Health, Politics

Concerns over the External Review into the Health Service

This month Tynwald approved the following:

That Tynwald notes the financial pressures for the future delivery of Health and Social Care services, and supports:

a) The Council of Ministers commissioning and receiving an independent review to determine change options for service delivery and funding to provide a modern, fit for purpose healthcare system for the Island; and
b) That the Council of Ministers report to Tynwald by January 2019 with recommendations for the future of the Healthcare Service.

I have serious concerns about the nature of this review and could not support it, and thought to add some further explanation in addition to my speech.

In essence –

1) What health services we need

2) The quality of those services; and

3) How we fund those services

Are all intrinsically linked.

So on paper this review seems to make sense right?

Well there have been a raft of reviews and reports for the Health Department that have already addressed the first two points. We have a 5 year health and care strategy that is aiming to move us towards a more efficient and modern healthcare service that meets our Island needs and we are looking to establish an independent health regulator to pick up where the West Midlands Quality Review Service has started to address the quality of our services.

What we are lacking is a firm long term plan as to how we fund the Health and Social Care into the future.

So is now the time for another strategic review of service delivery (of what services we need) to layer on top of all the others? Or should we be focusing instead on implementing those strategies that are taking us in the direction that we all know we need to go – towards more care in the community, more integrated care and more digital services in health whilst at the same time reviewing how we pay for all this?

I firmly believe that we should be implementing the strategies and policies that address the first two points whilst at the same time starting to work on the best way of funding our health service (the third point). Essentially the Health Department should just be getting on with the job instead of just talking about it.

Interestingly this is also the review of the Public Accounts Committee who have just last week released a report into the overspend at Nobles Hospital.

This review doesn’t do that – it wants to put another layer of policy and strategy on top of what we already have and in the meantime the Health Department will be stuck in limbo, unable to act for fear the review will show their actions to have been wrong, premature or inappropriate. So we could easily be looking at another significant overspend next year simply because the Department is afraid to make decisions while the review is ongoing.

So because the Health Department already have a plan for 1) and 2) I tabled an amendment so that this review could focus on 3). This was not supported by Tynwald.

Instead Tynwald decided to support the review and the Terms of Reference outlined by the Treasury Minister in his opening remarks. So another layer and another report that will be added to the pile and I fear it will only gather dust on a shelf.

The Terms of this review were outlined in Tynwald at such speed I doubt Members really had any opportunity to take them on board. Worryingly included in these Terms of Reference were the following:

1) Is the assumption of health services being largely free at the point of use still valid for the future, and what sort of alternative regime might be appropriate for the Isle of Man?

2) Should this principle continue of free delivery and should the scope of what is free at the point of use be more restricted – for instance, could certain procedures be charged for or made available on a means-tested basis?

3) What alternative models to the current state-provided services exist, and how would the implementation of any other model impact on the sustainability of the quality of the services provided by the DHSC?

Most worryingly is that despite both myself and my colleague Dr Allinson asking the Treasury Minister to reaffirm his commitment to the core principles of the NHS, being that it remains free at the point of use and that services are provided to people based on their clinical need – he did not to do this.

The first two Terms of Reference above open the way to start dismantling the NHS as we know it, whilst the third paves the way for the wide ranging privatisation of services – something that the Treasury Minister has categorically not ruled out

I could not support any review of the NHS that as one of its core terms of reference is to look at whether or not services can remain free at the point of use. Yes we should look at funding, yes we should look at how we deliver services but we can’t abandon our principles simply because Treasury thinks they are expensive. That is the first step towards dismantling the NHS and we cannot let that happen.

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