Manx Care’s financial plight has put into sharp focus the strains evident in the island’s healthcare model - and whether it can really ever operate at arm’s length from government.

The organisation’s chief executive Teresa Cope could not hide her frustration at how the Manx Care board had been ‘undermined’ by 11th hour decisions taken by politicians.

‘I’ve been put in an incredibly difficult position,’ she told Isle of Man Today.

As recommended by Sir Jonathan Michael’s report into healthcare reform, Manx Care was set up in 2021 as an independent organisation working at arm’s length from government to deliver health and social care services.

But with costs and the demand on services spiralling, and funding never sufficient to meet its mandate, the cracks in the model are now showing.

On January 9, the Manx Care board approved a raft of measures which included reducing elective care both on and off-island. This was to ensure it didn’t exceed a £15m overspend.

These measures were due to be announced in mid-January to staff, clinicians and members of the public ahead of their implementation on February 1.

But then the Department of Health and Social Care (DESC) effectively vetoed the plans - and the planned announcement was shelved.

Then at the 11th hour, Treasury unexpectedly gave the go-ahead for Manx Care to exceed its spending by around £800,000 so that it could reinstate routine outpatient activity on the island as well as some operations.

Ms Cope said: ‘I had a clear instruction from my board. We were all ready to go. I would have wanted to communicate this much sooner in a much clearer way and give as much reassurance to the public as possible. Any reductions in services are anxiety provoking for the public.

‘On behalf of Manx Care, I want to extend an apology to patients.’

She added: ‘I’m attempting to work collaboratively with our politicians and our public but I’m afraid it has backfired on Manx Care, and I feel it has personally backfired on me, she said.

‘There’s a debate around whether there’s an opportunity for the department to veto those plans. I would suggest it’s not. Manx Care has to be able to make those plans in order to balance our finances.

‘The public will know how much scrutiny there is on the Manx Care finances, and we are being asked to ensure that we do not breach those financial limits.

‘This was a very difficult decision to make and made much, much worse by not having the department allowing us to communicate it in the way we would want at the time we would want.

‘I’ve been put in an incredibly difficult position where we have been seeking an agreement to proceed with this but have not managed to be given the permission.

‘At the absolute 11th hour, suddenly the agreement to spend more money was allowed which means the decisions Manx Care have made have been undermined but actually that decision could have been made four weeks ago.’

The cuts would have been significantly worse if the board had been allowed to proceed because they would have included on-island treatment.

‘It’s all come rather late in the day, but Manx Care had to make those difficult decisions in order to hit the control total,’ Ms Cope said.

Asked whether this suggests the whole Manx Care model doesn’t work, she replied: ‘We all have to work collaboratively, and I recognise that what Manx Care does has an impact on government and vice versa.

‘However, because of this perpetual issue around the costs of healthcare, do I prioritise the budget and meeting those financial targets or do I continue to treat patients? I can’t do both.’

Much of Manx Care’s woes are tied up with the costs of off-island treatment, much of that spending on unplanned emergencies. The total this year is £32m, which is a significant part of the organisation’s budget and a significant overspend.

Incredibly, the organisation does not have, and has never had, any contingency funding.

Savings of around £750,000 were made following measures announced in October which resulted in off-island treatment for some 200 patients being delayed until the new financial year.

Actions announced last week go deeper, with UK hospitals asked not to treat routine cases that were listed. This excludes urgent, cancer, and time-critical surgeries and out-patients.

The move will affect 60 patients and around 600 overall, including outpatient follow-up appointments.

This is expected to create savings of between £750,000 and £1m - but does not reduce the £15m overspend, only stopping it from growing even larger.

Without the savings announced last week, the overspend could have risked ballooning to £17m or £17.5m.

Ms Cope insisted that the planned reductions are not linked to the doctors’ pay award which is costing the NHS and extra £2.2m.

Funding for the extra percentage increase which secured the settlement is coming from the DHSC, not from Manx Care’s budget.

She acknowledged that the savings were a short-term action, the only benefit of which is to reduce Manx Care’s overspend.

‘Having made an investment in waiting list reduction, this is not a position we would want to be in where we are effectively putting an eight-week delay in surgery,’ she said.

Ms Cope that 2025-26 will signal some very significant changes to the way healthcare will be delivered.

She explained: ‘Manx Care will not allow itself to be in a position where we are being asked to deliver certain services, but we haven’t got the budget to do it.

‘The mandate that we’ve been given is unaffordable - it does not match the budget that we have been given. Something has got to give.’

She said that healthcare systems across Europe were facing similar challenges with funding amid ever increasing demand on services.

‘It can be a bit of a bottomless pit,’ she admitted.

‘However, what we are attempting to do is make sure we are clear with the public moving forward about what the budget buys.’