The resignation with immediate effect of two top health bosses comes days before the publication of a hard-hitting report that will call for major reform of how the Manx health service is run.

It was announced on Friday - at 4.55pm just before the Bank Holiday weekend - that both Department of Health and Social Care chief executive Dr Malcolm Couch and his deputy Michaela Morris had left their roles. Their departure comes as Tynwald awaits a final report of a review of the island’s healthcare system by Sir Jonathan Michael which will be unveiled by him at a press conference this week.

And it follows a damning report by the Public Accounts Committee into overspending at Noble’s Hospital which criticised ’weak and ineffective leadership, starting with those at the top of the organisation’ for failing to tackle issues and ensure financial accountability and direction.

Clues about what this week’s report will say were given in a progress report on Sir Michael’s review which was presented to Tynwald in December.

It indicated that a wide range of reforms would be recommended to make health and care services sustainable and affordable in the face of rising demand.

And it spoke of the need to shift away from the current governance model, where the DHSC both sets the priorities and manages delivery.

Sir Jonathan notes: ’It is likely that my final report will include the recommendation to separate these functions and the establishment of a separate Health and Care Delivery organisation, run by a board, appointed by and accountable to the government but, critically, independent of it.’

There have been four chief executives of the DHSC in five years.

Mr Couch was appointed in June 2015, having previously been chief financial officer in Treasury.

The statement issued on Friday said Dr Couch has ’decided the time is right for him to pursue new opportunities’ and ’enable the DHSC to assemble a leadership team to take it through the transformation process’.

Health and Social Care Minister David Ashford MHK told the Examiner that he had decided that the press release about the two departures should go out on the eve of the Bank Holiday weekend.

He said: ’I could have left it until Tuesday but I didn’t want speculation to grow over the weekend. I think it is important to be open and transparent.’ Mr Ashford insisted that Dr Couch had decided the time was right to go on to other opportunities and Mrs Morris had felt the same.

He said with the Michael report due out this week, the two had felt it was the ’perfect break point for them to move on’.

He said he would not pre-empt what would be in the report but described it as ’exciting’ and one that offered ’great opportunities’.

The Minister pointed out that while the PAC had made comments about DHSC leadership it had made no recommendations on that issue.

The PAC report also criticised the ’farce’ of a ’Delivering Longer Healthier Lives’ vision document, of which Mrs Morris said she was the main author, but which was copied and pasted from a Wigan Council health strategy.

Mrs Morris joined the newly-merged DHSC in September 2014 and became executive directive and deputy chief executive.

Mr Ashford thanked Dr Couch and Mrs Morris for their ’dedication and enormous hard work’ they had given the DHSC - and also for the help and support they had provided him personally during his time as Minister.