Medics are calling for a substantial reduction in management roles at Manx Care.

The Isle of Man Medical Society (IOMMS) is suggesting that management should be ‘streamlined’ with a cut of at least 60% - with the freed-up resources redeployed into ‘clinical and clinical support’ roles.

The recommendation forms part of the society’s detailed response to a recent independent review which examined the relationship between the government’s Department of Health and Social Care (DHSC) and Manx Care.

The Mersey Internal Audit Agency’s (MIAA) governance review, published in August, highlighted a lack of accountability and ownership of actions within Manx Care as well as the duplication of roles and the need for clearer focus on strategic priorities.

The medical society initially responded to the document saying that the findings had validated long-standing concerns raised by medical professionals about weaknesses in governance capacity related to the arms-length healthcare organisation.

It also said the island’s current healthcare model was ‘not fit for purpose’ in light of the report.

The doctors' group has now produced radical new proposals on the back of the report suggesting how Manx Care should be governed.

The document has since been circulated to Members of Tynwald.

In its release, the IOMMS said the focus of governance should be on clinical leadership, transparency and accountability within Manx Care.

The society sets out a wide-ranging governance model intended to reshape how Manx Care is overseen, how decisions are made and how clinical voices are built into the organisation’s structure.

A key change proposed is a reorganisation of the Manx Care Board. Under the model, the chair and vice-chair would be elected Members of the House of Keys.

Meanwhile, non-executive membership would be adjusted so that a majority of those roles are held by island residents.

Executive representatives would include the chief executive, chief finance officer, chief medical officer and chief nursing officer.

The document also proposes creating a statutory Professional Executive Committee (PEC).

The body would embed clinical and operational expertise directly into Manx Care’s decision-making and act as a formal route for frontline professionals to contribute to planning, quality and service redesign.

Membership of the PEC would be elected rather than appointed, a move the society says would be essential for professional and democratic accountability.

Representation would include clinicians from acute, community and mental health services, operational managers, and patient or community members.

Subcommittees focusing on quality and safety, workforce and culture, finance and resources, and innovation would also be established.

The PEC would provide quarterly reports to the Board, covering performance, risks, cultural indicators and operational issues.

The society says this structure would create a clear ‘governance triangle’ between the board, the executive management team and the PEC, with each group independently accountable for different aspects of the organisation’s performance.

The society argues these measures would help improve organisational culture and support the delivery of safe, effective care within the organisation.

To bring the changes into effect, amendments to the Manx Care Act 2021 would be required.

In its note to media and politicians, the society said it looked forward to working with the Isle of Man Government to develop a governance approach that strengthens public confidence and supports improved outcomes for patients.