A bold call for reform has been made by doctors on the Isle of Man, demanding a significant shake-up of management roles at Manx Care. The Isle of Man Medical Society (IOMMS) has proposed a radical 'streamlining' of management, advocating for a reduction of at least 60% in these roles. But here's where it gets controversial: they want these resources to be redirected towards clinical and clinical support positions, a move that could spark debate among those who prioritize administrative efficiency over direct patient care.
This proposal is part of the society's response to an independent review examining the relationship between the government's Department of Health and Social Care (DHSC) and Manx Care. The medical professionals have expressed concerns about the current governance structure and its impact on the healthcare system's effectiveness.
In their initial response, the IOMMS validated the findings of the review, stating that it confirmed long-standing issues raised by medical professionals regarding the governance capacity of Manx Care, a healthcare organization operating at arm's length from the government. They went on to say that the island's healthcare model, as it stands, is 'not fit for purpose' in light of the report's findings.
The doctors' group has now taken a step further, presenting a set of ambitious proposals on how Manx Care should be governed. These proposals have been circulated to Members of Tynwald, the island's legislative body.
In its release, the IOMMS emphasized the need for governance to focus on clinical leadership, transparency, and accountability within Manx Care. They have outlined a comprehensive governance model aimed at reshaping the oversight of Manx Care, decision-making processes, and the integration of clinical voices into the organization's structure.
One of the key changes proposed is a reorganization of the Manx Care Board. Under the new model, the chair and vice-chair would be elected Members of the House of Keys, bringing a more democratic element to the leadership. Additionally, non-executive membership would be adjusted to ensure a majority of roles are held by island residents, fostering a sense of local representation and accountability.
The executive representatives would include key figures such as the chief executive, chief finance officer, chief medical officer, and chief nursing officer, ensuring a balance between administrative and clinical expertise.
The document also suggests the creation of a statutory Professional Executive Committee (PEC), which would embed clinical and operational expertise directly into Manx Care's decision-making processes. This committee would provide a formal channel for frontline professionals to contribute to planning, quality improvement, and service redesign, ensuring their voices are heard and valued.
Membership of the PEC would be elected, a move the society believes is essential for professional and democratic accountability. The committee would include representatives from various clinical areas, operational managers, and even patient or community members, ensuring a diverse range of perspectives.
Subcommittees focusing on critical areas such as quality and safety, workforce and culture, finance and resources, and innovation would also be established, further strengthening the governance structure.
The PEC would provide quarterly reports to the Board, covering performance metrics, risk assessments, cultural indicators, and operational challenges, ensuring transparency and accountability.
The society argues that this governance structure, with its 'triangle' of accountability between the board, executive management, and the PEC, would foster a culture of improvement and support the delivery of safe and effective care within Manx Care.
To implement these changes, amendments to the Manx Care Act 2021 would be necessary. The IOMMS has expressed its willingness to work with the Isle of Man Government to develop a governance approach that enhances public confidence and improves patient outcomes.
This proposal presents an intriguing balance between administrative efficiency and clinical expertise, and it will be interesting to see how it unfolds and the discussions it sparks among stakeholders and the public.
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