The architect of a major reform of the Manx NHS says good progress has been made but the challenges faced are even bigger than he anticipated.

Sir Jonathan Michael’s landmark review led to the setting up of Manx Care, which took over responsibility for the delivery of health and social care services at arm’s length from the Department of Health and Social Care from April last year.

His progress report on the transformation programme will be laid before next week’s Tynwald sitting.

He says he is pleased with the progress that has been made so far in many aspects despite the impact of the Covid pandemic - but admits there are some areas where there is much more work still to be done. Sir Jonathan states: ’Manx Care has made a determined and effective start but the size and number of challenging issues it needs to address was even larger than I anticipated and it will take time and resource to resolve them all.’

He says that while he envisaged that delivery of the necessary changes would be challenging and time consuming, he did not anticipate the arrival of a global pandemic and its ’significant ramifications’.

Outlining areas where good progress has been made, he cites the moving of the Public Health Directorate from the DHSC to the heart of government in the Cabinet Office.

He said it has played a key role in the handling of the pandemic and is in a better position to influence and advise the government on policy.

Hailing the establishment of Manx Care, Sir Jonathan says the new body has ’undoubtedly inherited a challenged service’ - the challenge heightened by Covid’s impact on costs, staffing and other aspects of service delivery.

He said the new leadership team has been able to generate a ’palpable sense of excitement and opportunity’.

’Whilst the governance, delivery structures and processes need to develop further, I can already see the clear intent and early achievement in improving the culture and performance of the organisation,’ he says.

’There is a lot to do in this regard and it will take time and perseverance to identify and resolve all the areas that need addressing.

’I have, however, been very encouraged by the first six months of Manx Care’s existence.’

He says that while there are encouraging signs that the relationship between the DHSC and Manx Care could develop into a collaborative and productive one, ’it is early days, and time will tell as to how easy it is for the parties, including politicians and the department itself, to sustain the principles of separation’.

Sir Jonathan welcomed the appointment of the Care Quality Commission as independent inspector of publicly funded health and care services.

Turning to areas where there has been less improvement than he had hoped, he highlights unsatisfactory progress towards greater data availability, data accuracy and information governance, including data sharing.

’The integrated Manx Care record seems as far away as ever,’ he notes.

He says the Care Pathways and Service Delivery Transformation project has been particularly hit by a shortage of clinical and managerial staff due to their need to focus on the Covid pandemic and by the travel restrictions.

And Sir Jonathan concludes in his report: ’There is a high price to pay for inefficiency and poor service delivery.

’Thus, it is crucial for key policy and difficult operational decisions to be taken swiftly to enable timely service improvement and financial sustainability.

’Costs will continue to be higher than necessary (due to historic inefficiency, poor practice and poorly negotiated contracts with off-island providers) unless and until these issues are addressed.’