The model of health and social care is not operating as well originally intended when Manx Care was founded, a new report acknowledges.

An independent review of the arm’s length arrangements between it and the Department of Health and Social Care will be debated at December’s Tynwald sitting.

It examines four strategic options for the future - do nothing, scrap Manx Care, implement in full the recommendations of the report which first led to it being set up, and strengthen partnerships between it and the DHSC.

Doing nothing is ruled out as not viable.

And consultants MIAA said that while concerns were raised about the effectiveness of the current model, there was ‘minimal appetite’ for reverting to the old system.

But DHSC interim chief officer Tim O’Neill said Tynwald could still consider that option.

He said: ‘The report's pretty clear sighted from the stakeholder interviews that there was very little appetite for that. That's not to say that members won't, after consultation, still consider that option.’

Professor O’Neill said the report gave ‘a clear steer’ as to areas that needed looking at.

The review, which was commissioned following a Tynwald motion in October last year, outlines six recommendations.

They include developing a 5-10 year clinical strategy underpinned by a three-year financial settlement and strengthening partnership arrangements with the DHSC.

Manx Care was established April 2021 in line with the recommendations of Sir Jonathan Michael ‘s independent review.

The MIAA says: ‘It is evident that the current health and social care model in the Isle of Man is not operating as well as originally intended.

‘The size and scale of the island, along with its governance and funding structures, have limited the ability of Manx Care to fully function as an independent arm’s-length body.’

It said it is generally viewed that the model is the right one but as a small island, Manx Care’s ability to operate as truly arm’s-length ‘may need to be reconsidered across a number of areas’.

MIAA says the current funding model is one of the biggest challenges faced.

‘It remains based upon an annual allocation. There has been little or no progress made in the implementation of the Sir Jonathan Michael report recommendations relating to the funding model,’ it states. ‘The focus from Manx Care is on reducing the overspend in year, rather than enabling a more strategic and longer-term focus.’

The DHSC’s current governance model ‘did not meet ministerial needs’ when it came to engagement, information sharing and holding Manx Care to account, its report says.

Full implementation of Sir Jonathan’s report would provide a clear separation of roles and aim to create a financially and clinically sustainable system, it adds.

But it acknowledges the risk that achieving the funding levels and standards set out in the review might not be realistic.

The report says the DHSC does not have the necessary financial oversight to hold Manx Care to account, notably due to the absence of a DHSC director of finance - but this highlights the potential duplication of roles as Manx Care has its own finance director.