Business Cases

AuthorityManx Care
Date received2025-02-20
OutcomeSome information sent but part exempt
Outcome date2025-04-07
Case ID4461137

Summary

The requester asked for business cases regarding children's therapy and respite services, and Manx Care disclosed minutes from an October 2024 review meeting discussing a revised business case for short breaks and residential services, as well as a patient engagement platform.

Key Facts

  • Manx Care disclosed minutes from an Extraordinary Business Case Review Group meeting held on 22 October 2024.
  • A revised business case for 'Children with Disabilities – Short Breaks and Residential Services' was discussed, noting current services are not meeting statutory requirements.
  • The meeting highlighted that future needs for children's respite services will result in a crisis if requirements expand without intervention.
  • A proposal for a 'Patient Engagement Platform' (Doctor Doctor) was reviewed to reduce appointment letters and DNA rates.
  • It was noted that strategic planning and direction are currently lacking for the children's services business case.

Data Disclosed

  • 22nd October 2024
  • 1.30pm
  • 1.50pm
  • 5 bedroom unit
  • item 155/24
  • item 156/24
  • Page 1 of 3
  • Page 2 of 3
  • Page 3 of 3

Original Request

Dear sirs Please provide copies of business cases (whether approved or not). For the following: - Childrens therapy including, speech and language, occupational therapy, physio therapy. - Childrens respite services

Data Tables (43)

No. ITEM Action
154/24 S Apologies Apologies were received from
155/24 Children with Disabilities – Short Breaks and Residential Services A copy of the revised Children with Disabilities – Short Breaks and Residential Services business case was circulated ahead of the meeting and taken as read. joined the meeting at 1.30pm. advised that this is a revised business case following feedback and additional discussions from the previous business cases presented. highlighted that the current needs for children within this cohort are not being met and the service is not meeting the statutory requirements. Agencies are also recognising the unmet need and data is currently being collated to present to Public Health to state the unmet need. A specific cohort of children have recently been stepped down as services are unable to accommodate various sessions and care has only been provided within respite services. Office space has recently been converted to accommodate a child.
The service is not currently in crisis but future needs will result in a crisis as the requirement for the service expands. highlighted that this item is stated within the mandate but no there is no service specification currently available, the mandate addresses that this is to be developed. advised that the initial business case was for residential accommodation but discussions offline altered the need and highlighted the requirement for project support, the business case has been revised to state residential setting and what is available to improve and enhance the service. advised that project development funding could be considered with this project for an analysis to be completed. It was acknowledged that business case are often drafted by individuals that do not hold the expertise required to develop various services, agreed as she has recently been involved with estate agents and attending property visits which is outside of her expertise. queried how the 5 bedroom unit aligns with the strategic vision for this service, advised that the Braddan Hub has bedrooms available and will need to be converted, and a strategic plan is not currently available. It was highlighted that it is difficult to progress and design a service without strategy and agreed direction of travel. advised that the organisation is discussing options to develop a clinical, practitioner lead social care strategy of which this could be included. It was noted that the previous direction for this business case was to discuss with Transformation but the need and direction has since changed. Strategic thinking and detail is required to progress this proposal, with involvement with multiple departments. suggested this be discussed further with in relation to the development of a wider strategic vision and discuss with offline to see what may be available in terms of project resource and additional guidance. left the meeting at 1.50pm
156/24 Patient Engagement Platform A copy of the Patient Engagement Platform business case was circulated with the meeting agenda and taken as read. joined the meeting at 1.50pm. declared a conflict of interest with this business case.
summarised the proposal presented which is to provide an online application to allow patients to access information and arrange appointments, reduce calls to PIC team for appointment rearrangements, reduce the DNA rate and costs involved with printing appointment letters and postage. The pricing provided within the business case is based on a market leader in the UK for this functionality, which has also been recommended by our current supplier. queried the options within the funding costs detailed and questioned the deployment costs, confirmed that the deployment costs for Doctor Doctor include the staff training element. highlighted that the data in relation to the cost of appointment letters does not include any cancellation and revised appointment letters, in addition suggested providing reminders by push notifications to reduce the volume of text messages. Doctor Doctor is there preferred option for current services, advised that the platform would overlap once Manx Care Record is in place. PMO requirements were queried, is confident that this can be accommodated within his office inclusive of the testing element. summarised and advised that:  request additional data from and enhance the letters costs detailed within the proposal.  Digital transformation fund is a potential funding source, which will require an additional template to be presented for capital costs but not the revenue. It was agreed that the proposal is supported to progress for digital transformation funding. left the meeting at 2.00pm
157/24 S Any Other Business No other business.
158/24 S Date of next meeting 6th November 2024 at 10.00am. The meeting concluded at 2.00pm.
BCDP title Augmentative and Alternative Communication (AAC) and Environmental Controls (EC) for Isle of Man Adults and Children
Care group Medicine & Urgent Emergency Care / Integrated Primary and Community Care
Service area Neurology / Stroke /Children’s Therapy
Author
Author job title General Managers
Date December 2022
1.Proposal summary
Everyone has the right to get the support they need to communicate, be understood and to reach their potential. Everyone has the right to live safely and independently within their home environments. Some people on the Isle of Man are currently being failed in that respect. Overview of current situation: There is currently no provision in place across the life span of individuals with a serious disability and neurological or progressive conditions living on the Isle of Man, who require support to communicate and/or to live independently and safely within their own homes. This has a devastating impact on their quality of life, their opportunity to access education, family life, & their community to thrive and develop. It will limit life chances and has potential to impact patients’ wellbeing and prognosis. Furthermore, it places undue distress and pressure on family members and on those who provide their care, including Health and Social Care Professionals within Manx Care. What is Augmentative and Alternative Communication? Augmentative and Alternative Communication (AAC) is the term used to describe methods of communication that can supplement speech and writing when they are impaired. Communication may be impaired due to physical speech difficulties, cognitive and language difficulties and this occurs in a wide array of diagnosis across all age ranges. (Appendix 1.) Speech is a powerful medium of identity, communicating mood, humour, geographical information, social and educational background, health status, gender - as well as the content of a message and being able to ask for help. To be able to communicate and have a voice is a basic human right. AAC is a range of provision determined from assessment. The highly specialist devices utilise computer technology accessed by eye tracking or switches activated with a small movement by a part of the body. Whereas the non-specialist low technology resources incorporate pictures or letter charts to support communication. What are Environmental Controls? Equally important to assist with daily living needs and wellbeing are Environmental Controls (EC). These systems enable remote access to many devices in the home for people with significant physical disabilities, who cannot use conventional equipment. EC devices may include a door entry or intercom for access, loud speaking hands free telephone, a call system to be able to seek urgent help, support control of media devices or lightening in the home or support access to a computer. Access to control these devices remotely supports independence, reduces reliance on others to be present at all times, & assists to maintain their safety and enhances the person’s participation in life. AAC and EC are vital with the complexity of patients’ impairment (complex physical/cognitive/language/sensory disability often in combination), as they overcome these barriers, to make communication and control of the home environment possible. AAC & EC services therefore necessitates specialist assessment, patient and carer training to maximize effectiveness of use, timely review and re-assessment of patients’ to account for progressive or changing presentation over time. The
Total population Total population Total population requiring Total population requiring
demand for AAC & EC specialist AAC & EC non specialist AAC & EC
(= 0.5% of total population) (10% of AAC & EC demand) (90% of AAC & EC demand)
88409 442 44 398
Total
population
Total Demography by age groups Total population requiring AAC Requiring Requiring non specialist AAC & EC
population by specialist AAC &
age groups EC
aged 0 to 4 5481 27 3 24
aged 5 to 24 21660 108 11 97
aged 0 to 24 27142 136 14 122
aged 25 to 90+ 61267 306 31 276
Total population
requiring AAC
Impairment Numbers Need Additional Information
Physical impairment (in mainstream) 3 EC Children with Duchenne Muscular Dystrophy or Cerebral Palsy. All are in mainstream and are verbal.
Physical impairment (in mainstream) 6 AAC Children with a progressive or static physical condition that results in poor intelligibility of speech, limits their expressive language or has resulted in delay.
Physical & Learning Impairment (specialist schooling) 7 AAC & EC This group of children have either a progressive/static condition and are non verbal and in specialist education c entres.
Developmental language Disorder 2 AAC
Autistic Spectrum Disorder 56 AAC We have approx 113 children with ASD in schools with 50% who may benefit from non-specialist AAC.
Total 74
In summary, the absence of Manx Care provision of AAC & EC is harming the quality of life, independent living and life chances of the Island’s most vulnerable. A lack of provision compromises patient safety. Limited and varied charitable support results in inequalities and inconsistencies of care. Patients are increasingly aware of what is available nationally and understandably get angry and upset when they are made aware that these are no AAC or EC services currently funded by Manx Care. Locally OT and SLT children and adult services lack the specialist expertise, resources and budget to develop and establish an AAC and EC services within existing staffing. AAC Service Standards: https://www.communicationmatters.org.uk/wpcontent/uploads/2019/02/aac_services_standard_aug_2012.pdf https://www.england.nhs.uk/wp-content/uploads/2018/08/complex-disability-equiptment-environmental-controls- all-ages.pdf
2. Benefits and expected outcomes
Benefits to patient Expected outcome Patients’ have a voice. Meeting patients’ basic human rights. Enabling patients’ to Supporting wellbeing, mental health and prognosis. live as independently as possible Commissioned service Patients’ will have improved service with the option to trial devices. offering assessment. Direct access to highly specialist skills and knowledge. Having local therapists Ensuring that the patients’/carers have knowledge and skills through to support after initial training to know how to effectively use AAC and EC in daily life. set up of AAC or EC. This may take various sessions to implement. Benefits to Manx Expected outcome Care Provision of an AAC and Provide service more aligned to that in the UK. EC services on island. Equity of access and provision across the life span. Reduce potential of litigation with no provision. Reduction of care needs that could be attributed to Manx Care. Commissioned Risk sits with this provider. assessment led service Implemented solution is overseen by experts in this field. There is availability of technical support when needed Commissioned service will oversee procurement, asset management, data cleansing, maintenance and replacement of devices. Commissioned services have greater buying power for cost efficiency. Commissioned service will have range of stock to offer trial of devices. Provision of local High quality and resilient service provision with addition of local staff. therapist to support Local staff can manage the ongoing implementation/training beyond the Commissioned service. initial set-up by commissioned provider. Local contact for fault finding. Staff would assist with implementation of non specialist AAC provision. Capacity building of expertise across the Manx Care workforce Increase to staff morale, retention.
Benefits to patient Expected outcome
Patients’ have a voice. Meeting patients’ basic human rights. Meeting patients’ basic human rights.
Enabling patients’ to live as independently as possible Supporting wellbeing, mental health and prognosis.
Commissioned service offering assessment. Patients’ will have improved service with the option to trial devices. Direct access to highly specialist skills and knowledge.
Having local therapists to support after initial set up of AAC or EC. Ensuring that the patients’/carers have knowledge and skills through training to know how to effectively use AAC and EC in daily life. This may take various sessions to implement.
Benefits to Manx Expected outcome
Care
Provision of an AAC and EC services on island. Provision of an AAC and Provide service more aligned to that in the UK.
EC services on island. Equity of access and provision across the life span.
Reduce potential of litigation with no provision.
Reduction of care needs that could be attributed to Manx Care.
Commissioned assessment led service Risk sits with this provider.
Implemented solution is overseen by experts in this field.
There is availability of technical support when needed
Commissioned service will oversee procurement, asset management, data
cleansing, maintenance and replacement of devices.
Commissioned services have greater buying power for cost efficiency.
Commissioned service will have range of stock to offer trial of devices.
Provision of local therapist to support Commissioned service. High quality and resilient service provision with addition of local staff.
Local staff can manage the ongoing implementation/training beyond the
initial set-up by commissioned provider.
Local contact for fault finding.
Staff would assist with implementation of non specialist AAC provision.
Capacity building of expertise across the Manx Care workforce
Increase to staff morale, retention.
Commissioned
assessment led service
Provision of local
therapist to support
Commissioned service.
Post WTE Salary
SLT Band 6 Children 0.6 £24,353
OT Band 6 Children 0.6 £24,353
Generic Assistant B4 1.5 £43,879
Commissioned Service for AAC and EC Provision AAC (Appendix 4 for breakdown of expected costs) Clinician service visits: £28,500 (inc. travel and accommodation) Tier provision of equipment Tier 1:£3620 per device, per year Tier 2:£1560 per device per year Tier 3: £360 per device per year
Commissioned Service for EC Provision EC: Clinical visits: £4,000 (predicted including travel and accommodation) Tier provision of equipment This is not possible to predict. Total known patients @ x £250 per patient
Total £157,557 clinician service Equipment provision The total patients predicted on Island is 442. 44 are most likely to require Tier 1 and the remaining 398 are most likely to require Tier 2 or 3. Costings based on predicted need and demand: Tier 1 44 x 3620 = £159,280 Tier 2 199 x 1560 = £310,440 Tier 3 199 x 360 = £71,640 Clinician service = £157,557 Clinician visits = £28,500 + £4,000 Grand total = £731,817 (based on predicted need) Year 1 costings based on actual known cases of 121 Tier 1 = 12 x 3,620 = £43,200 Tier 2 = 55 x 1560 = £85,800 Tier 3 = 54 x 360 = £19,440 AAC equipment total = £148,440 EC equipment total -121 x £350 = £42,350 Clinician service =£157,557 Clinician visits = 28,500 + 4,000 Grand total = £380,847 (based on current known need)
Post WTE Salary
Generic Assistant 4 2 £58,506
Commissioned Service for AAC and EC Provision AAC (appendix 4) Clinician service visits: £28,500 (inc travel and accommodation) Tier provision of equipment Tier 1:£3620 per device, per year Tier 2:£1560 per device per year Tier 3: £360 per device per year
Commissioned Service for EC Provision EC: Clinical visits: £4,000 (predicted including travel and accommodation) Tier provision of equipment This is not possible to predict.
Total £91,006 clinician service Equipment provision: The total patients predicted on Island is 442. 44 are most likely to require Tier 1 and the remaining 398 are most likely to require Tier 2 or 3. Year 1 costings based on current known cases of 121 Tier 1 = 12 x 3,620 = £43,200 Tier 2 = 55 x 1560 = £85,800 Tier 3 = 54 x 360 = £19,440 AAC total = £148,440 EC 121 x £350 = £42,350 Clinician service =£91,006 Clinician visits = 28,500 + 4,000 Grand total = £314,296 (based on current known need)
Benefit to Patients: • Receive a highly specialist care which offers a local on island assessment reducing need for patients to travel. Benefits to Manx Care: • This option is significantly less and therefore a cost efficiency. • Recruitment to generic assistant posts rather than qualified therapist as it is likely to result in greater potential candidates Concerns: • Manx Care would be solely reliant on Commissioned service, which add fragility to provision of care. • With no qualified staff in this option there is no opportunity for development of local knowledge and skills through joint working with Commissioned service. There is no local capacity to absorb this new service provision within existing staff. • This option maybe demotivating for existing qualified therapists, as they would not be involved in AAC or EC interventions their patients are receiving. The complex nature of these patients’ means they are likely to have multiple needs, and the local therapists would only be meeting some. • The draw back with this option is Manx Care will continue to have a deficit in qualified staff locally to support on non-specialist provision to patients. This would need to sit with the Commissioned service. • Having no qualified therapists working with the Generic Assistants, as would be typical, this would need to be handed over to Commissioned service. There is potential that the Generic Assistant would feel isolated with no local support. • This option has limitation in staffing resilience and no potential for cover. It is clinically therefore considered to offer the greatest clinical risk to Manx Care. Option 3 - do nothing Concern • This is viewed as a potential risk to effectiveness of patient care as fully evidenced in the body of this report and is therefore not a viable option. • Patients’ with complex and multiple impairments will continue to suffer and be disadvantaged. • Patients’ will have limited or no access to a voice when they are most vulnerable and at greatest need of being heard. • If we do nothing patient’s safety is put at risk – they cannot communicate and potentially in the event of something like a fire for example they could not do something as simple as call for help. • Doing nothing impacts staff morale and resilience - our staff are currently working in an environment where they feel it’s difficult to uphold Manx Care values because of the lack of resources they have in this area.
3. Estimated cost and proposed funding source
In order to deliver on the proposal we offer 3 options for consideration before making a recommendation. The costs are identified for ease of reading, within the options • Option 1 £157,557 clinician service only. Grand total of £380,847 for clinician service plus equipment provision based on actual and current known need.
• Option 1 £ 157,557 clinician service only. Grand total of £380,847 for clinician service plus
equipment provision based on actual and current known need.
Option 2 £ 91,006 clinician service only. Grand total of £314,296 for clinician service plus equipment
provision based on actual and current known need.
• Option 3 No upfront costs but with significant on-costs such as hospital episodes, bed days, unplanned
incidents, and residential and community care costs.
implementation which explores opportunities for further partnership working and input which meets disease specific needs. Timescales Period of adjustment from commencing the service, reviewing at an appropriate stage (12 months) Criteria for prioritising will sit with the Commissioned Service. As a measure of success, we would expect, within one year of commissioning this Service that: • Patient users audit will be completed to include Quality of Life questionnaire • Audit of care cost reduction where independence is improved with this technology ie what savings could be made in terms of return on investment, e.g. patients not being admitted to residential care and staying in their own homes longer • Audit of the carers supporting the individual e.g. School or respite facilities • Establishing accurate understanding and forecast of future demand and anticipated costs
4. What Board priority does the proposal fulfil? Patient Safety; workforce resilience and integration of services.
5. How does the proposal support the recommendations of the Independent Healthcare Review (i.e. decentralisation of services, integration of care)? This proposal supports the recommendations of the Independent Healthcare review in terms of providing all of the above. Sir Jonathan recommendations Recommendation 1: The Council of Ministers should formally adopt the principle that patients and service users are fully engaged in, and at the centre of, all aspects of planning and delivery of health and social care services. Recommendation 11: A service-by-service review of health and care provision, in conjunction with the needs assessment and an analysis of care pathway design, should be undertaken to establish what services can, should or must be provided on and off-Island, against defined standards. Where services cannot be provided safely or deliver best value by Island- based providers, the default position should be to seek services from third parties for delivery on-Island whenever possible and off-Island where necessary. Recommendation 12: Service by service integrated care pathways should be designed, agreed and delivered. These should encompass both on and off-Island components of clinical service models Recommendation 25: A fit for purpose workforce model needs to be developed to reflect the emerging needs of the new model of care. It should maximise the potential skills available within the workforce as well as the opportunity to recruit and retain high quality professionals. It will then increase the attractiveness of the Isle of Man as a career destination.
6. Will the outcome of No
this paper impact on
other IoM Government
Departments or
Statutory Boards? Will a
4. What Board priority
does the proposal fulfil?
5. How does the
proposal support the
recommendations of
the Independent
Healthcare Review (i.e.
decentralisation of
services, integration of
care)?
legislative policy
change be required?
7. Review/impact on other areas
Care Group Comments Reviewed by
Medicine, urgent
care, and
ambulance
service
Surgery,
theatres, critical
care, and
anaesthetics
Integrated
diagnostics and
cancer services
Integrated
women’s,
children’s and
families,
services
Integrated
mental health
services
Integrated
community and
primary care
services
Social care services Social care
services
Other
operational and
support services
e.g. digital,
operations,
communications,
infrastructure
etc.
8. Approvals
General Signature Date Date
Manager/Service
Lead
Mark Cox
Executive Lead Signature Date
BCDP title Children with Disabilities – short breaks and residential services
Care group Integrated Social Care, Mental Health & Safeguarding
Service area Children & Families – Children with Disabilities
Author
Author job title – Children & Families Services
Date 12/7/24
1.Proposal summary
There is currently a high level of unmet need in the Children with Disabilities (CwD) short breaks service. We currently do not have the capacity to meet the current or projected needs of this cohort of children and young people. The current waiting list for services is:- Setting Number Service waiting for Braddan Hub 9 After school Ramsey Respite 3 Overnight respite Centre 4 Outreach 2 Pre-school sessions 18 total The needs of the future cohort are forecast as being more complex with greater numbers.
2. Benefits and expected outcomes
The benefits of these proposals are that we will have a service that better meets the ongoing needs of the
Islands young disabled community. We will be able to provide much needed respite and outreach support to
those that most need this type of service. We will also have a facility to provide safe care in an appropriate
setting for children and young people who can no longer be cared for at home.
Rather than fitting them in to an existing provision that doesn’t particularly meet all of their needs and has a
significant impact on the wellbeing of others.
3. Estimated cost and proposed funding source
To meet the service levels needed of the current caseload of CwD with future needs factored in, a
3-pronged proposal with costings is outlined below:-
Element 1 – Outreach Service
The Outreach Service will provide flexible support to children with disabilities and their families.
This support is needs-led and can range from supporting children in the community or at home.
The service will provide a wide range of support and interventions to develop children and support
families to enable children and young people to meet their maximum potential and have a fulfilled
life. The provision will be bespoke to each individual young person and family, and will work
Setting Number Service waiting for
Braddan Hub 9 After school
Ramsey Respite Centre 3 Overnight respite
4 Outreach
2 Pre-school sessions
18 total
towards life skills, behaviour management within the home and community presence. Short breaks
and outreach come in many different forms especially where overnight or centre provision is not
for the individual.
Costs (staff costs include on-costs)
x1 Senior Residential Support Worker £54,950
X2 Residential Support Worker £96,750
Total staff costs £151,700
Vehicle for the service £125,000
Grand total £276,700
Element 2. Development of Braddan Hub into Residential centre, with extra respite provision
Braddan Hub currently provides after-school care for children with complex needs. This service is
outgrown by the needs of the current cohort, so this element proposed to develop the Hub into a
bed residential setting to add capacity to respite, and will provide care. ( this element does not
provide the costings for the minor adaptions to the hub for this ourpose)
Position FTE Payscale Hourly rate Annual No of Total annual
Cost positions cost
Centre Manager 1 35-38 1
Senior RSW 1 28-32 2
RSW 1 24-28 3
RSW waking night 1 24-28 2
Part time 25 hours 0.68 24-28 9
Part time 18.5 0.5 24-28 3
Sleep in 1
On call
Secretary 0.5 12-16 1
Total £708,620.14 £708,620.14
staffing
costs
Based on 2024 rates
Element 4 – Extra capacity in the CwD social work team to enable focus time and effective
work with the families
Adding another social worker will enable focus time and more effective work with the families
to take place. The team is currently stretched, supported by agency colleagues and currently
has an additional agency social worker contracted to assist with the heavy caseload.
Staff costs
1 social worker with on costs (pay band 21)
Grand total
Element 4 – engage a service lead to manage the short breaks and residential service
For a number of years he short breaks service has been an ‘add on’ to the manager of the
children’s with disabilities Social Work team. As a result of this there has not been a key person to
develop and move the service forward, or to ensure that the service is running in an efficient or
productive way. It has just been continuing to work in the same way that is now not productive for
the ongoing and future needs.
This post will ensure that there is appropriate oversight, monitoring and future planning for the
whole service to enable it to develop the services to meet the current need and projected need for
the island community.
Staff costs
1 service lead (with on costs) – pay band 25
Grand total
This element is long term and aspirational and we will need to start to plan for this 2025/26
Element 5. Identification of 5 bed residential setting for children with disabilities
Should the future needs continue on the current trajectory of growth, service users and families would
benefit from a residential setting for children with disabilities who can no longer reside at home. There
is not current provision of this type on Island yet, parents of children with complex needs have to
manage with the current offering of respite, which is stretched. A number of these parents are suffering
with carer burnout, with some reaching the end of their tethers and becoming unable to cope before
their children transition to Adult Social Care where residential services for complex needs are available,
albeit also stretched. We do have a number of families who have given us prior warning that they will
require residential provision for their child before they attain adulthood
Costs for this provision are estimated as follows:-
Staff costs
To be determined – this will depend on more in- £ £
depth evaluation of the cohort of younger children
with complex needs
Building costs
To be determined when building is identified to £ £
include refurbishment
A 5 bed residential based on similar figures of a £650,000 £400,000
provision in Liverpool is £650,000 per year with an
additional set up cost of £400,000
Grand possible total £ 1.6 million
Once the need for this type of service is fully scoped out and costed, a more in-depth case will be brought to
BCRG. This is intended as long-term notice of the projected future need.
Options Appraisal
The options are:-
1. Do nothing and continue with the services as they currently are. This is not a tenable situation,
as the service does not meet the needs of the Island, the cohort of children and young people
and their families. It would also be contrary to the findings of the Ofsted inspection and
resulting action plan and the work of the Children’s Services Improvement Board, as well as the
findings of the Short Break Services Review and the Sir Jonathan Michael report
recommendations.
2. The option of partly implementing the proposals would not be viable as it would not solve the
current problem of available resources and capacity across existing provision in an holistic and
realistic way. The service would not be future-proofed.
3. Funding be approved to implement 1-4 elements of the proposal, thereby starting to build
a sustainable and future-proofed service that meets the needs of this cohort of young people
and supports their families.
Recommendation – BCRG are asked to approve elements 1-4 of the proposal. There has been a significant
number of complaints made by families and professionals over the past 18 months, regarding the lack of
availability of services that are leaving families in crisis. This has caused reputational damage to Manx Care
as well as some legal challenge regarding Manx Care not providing services which caused us to be in breach
of the Equality Act 2017. The financial risk to the organisation is great as we are having to look off island to
provide residential provision for children, and for one young person in particular we have had to
commission an agency to provide in house care for her at home. The agreement to these proposals and
consideration to the longer term proposal 5 will be a spend to save initiative in terms of the reduction of
children coming into care in crisis, whereby we have to reduce the offer to existing families in response to
the crisis. Where we do have to bring these children and young people in then we will have an on island
provision thereby reducing the need to place off island or reduce the current provision to families. We will
also be able to meet the current and growing needs of children who require these services.
4. What Board priority does the proposal fulfil? 4. What Board priority does the proposal Please provide information, particularly which specific priority area the request is fulfilling as per the Required Outcomes Framework: Top priority is ‘provision of high quality care for our patients and service’ with 3 key areas in focus: 1) Improving patient safety 2) Creating a positive working culture
fulfil?
£650,000
£400,000
3) Improving financial health Improving service user safety. Given that Manx Care is not able to currently meet the needs of these children and young people, the extra capacity and service across short breaks would significantly increase their overall wellbeing and help to reduce the need for them to come into care permanently, Improving financial health. The proposals form a cohesive preventative measure, to help support families and young people and help to prevent them requiring crisis intervention or costly in-house or commissioned residential care in future.
5. How does the proposal support the recommendations of the Independent Healthcare Review (i.e. decentralisation of services, integration of care)? Integration of care is about placing patients at the centre of the design and delivery of care. It leads to better outcomes for patients, safer services and improved patient experience, and can also act as an enabler of more cost effective care The proposal supports the findings from the Ofsted report that determined that we are not meeting the needs of the children on Island who have a disability:- “Provision for disabled children is limited and as a consequence many children and their families do not receive the necessary help or support. Consequently their needs are not fully met’ services for disabled children need to improve.” ”Disabled children receive a very inconsistent service, and for many the service does not meet the needs of these very vulnerable children despite the best efforts of the workers in the service.” “Too often the interventions and services that disabled children need are either not available or are restricted in availability, which means services have to be prioritised, resulting in delay for children receiving support. This has a detrimental impact on too many disabled children, meaning their needs are not sufficiently met or only met when they have escalated to a point of crisis.” The proposal also supports recommendations 19 and 25 of the Sir Jonathan Michael Review:- “Increases in funding for health and care will be required to support the increased demands that will be placed on
5. How does the proposal support the
recommendations of the Independent
Healthcare Review (i.e. decentralisation
of services, integration of care)?
those services due to demographic changes, non- demographic changes and inflation.” “A fit for purpose workforce model needs to be developed to reflect the emerging needs of the new model of care. It should maximise the potential skills available within the workforce as well as the opportunity to recruit and retain high quality professionals. It will then increase the attractiveness of the Isle of Man as a career destination.”
6. Will the outcome of this paper impact on other IoM Government Departments or Statutory Boards? Will a legislative policy change be required? Please provide detail and likely impact No legislation or policy change is required in relation to these proposals and they will not impact negatively on other service areas. This proposals will ensure that we are meeting the needs of the current and future cohorts of young people that require short breaks or residential care in the future. The proposals regarding outreach will reduce the need for crisis intervention and the situation we are increasingly finding ourselves in whereby we either cannot offer short breaks or we have to step down families because we are dealing reactively to crisis.
6. Will the outcome of this paper impact
on other IoM Government Departments
or Statutory Boards? Will a legislative
policy change be required?
7. Review/impact on other areas
Care Group Comments Reviewed by
Medicine, urgent care and ambulance service Medicine, urgent
care and Agreed with updated costs
ambulance service
Surgery, theatres, critical care and anaesthetics
Integrated diagnostics and cancer services
Integrated
women’s,
children’s and
families services
Integrated mental health services Integrated mental
health services
Surgery, theatres,
critical care and
anaesthetics
Integrated
diagnostics and
cancer services
Integrated
community and
primary care
services
Social care services Social care services
Tertiary
Care/Strategic
Partnerships
Other operational and support services e.g. digital, operations, communications, infrastructure etc. Other operational
and support
services e.g. digital,
operations,
communications,
infrastructure etc.
8. Approvals
General Manager/Service Lead Signature Date
Executive Lead Signature Date

Full Response Text

Page 1 of 3

Extraordinary Business Case Review Group Tuesday 22nd October 2024 1.30pm MS TEAMs Present:

Head of Strategic Partnerships (Chair)

Finance Business Partner

Head of Contracts

Deputy Chief Information Officer

Programme Office Manager

Interim Director for People

Executive Director of Operations

Invitees:

Assistant Director of Children & Families (item 155/24)

Chief Clinical Information Officer (item 156/24)

Secretary:

(Minutes)

No.

ITEM Action

154/24 S Apologies

Apologies were received from

155/24 Children with Disabilities – Short Breaks and Residential Services

A copy of the revised Children with Disabilities – Short Breaks and Residential Services business case was circulated ahead of the meeting and taken as read.

joined the meeting at 1.30pm.

advised that this is a revised business case following feedback and additional discussions from the previous business cases presented.

highlighted that the current needs for children within this cohort are not being met and the service is not meeting the statutory requirements. Agencies are also recognising the unmet need and data is currently being collated to present to Public Health to state the unmet need.

A specific cohort of children have recently been stepped down as services are unable to accommodate various sessions and care has only been provided within respite services. Office space has recently been converted to accommodate a child.

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The service is not currently in crisis but future needs will result in a crisis as the requirement for the service expands.

highlighted that this item is stated within the mandate but no there is no service specification currently available, the mandate addresses that this is to be developed.

advised that the initial business case was for residential accommodation but discussions offline altered the need and highlighted the requirement for project support, the business case has been revised to state residential setting and what is available to improve and enhance the service.

advised that project development funding could be considered with this project for an analysis to be completed. It was acknowledged that business case are often drafted by individuals that do not hold the expertise required to develop various services, agreed as she has recently been involved with estate agents and attending property visits which is outside of her expertise.

queried how the 5 bedroom unit aligns with the strategic vision for this service, advised that the Braddan Hub has bedrooms available and will need to be converted, and a strategic plan is not currently available.

It was highlighted that it is difficult to progress and design a service without strategy and agreed direction of travel. advised that the organisation is discussing options to develop a clinical, practitioner lead social care strategy of which this could be included.

It was noted that the previous direction for this business case was to discuss with Transformation but the need and direction has since changed. Strategic thinking and detail is required to progress this proposal, with involvement with multiple departments.

suggested this be discussed further with in relation to the development of a wider strategic vision and discuss with offline to see what may be available in terms of project resource and additional guidance.

left the meeting at 1.50pm

156/24 Patient Engagement Platform

A copy of the Patient Engagement Platform business case was circulated with the meeting agenda and taken as read.

joined the meeting at 1.50pm.

declared a conflict of interest with this business case.

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summarised the proposal presented which is to provide an online application to allow patients to access information and arrange appointments, reduce calls to PIC team for appointment rearrangements, reduce the DNA rate and costs involved with printing appointment letters and postage.

The pricing provided within the business case is based on a market leader in the UK for this functionality, which has also been recommended by our current supplier.

queried the options within the funding costs detailed and questioned the deployment costs, confirmed that the deployment costs for Doctor Doctor include the staff training element.

highlighted that the data in relation to the cost of appointment letters does not include any cancellation and revised appointment letters, in addition suggested providing reminders by push notifications to reduce the volume of text messages.

Doctor Doctor is there preferred option for current services, advised that the platform would overlap once Manx Care Record is in place.

PMO requirements were queried, is confident that this can be accommodated within his office inclusive of the testing element.

summarised and advised that:
 request additional data from and enhance the letters costs detailed within the proposal.
 Digital transformation fund is a potential funding source, which will require an additional template to be presented for capital costs but not the revenue.

It was agreed that the proposal is supported to progress for digital transformation funding.

left the meeting at 2.00pm

157/24 S Any Other Business

No other business.

158/24 S Date of next meeting

6th November 2024 at 10.00am.

The meeting concluded at 2.00pm.

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 4461137 2 April 2025

Dear

We write further to your request, received 20 February 2025, which states:

"Dear sirs

Please provide copies of business cases (whether approved or not). For the following:

  • Childrens therapy including, speech and language, occupational therapy, physio therapy.

  • Childrens respite services"

Our response to your request is as follows: I have enclosed copies of the information.

Response Please see attached documents in relation to this FOI request. s25(b)(i)&(ii) • While our aim is to provide information whenever possible, in this instance we are unable to provide some of the information you have requested because it is absolutely exempt under section 25 of the Act (absolutely exempt personal information). The reasons why that exemption applies are that: • The Manx Care is satisfied that the information amounts to personal data of which you are not the data subject; and • The Manx Care is satisfied that disclosure of the information would contravene one of the data protection principles as set out at Article 5 of the General Data Protection Regulation as it applies in the Isle of Man pursuant to the Data Protection (Application of GDPR) Order 2018, namely that the Manx Care can only disclose the information where it would be fair, lawful and meet one of the conditions for lawful processing in Article 6 [or if you are dealing with sensitive personal data “and one of the conditions in Article 9 of the GDPR and Schedule 2 of the Implementing Regulations is met”] and in this case, none of those conditions have been met therefore names have been redacted.

Please quote the reference number 4461137 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im. Should you have any queries concerning this letter, please do not hesitate to contact me. Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely

BUSINESS CASE DEVELOPMENT PROPOSAL

1

BCDP title Augmentative and Alternative Communication (AAC) and Environmental Controls (EC) for Isle of Man Adults and Children Care group Medicine & Urgent Emergency Care / Integrated Primary and Community Care Service area Neurology / Stroke /Children’s Therapy Author

Author job title General Managers Date December 2022

1.Proposal summary

Everyone has the right to get the support they need to communicate, be understood and to reach their potential. Everyone has the right to live safely and independently within their home environments. Some people on the Isle of Man are currently being failed in that respect.

Overview of current situation: There is currently no provision in place across the life span of individuals with a serious disability and neurological or progressive conditions living on the Isle of Man, who require support to communicate and/or to live independently and safely within their own homes. This has a devastating impact on their quality of life, their opportunity to access education, family life, & their community to thrive and develop.
It will limit life chances and has potential to impact patients’ wellbeing and prognosis. Furthermore, it places undue distress and pressure on family members and on those who provide their care, including Health and Social Care Professionals within Manx Care.

What is Augmentative and Alternative Communication? Augmentative and Alternative Communication (AAC) is the term used to describe methods of communication that can supplement speech and writing when they are impaired. Communication may be impaired due to physical speech difficulties, cognitive and language difficulties and this occurs in a wide array of diagnosis across all age ranges. (Appendix 1.) Speech is a powerful medium of identity, communicating mood, humour, geographical information, social and educational background, health status, gender - as well as the content of a message and being able to ask for help. To be able to communicate and have a voice is a basic human right. AAC is a range of provision determined from assessment. The highly specialist devices utilise computer technology accessed by eye tracking or switches activated with a small movement by a part of the body. Whereas the non-specialist low technology resources incorporate pictures or letter charts to support communication.

What are Environmental Controls? Equally important to assist with daily living needs and wellbeing are Environmental Controls (EC). These systems enable remote access to many devices in the home for people with significant physical disabilities, who cannot use conventional equipment. EC devices may include a door entry or intercom for access, loud speaking hands free telephone, a call system to be able to seek urgent help, support control of media devices or lightening in the home or support access to a computer. Access to control these devices remotely supports independence, reduces reliance on others to be present at all times, & assists to maintain their safety and enhances the person’s participation in life.

AAC and EC are vital with the complexity of patients’ impairment (complex physical/cognitive/language/sensory disability often in combination), as they overcome these barriers, to make communication and control of the home environment possible. AAC & EC services therefore necessitates specialist assessment, patient and carer training to maximize effectiveness of use, timely review and re-assessment of patients’ to account for progressive or changing presentation over time. The BUSINESS CASE DEVELOPMENT PROPOSAL

2

AAC & EC devices will require asset management and ongoing maintenance, repair or replacement with advances in technology or software. The absence of AAC and EC provision on the Island inevitably creates significant health inequalities and poor patient outcomes for residents, in comparison to those living with the same conditions in UK. AAC & EC services needs have been highlighted in the UK with political lobbying, resulting in there now being 20 EC services and 17 AAC covering England https://assistivetechnology.org.uk/#aac-services (Appendix 2 North west providers)

This business case looks to demonstrate the importance of AAC and EC provision and aims to highlight the risks and impact of sub-optimum care to the individual, their families, to Health and Social Care Professionals and to reputation of Manx Care. The business case will set out a plan to address this significant gap in services; a plan which seeks to meet both current and future needs like specialist equipment services do in UK.

Background: In March 2022, an AAC And EC Working Group was formed. Membership consists of Health and Social Care Professionals from Manx Care, Education Leads and Third Sector Partners. The Working Group committed to understanding the current provision, its challenges and impact with an aim to develop and present a workable solution which met the existing and future needs of IOM citizens requiring these specific services. As part of this programme of activity, the Third Sector Partners were asked what provision and support they currently offer and to indicate how sustainable this support was.

Below is an overview of this feedback which evidences the limitations, inconsistencies and fragility of the current arrangement: • Huntington’s disease association IOM – will provide grants, not means tested, no upper limit but cannot offer specialist assessment and review of needs or specific equip

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