Major problems facing the island’s health service have defeated a succession of government ministers, it was revealed this week.

Although the financial issues facing the Department of Health and Social Care are well-documented - a major review is taking place to try to balance the budget after years of health ministers going cap in hand to Tynwald for extra money - the specific problems, when put together on a single list, is startling.

Earlier this week, Health Minister David Ashford said he was confident that his department would hit the 2018-19 Budget target, even though his department was £1 million over the line in the first quarter.

But in an answer to a Tynwald question from his predecessor Kate Beecroft (LibVannin, Douglas South), Mr Ashford listed the number of issues coded red on the ’risk register’ for the DHSC.

The register is reviewed monthly. Many of the issues first went on it years ago, dating back to when Mrs Beecroft was Minister, or to her predecessor Howard Quayle, who was in charge at the department from 2014-16, before becoming Chief Minister.

But there are even some that pre-date all three - going back to the days of David Anderson as Health Minister - which means that, so far, four ministers have failed to solve some of the problems.

For instance, the ’failure to implement systems for appropriate budgetary management’ in the corporate division, has been on the register since 2013, as has staff recruitment and retention at Noble’s Hospital.

Possibly more damning is the failure to plan for adequate after-care provision for people released after detention under the Mental Health Act, which first went on the risk register in 2012.

Among the issues to be added in the last two years are insufficient levels of out of hours paediatric medical cover on the wards and that DHSC screening programmes, including adult, antenatal and newborn, are ’set up in ad hoc/piecemeal fashion, lack management and clinical leadership/oversight’.

The fact that MRI demand has been outstripping capacity has been on the register since January 2015.

This year a reduction of the number of GPs willing to staff the Manx Emergency Doctor service, making it unsustainable in the long-term, has been added, along with concern the learning disability service provision will not meet future demands and the ratio of older people going into permanent residential and nursing care will continue to outstrip the UK unless community services are expanded.

Meanwhile, a review of theatres at Noble’s Hospital has revealed a series of problems affecting how they are run.

Health chiefs are drawing up an improvement plan in response to the issues highlighted in the review of theatre efficiency and productivity.

The review pinpointed ’potential efficiency gains’ of £3.5 million per year.

But it pointed out a number of other issues.

These included:

The high volume of staff vacancies;

A lack of training support and opportunities;

A lack of clearly defined roles and responsibilities, plus ’no team vision’;

’Public theatre utilisation is significantly less efficient than private theatre utilisation’;

A lack of published metrics and benchmarking relating to performance;

’Absence of clear accountabilities for theatre performance and procedures’

A perception that communications structures do not work.

’Lack of faith in escalation process for incidents and issues raised’ and lack of Quality Assurance processes.

The outcome of the review was revealed by Mr Ashford, in a written answer to another Tynwald question posed by Mrs Beecroft.

Mr Ashford said: ’The department is committed to developing and implementing an improvement plan and discussions with Treasury are ongoing regarding the funding required to commission the improvement plan.’