered by management to boost many of their wages by 10 to 40,000 pounds each. They receive much more than UK counterparts, pay less tax and have an unaccountable workplace, where they can pretty much do as they please. There is no appraisal process to check on any of their work standards. In many cases there are no work standards. The structure is completely broken. Accountability and public accountability does not exist. Lip service is everything. Everyone is also a Specialist at something, since you get paid more. Staff morale is extremely low in most areas, determined largely by the calibre of manager/leader in that area. Many of whom are untrained in management. A very serious point to note here is that there is a very high number of staff who "retire" to the Island, many of whom can no longer cope with life in a busy circumstance in the UK. They pay a little into the pension fund each month, live the very easy life and then retire at the local economy's expense. Our expense. And here is the crux of the matter: how do you lose these overpaid loafers ?
PK

One of the ongoing budgetary problems within the DHSS (NHS) has been caused by the Agenda for Change. This project came about because the DHSS allowed the previous staff Terms and Conditions to run out and had to quickly offer, without full consideration, an alternative proposal. This was to follow the UK methodology. This resulted in some staff getting considerable pay increases and a back-pay totalling between £7-10million. If the DHSS had managed the demise of the previous T & C's properly we might not be having these budget issues now, and in the future. Let's make certain this does not happen again.
MRC, Douglas

PEEJAY v CIVIL SERVANT; the latter is right, most of us dont know 'how govt works' we can only absorb the facts we read, hear about or know about. These are the things that concern us immediately, what we should be more concerned about are the things that are not reported, of which there are many. If the DHSS were a private company it would either be bankrupt or have to be bought back by the taxpayer like Lloyds or RBS!The overspend is not a huge amount in the scheme of things, just over 3%, it will of course be paid. The health agreement fiasco is about 1% of total spend by comparison. The department, in the coming year needs a total revamp of staffing (less admin, more nursing), procurement, maintenance costs, a top to bottom review as a private sector organisation would carry out and more importantly act upon without question. This time next year they should be reporting at or just under budget.
T TASH

I think the NHS should provide top quality care and the same level of treatment for all residents.If however some want to go private then go off Island.This would make the system easier to run and stop any conflict of interests.With the IOM Government offering greater transparency maybe we could have a detailed breakdown of costs at Nobles to see how the 60% on wages is spent.I would advocate fines both ways for broken appointments and customer satisfaction surveys after treatment.With the VAT shortfall looming we need to see a more aggressive stance to contain budgets in all departments or a panic may set in.
RUBY

Well done T Tash, a more contradictory posting I have yet to see.
PEEJAY

It is so very interesting to hear everyone up in arms against the DHSS. Unfortunately it is also very disappointing to realise that the staff at Nobles are under attack from some of you. I have had the misfortune to have stayed quite a few times in Nobles and the staff and ward managers have all been very kind and helpful. They have supported not only myself but my family and to tell you the truth I don't mind having an increase in Tax if it is going to the right place. I am sure the internal structure within the Hospital doesn't really differ that much from our next door's larger Islands apart from the fact that normally individual hospitals come under a rather larger banner of a NHS Trust, whereas here we only have the one hospital where the total staff have to do the same job as not only the Hospital management but also the Trust's management. I have to admit though I am not too sure if the word manager or management isn't just a name thing, maybe they are called something different so it is just giving the impression that there are more Chiefs than Indians. With the onset of the Island becoming more of a glorified Old Age Pension sheltered housing area, it is going to be inevitable that increases in costs for treatment and drugs for our aging population is going to increase. I couldn't believe the cost of the tablets I have been taking to help with my problem, but one course of only 3 months was over £500. The drugs are getting more and more expensive and don't forget the additional burden of the Bird flu worry that didn't materialise, but the cost of making sure that the Island was covered must have been huge. Each injection could have been easily well over £100 each and if you multiply this by the amount we would have needed to help everyone, then this alone would have been a huge cost to a budget that was already under pressure. But I am dammed sure that if they didn't buy enough if the bird flu was worse than expected, and thank god it wasn't, then PeeJay and the rest would have been the first on here moaning about why, when they knew it was coming didn't we act. You can not expect any sort of service and not expect to pay for it or be prepared for instances such as the recent bird flu without incurring unexpected costs to a budget which is always under pressure. You are right in some instances though, the amount of waste is something that should be looked at, but as always when things are going well and there is no need to have to look to make drastic cuts, then these things go unnoticed. I do know someone who works in a surgery and the number of people that come in for prescriptions that don't actually need them is unreal. This is also a huge burden on the DHSS, and how many of you out there still have drugs in your draws at home that you have never really used, or remember throwing them away? The drug problem on the Island is also a huge burden, I have no idea why these people think its fine to inject themselves with stuff and then expect us lot to pick up the pieces at our expense. They probably don't work so have no NI contributions, probably on sick so expect not to work, and claim everything they can from the DHSS and they have to give it to them under the rules that are there to protect us when we are sick, but these people take the mike. If it self inflicted, I think they should pay, and if not them then their family, it's their kids so let them pay for their upkeep. Sorry to have gone on one, but it just needed to be said.
DUCK

Sir, The current overstaffed management at Noble's is not only causing a huge drain on finances, but also getting in the way of frontline healthcare workers, the nurses and the doctors who actually look after patients. I have been reliably informed that the recent departure of a consultant anaesthetist and the impending departure of a consultant surgeon were entirely due to the managers. I would strongly recommend Tynwald demands that the DHSS in general and Noble's in particular seriously trim their management structure much like Mr. Obama demanded of GMC and Ford before bailing them out.
A NOBLE'S EMPLOYEE

If what A NOBLES EMPLOYEE says is true and there are 9 levels of management above a nurse (before you even get to Mr Teare) then the whole system needs to be revamped. There is absolutely no reason for any organisation the size of the IOM DHSS to have this many levels – a flatter, leaner and cheaper way forward needs to be found. Quickly………
MJM

PeeJay - my spelling is done that way so as to keep you on your toes ..
You are such an all round expert what ever it is eg "Bendy Bus", DHSS, dog walkers in parks, MHKs, etc etc .. are you sure youre not TONY BROWN !!
MR IM CROSSTOO

RE FRED'S COMMENT Nurses do not and never have received double pay! Unsocial hours are paid at a rate of time plus 30% or time plus 60% on Sundays and bank holidays! Other Non-nursing staff do indeed receive double pay for certain hours worked within the hospital/social services but not nurses! We miss out on this enhancement for some reason!
MEMBER OF STAFF