Health Minister Kate Beecroft says big decisions need to be made about what acute care services can be provided in the island and which ones will require patients to travel away.

Mrs Beecroft found herself before the public accounts committee on Monday as part of its review of the Department of Health and Social Care’s £11.1 million budget overspend.

The department had to ask for the extra funding to cover last year and also needed £9 million to cover an overspend the year before.

It was given an extra £11m in this year’s Budget, but Mrs Beecroft warned in the summer that another supplementary vote may be needed.

On Monday, committee chairman Juan Watterson asked Mrs Beecroft, who was a vocal critic of the department before becoming minister last year, what she was doing differently.

The minister said one difference was that there was a strategy group looking at acute care provision at Noble’s Hospital.

’We have to have a plan now for what we should be doing in the island,’ she said.

’That is quite a big piece of work.’

She added: ’We are looking at reconfiguring the hospital, so the emergency and acute medical sit close together and maybe the ambulances come under that division as well.

’We are looking at all the different options of what should go out, what should be sent away to centres of excellence.

’Things like cancer, I cannot see that changing, because we wouldn’t have the throughput for any oncologist to maintain competency in a particular area.’

The minister continued: ’People are going to have to be aware of the reason, sometimes, why they cannot have a particular service in the island.

’Everybody wants everything done here - and I can understand why they would - but it is not always in their best interest for everything to be done here.

’But, if there are enough of those people then, it may be very feasible to bring somebody from a centre of excellence, once a month, once a week, whatever the need is.’

Mr Watterson asked why it seemed previous strategies, announced over the years, had brought about little effect.

Chief executive Dr Malcolm Couch said there was an ’elephant’s graveyard’ of strategies where nothing was done.

He commented: ’A strategy is a complete waste of time without an implementation plan. I suspect, historically, that hump was not got over and there was just a sort of settling back and saying, "we have a strategy now, it will happen" as if by magic.’

He said the department was better placed, now, to implement changes.