A hard-hitting report is recommending wide-ranging reform of the island’s health and social care services.

Sir Jonathan Michael, who led the independent review, has not pulled any punches in his criticism of the current regime, highlighting a dearth of data on quality, performance and costs and a culture of mediocrity.

He says his report should be seen as a ’catalyst for change’. At its heart is a call for the creation of a new delivery organisation for health and social care services, separate from the body which sets policies and priorities.

The landmark report, to be laid before Tynwald this month, contains no fewer than 26 recommendations that have been accepted in their entirety by government.

Its publication comes just days after it was announced that the two top civil servants in the Department of Health and Social Care had resigned with immediate effect.

The Michael report notes that previous reviews have identified ’deep-seated problems’ in the way the services were organised and delivered but recommendations were not implemented fully or at all.

It criticises a ’dearth of accessible, meaningful and published data on quality and performance’ and a lack of data and transparency around costs and spend.

This means ’it is not possible to judge whether or to what degree health and care spending of public money is appropriate or effective’.

And it adds: ’There is something about the health and care system on the island that drives a culture where the service user is not at the centre - this is highly concerning and should change.’

It says there is a ’systemic lack of communication between the DHSC and the wider system’ and, most damning of all, it notes: ’There is not an embedded culture of continuous improvement; rather, a tacit acceptance of mediocrity or even failure.’

Delivery of aspects of health and care and politics can become intertwined, with the associated risk of political interference with clinical decision-making, the report concludes.

’A consistent theme of discussion throughout the review is that staff at the front line feel disengaged and demotivated because they are not given the opportunity to influence how the services they provide are delivered.’

It recommends the creation of a single public sector organisation, perhaps to be known as ’Manx Care’, which should be responsible for the delivery and/or commissioning from other providers of all required health and care services.

Manx Care should be set up as an arm’s length body and run by a board appointed by government and approved by Tynwald but importantly, should be operationally independent of both.

Sir Jonathan proposes a modern model of integrated health and care services focussed on the service user, with care delivered locally whenever possible, either in the home or close to it. Off-island care should be limited to those cases requiring specialist treatment that cannot safely be provided here, the report says.

A service-by-service review should establish what services can, or should, or must be provided on- and off-island, against defined standards.

Manx Care should deliver an enhanced 24/7 emergency air bridge, potentially using helicopters or fixed wing aircraft, allowing for patients to be stabilised locally and moved quickly and safely to contracted off-island specialist centres.

Turning to funding, the report notes no government has an unlimited budget and, while it does recommend increases, it says these should be linked to regular improvements in efficiency to ensure any extra money delivers the maximum benefit.

unsustainable

If changes are not made to the health and care system, costs are forecast to rise by 2.7% a year on average in real terms and the annual cost of delivering current services would rise to £433m by 2035-36 - which would require an unsustainable extra £156m in funding.

The report recommends funding should move from the current annual budget allocation to a three- to five-year financial settlement.

A ring-fenced additional £4.3m for up to five years would be needed to support the transformation programme, it notes.

There is no direct criticism of the outgoing DHSC management in the report although it considers that the ’leadership of staff and service delivery has not been as effective as it could have been and has been somewhat constrained by bureaucratic inertia’.

Sir Jonathan, a former consultant physician and chief executive of three UK NHS Foundation Trusts, began work on the review in April last year.

His remit was to explore whether health and care services offer value for money, and whether current strategies and delivery of services are well placed to meet the island’s needs.

He told reporters at a press conference yesterday: ’I think this is a really exciting opportunity to create a fully integrated health and care system.

’The reality is this is not going to be a short term fix - it needs to be thought of as a long-term programme.’

He said he had been struck when he first came to the island how our health care system seems to have been stuck in the 1980s.

While the Manx NHS’s expenditure on drugs is 30% higher than the UK equivalent, the review found we were actually paying the same but they were being used in a less efficient way.

Asked if his plan would simply create another layer of bureaucracy, he replied: ’I see no reason why it should. I would hope in fact that bringing in skill sets from outside government, from outside the healthcare system, onto the board would actually encourage greater efficiency and reduce bureaucracy rather than increase it.’

Sir Jonathan said he was not in a position to comment on the departure of DHSC chief executive Malcolm Couch and his deputy Michaela Morris. ’I worked closely with them on this report. Why they left and when they left is something I cannot comment on.’

Treasury Minister Alfred Cannan described it as a ’credible, robust and forthright’ report. He said: ’It provides the detached external scrutiny necessary to plan a viable, fair system of health and social care for our people.

’The final report pulls no punches in addressing fundamental and searching questions regarding the need to reform service delivery and financial forecasts for the future.’