Manx Care said work is progressing on implementing the recommendations of a scathing report into the general surgery service at Noble’s Hospital.

A 2025 report, marked private and confidential and seen by Isle of Man Today, revealed a toxic culture with claims of bullying and junior staff fearful of raising concerns.

The review was commissioned by the interim executive medical director in 2024 following complaints from junior doctors concerning insufficient supervision and support, and subsequent patient safety incidents classified as ‘Serious Untoward Incidents’.

However, the review team did not identify any major concerns about overall quality and safety in the general surgery service.

But the team raised concerns at the standards of teamwork at the consultant level which they considered ‘dysfunctional and toxic’. ‘This had an impact throughout the general surgery department and was felt at every level,’ their report found.

There was consensus among stuff that most of the consultants were excellent and dedicated to their work but ‘interpersonal behaviours’ between some were ‘very poor’, resulting in ‘silo-type working which was considered dangerous’.

The report added: ‘It was of concern that colorectal and general surgeons have perceived conflicts that have contributed to a toxic culture and claims of isolation and bullying.

‘It was concerning for the review team that disagreements among consultants had led to constant bickering, while some staff feared speaking out and raising issues for fear of repercussions.’

Consultants were not using their lists effectively, transferring patients to others and delegating work they should have been doing, the report found.

The review team was concerned that practitioners were being paid twice for the same time, and Professional Activities - clinical units of time used to plan, measure and fund a healthcare professional's weekly schedule - were being manipulated and paid despite the consultants not working them.

They were also concerned that the on-call rota being manipulated with consultants taking leave when they were scheduled to be on-call.

Trainees were being little surgical exposure and training.

The report recommended a change of clinical director within general surgery, with the new post-holder appointed from outside the department.

It said: ‘The dysfunctional consultant body has impacted decision making. The resolution required a change of clinical director.’

A spokesperson for Manx Care confirmed that the findings of the report had been accepted in full.

She said: ‘In March 2024, the interim Medical Director, Dr Marina Hudson, invited the Royal College of Surgeons to review Manx Care’s general surgery services.

‘The review visit took place in October 2024, and the report was received in July 2025 and accepted in full.

‘Following receipt of the report, the newly appointed Clinical Director for Surgery, Dr Peter Neville, started a programme of work to implement the recommendations.

‘Dr Neville’s work is fully endorsed by the Manx Care board and supported by the Divisional Director, Mr Ian Wright.

‘The work continues to progress, and staffing issues have been carefully addressed.

‘In all circumstances where disciplinary investigations are necessary regarding doctors, Manx Care follows the UK ‘Maintaining High Professional Standards’ framework and GMC Good Medical Practice guidelines.’

Asked whether the report had led to disciplinary proceedings, Manx Care’s spokesperson said they could not confirm details of confidential workforce matters. but could confirm that ‘appropriate actions were taken in line with policy’.