Following the unveiling of the Isle of Man Government’s Budget for 2013/14, the Department of Health is highlighting the challenges that lie ahead for the Island’s Health Service. Despite the Department receiving a budget increase of around 2.5% for 2013/14, the growing demand for health care services, inflationary pressures, and the developments in health care provision – such as new drugs and treatments – means that difficult decisions will likely need to be made in the months and years ahead; and this may need to include considering of how the Island operates its current model of a state-funded health service.
The Department of Health began a comprehensive programme to review services and improve overall efficiency in 2006, and to date has saved in excess of £8 million. However these gains have largely been consumed by inflation, new treatments, and growing demand.
Minister for Health, David Anderson MHK said: “The Department has been fortunate to receive a budget increase for the forthcoming year. The Department is continuing work to deliver further efficiencies where possible, but there will likely come a stage where the sustainability of how we operate our present model of health care may need to be examined. The Isle of Man, like the UK, is practically unique in providing a completely state-run health service – even similar jurisdictions such as Guernsey and Jersey operate a notably different system to that found here and in the UK. Despite a three-fold increase in NHS spending in the UK, hugely significant health care challenges remain, highlighted only this week in a report by the Lancet, comparing the outcomes of the UK’s health care system with those of European neighbours. ‘Grasping the nettle’ of the funding pressures and examining the sustainability of our own model is something we cannot afford to shy away from. That is not to say that this will necessarily see a wholesale change to the Island’s state-funded health care system; but options such as the level of charges, funding models, and the scope of certain services may all need to be reviewed.”
With the debate concerning the sustainability of state-funded health care, both in the Isle of Man and in the UK, it’s prudent that the Department examines how its costs are incurred; whether the ways in which particular services are delivered and provided remains appropriate, and whether there is scope for alternative delivery methods. Financial and resource imperatives, together with the need for ever improving efficiency, are likely to drive such changes.
Pressures are intensified by increasing demand. Many of the public will be aware of concerns around lifestyle choices – being overweight, not taking enough exercise, smoking, or drinking too much – and the impact these choices have on a person’s health and the costs incurred by the Health Service. This throws into focus the significance of both preventative medicine and health education.
Examples of growing demand include an increase in total referrals to Noble’s Hospital of 5% between April 2010 and September 2012, addressed with various efficiency measures over the same period to increase capacity for elective admissions by 15%. Between 2010 and 2011 pathology activity for just clinical chemistry tests alone saw an increase of over 6,000 tests a year. Radiology work has risen from a total of 55,332 procedures for 2007 to 68,618 in 2012 – an increase of over 18,000 new procedures without increased headcount being provided. Introducing self-referral for physiotherapy – which has eliminated the waiting list – has increased capacity by 69% compared to the former appointment system.
Just one example of the work to address the pressures facing the Health Service will be seen at the March sitting of Tynwald where the Department will present proposals to change the age for entitlement to exemption from dental and prescription charges so as to be in line with state pension age. Further, virtually 90% of prescriptions issued each year are to persons who, in some way, are exempt from prescription charges. The Department will be examining the present arrangements concerning exemption from prescription, and other charges, to establish whether this remains a viable situation. The Department will also be considering the level of charges themselves and the current arrangements that apply in terms of services such as dentistry and ophthalmology.
The Minister added: “The wellbeing of all of those in our community remains an extremely high priority for the Government, and the public can be assured that we will continue to do all that we can to maintain an effective state-funded National Health Service in the Isle of Man. The Department also has a stretching ten year strategy to deliver, which is aimed at improving services and the overall health of the population. But given the fiscal challenges facing the Island and with Health Services accounting for such a sizeable portion of Government’s overall spend, the Department of Health cannot be seen – and is not seen – as a sacred cow. Work to examine the scope of the Island’s Government will of course therefore include Health Services which will afford the Department an opportunity to further review services, in conjunction with the whole of the Isle of Man Government. This exercise will undoubtedly help to focus minds on prioritising services – both for government as a whole and for the Health Service.”
Beyond 2013/14 there will likely be revisions to, and evolution of, health care delivery – though this would simply reflect a long history of change – as the Department strives to balance the maintenance of an effective and efficient health service with the reality of financial and resource limitations.