Presentations or Briefings from Manx Care to the DHSC

Summary

The request sought presentations and briefings between Manx Care and the DHSC from January to February 2025, resulting in the disclosure of documents detailing the 2025-26 Mandate and Operating Plan, though some information was withheld under exemptions.

Key Facts

• The DHSC and Manx Care held Board to Board Roundtables on 8th and 14th January 2025 to discuss the 2025-26 Operating Plan.
• Key priorities for 2025-26 include fully integrated health services, early intervention, and maintaining spending within a £357m financial envelope.
• Manx Care is tasked with reconfiguring service delivery to drive efficiency, including slowing elective activity and exploring alternative care models.
• Challenges identified in the planning process include governance autonomy, data availability, workforce culture, and statutory compliance timelines.
• The final Operating Plan was targeted for completion in the week commencing 20th January 2025, with operational delivery ready for 1st April.

Data Disclosed

• 1st January 2025
• 1st February 2025
• 8th January 2025
• 14th January 2025
• 20th January 2025
• 1st April
• £357m
• 2025-26
• 58 pages
• 4 documents

Original Request

Please provide copies of any presentations or documents used at briefings between Manx Care and the DHSC - from the 1st January 2025 to the 1st February 2025

Data Tables (1)

Data Tables (reformatted)

Full Response Text

Mandate and Operating Plan 2025-26 Board to Board Roundtable 8th January 2025 Key Principles and Decisions - DHSC Priorities remain unchanged for 2025-26:- 1. Fully integrated health and care services 2. Early Intervention, Prevention and Childhood Experience 3. Safe, Appropriate and Consistent Care 4. Planning for Future Population Needs 5. Governance, Compliance and Accountability Ministerial statement setting out key areas of focus: - • Spending within the allocated financial envelope; • Consistency, availability and accessibility of services in primary care; • Modernising models of service delivery in mental health; and • Supporting services to keep people in their homes for as long as is safely possible. DHSC – Risk Appetite 1. Removal of Cross-Government Funding Pressures from baseline 2. Manx Care autonomy to reconfigure service delivery to drive efficiency/productivity 3. Transformation Shift from SJM Recommendations 4. Income Generation 5. Partnerships and Different Models of Delivery 6. Investment and significant shift in service provision All Care Groups requested to consider their proposed budgets against the following; 1: Essential and Efficient Services • Goal: Determine which services deliver meaningful outcomes and reduce or phase out those with limited benefit. • Considerations: Identify services with minimal impact, focusing on population health, health equity, and data-driven efficiency improvements. 2: Service Cessation – What Can Be Stopped • Goal: Assess activities that can be stopped without clinical consequence, considering potential revenue from services that could be charged. • Considerations: Clarify the impact of service cessation on population health, waiting times, and overall clinical outcomes. 3: Alternative Service Delivery • Goal: Explore innovative pathways to deliver services effectively, including virtual, local, and multidisciplinary care options. • Considerations: Review off-island contracts, reduce unnecessary diagnostics, and assess outpatient models for potential savings. Maintain quality and safety parameters in all we provide; • Clinical & Care Strategy, Clinical Pathways, Home First, Hospital at night • Speak Up for Safety & Act, Everybody’s business • Professional Standards & Behaviour, commitment to Colleagues Manx Care – Operating Plan Development Session Aims • Understand the work to date and steps taken to reach draft documents • Acknowledge the challenges and constraints and where further detail is required • Highlight and discuss key recommendations around service delivery for 2025-26 to drive detail for further reiteration of the documents Challenges/Constraints in work to date • Governance – Manx Care autonomy • Data/Information - Financial • People – Culture • System Capacity – Focused delivery • Time – statutory compliance Budget Allocations 2025-26 And ongoing costing work Budget Allocations 2025-26 Cash out delivery;- • Procurement • Workforce • Slow down elective activity (working further detail) • "Left-shift" (remove hospital costs) Enhanced Productivity and Efficiencies;- • GIRFT • Job Planning (consultant, community nursing, therapists etc.) • Eligibility and Charging (Prescriptions) Manx Care Operating Plan = Delivering Core Services Efficiently Manx Care Operating Plan = Delivering Core Services Efficiently Services Reconfiguration;- • Outcomes focus • Alternative care models – Partnerships • Alternative service delivery – Third Sector Manx Care Operating Plan = constraining Core Services • Elective Care – *working on data • Transformation – efficient, outcomes, affordability • Regulatory Bodies inspection recommendations • Policy decisions • Parliamentary recommendations Key Questions • Do we have the detail to be assured that what is planned does not exceed £357m? • Delivery – are we assured we can deliver what is planned? What needs to start now, what needs to be built into the forecast for partial saving/efficiency? • Measuring - how will we know we are meeting our objectives?
Timeline Mandate and Operating Plan ➢Next Roundtable = 14th January ➢Final Operating Plan = w/c 20th January Operational Detail and delivery = ready for 1st April ➢Fortnightly meetings with care groups and clinicians ➢4 Workshops February/March Questions ?

Mandate and Operating Plan 2025-26 Board to Board Roundtable 14th January 2025 Recap • Documents - Operating Plan (Executive Summary circulated) • Ongoing constraint around financial detail and timings • Continuing "exam question": Are we collectively assured that what is being proposed in feasible for £357m Financial Detail Ongoing Challenges
Session Aims Explain the methodology being used to model 2025-26 performance within care groups Understand how budget constraints are likely to impact services in 2025-26 and explore some examples Agree next steps Work on Performance to Date And Key Challenges
Increase in data provision in recent years; creation of Integrated Performance Report (IPR) Review of Key Performance indicators (KPIs) in current mandate: 1. Rationale for inclusion – link to best practice guidance and quality standards 2. Validity of data and comparability to NHS England statistics Service specifications – comprehensive set of KPIs for every service to be defined Modelling of costs and activity – elective care waiting lists Challenges: • Limited set of metrics and data quality issues • Availability of cost/activity data in Manx Care • Access to intelligence on costs and activity for Department • Distance between interim targets and quality standards Discussion on Key Areas of Performance • Overview of methodology to forecast impact in 2025-26 and factors in reaching targets • What efficiencies are assumed? • What does that mean for cessation or degradation in:- Emergency Care and Ambulance Elective Waiting Times Cancer Services Example - Gyn • Pathway from Al at high level Next Steps

• Timeline for next iterations of documents • Placeholder for third meeting • Political Engagement – Council of Ministers and Tynwald • Deadlines - Feasibility Questions ?

Mandate and Operating Plan 2025-26 Council of Ministers Workshop 3rd February 2025 Session Aims Understand the work to date and steps taken to reach draft documents Highlight and discuss key impacts around service delivery for 2025-26 within the £357m financial envelope Seek steer ahead of finalising the draft documents and submitting for approvals Confirm next steps The Ask What = Mandate  Financial Envelope  Core Services  Statutory Services How = Operating Plan  Service delivery  CIP £357m Safe, good quality value for money service Alignment Financial Position = Drivers Discussion Point 1 1. 2024/25 Spend 2. Inflation 3. Pay 4. Hold 24/25 Level of Contingency (£2m) 5. Implementation of CIP Programme (£14.5m) £357m budget = Assumptions: Discussion Point ​2 6. Removal of Cross-Government funding pressures ( ) - Additional funding required or the following will not be delivered:- Known pressures without funding Council Direction = Vaccinations and Immunisation

Council Decision = Non-Emergency Patient Transfer not accepted for Transfer by Manx Care Board without funding) Cross Government = DfE and DoI solution Off-Island Patient Transport Service ( ) Marker for other funding pressures Offender Healthcare £357m budget = Assumptions cont.: Discussion Point 3 7. Addressing Additional Pressures c£9m Risk can't be entirely offset by CIP or DHSC budget as addressing other pressures Pay – over and above current staff budget ( ) Additional Inflation (£1.6m) Drugs High-Cost Mental Health Court Ordered placements (£1.7m) Mental health s115 placement growth (£0.3m) Care Packages Social Care (£0.8m) Learning Disability Clients Growth (£0.7m) £357m budget = Assumptions cont.: Discussion Point 4 8. Application of Transformation Investment (c.£5m) £3m = already committed Primary Care at Scale Urgent and Emergency Integrated Care Children and Adolescent Mental Health Service £2m = new Shift of Care into the Community - Locality Hubs Digital activation/small scale change/optimisation of current systems Workforce Planning Clinical input – implementation e.g. GIRFT/Patient initiated follow- up etc. (new) £357m budget = Assumptions cont.: Discussion Point 5 9. No New Services Previous Mandate commitments: Multi-Agency Safeguarding Hub (MASH) Adult ADHD Diabetic Retinopathy NICE TAs Discussion Point 6 10. No new workstreams without investment Inspections and reviews: CQC actions Prison review (linked to the future costs as indicated previously) Royal College Reviews (Surgery/Gastro/ENT) £357m budget = Assumptions cont.: Mandate 2025-2026 = Key Principles Priorities unchanged for 2025-26:- 1. Fully integrated health and care services 2. Early Intervention, Prevention and Childhood Experience 3. Safe, Appropriate and Consistent Care 4. Planning for Future Population Needs 5. Governance, Compliance and Accountability Mandate 2025-2026 = Key Priorities Discussion Point 7 Services which enable people to access care closer to home, and support people to stay in their homes for as long as is safely possible.
Availability and accessibility of services in the community - seeing the right person first time. Modernising models of service delivery to focus on early intervention and prevention – particularly Mental Health. Operating Plan 2025-2026 = Key priorities Model of Care currently = medically driven Services in the community = budget uplift c£6M (c2%) Service changes - outcomes focused and looking to alternative models to manage drivers of demand Single Point of Access – Urgent and Emergency Care Care in the Community Shared Care Diagnostics Outsourcing/Insourcing Operating Plan 2025/26 = Principles Manx Care will manage back to budget = £357m Prioritise urgent, emergency and cancer care = can’t control and demand driven Discussion Point 8: Controls will be increased Recruitment Contracting (off-Island Tertiary) Suppliers New Financial System Further Productivity and Efficiency Driven Application of Principles + £357m budget Levers that we can’t control Urgent and Critical Care funding = hold current levels Unfunded services will not be provided by Manx Care = no new services Care contract uplifts held to 2.5% = impact for commissioned services and Third Sector Application of Principles = Impacts on Activity Discussion Point 9 Hold Urgent and Critical Care at current funding Discussion Point 10 Social Care – hold contract uplifts to 2.5% Application of Principles – Examples Activity Plans and Modelling Application of Principles = Impacts Discussion Point 11 Elective Care Reduction Reduction of Impacts Discussion Point 12 Clinically-led controls Getting it Right First Time (GIRFT) Patient Tracking List Validation Review of Follow-up activity (25% reduction, patient initiated from 26/27) Job Planning

Break for any questions ? Discussion Points Discussion Points 1 - 4: Budget Assumptions 1. 2024/25 Spend 2. Inflation 3. Pay 4. Hold 24/25 Level of Contingency (£2m) 5. Implementation of CIP Programme (£14.5m) 6. Removal of Cross-Government funding pressures ( 7. Addressing Additional Pressures (c£9m) 8. Application of Transformation Investment (c£5m) Discussion Points Cont. Discussion Point 5: No new Services Discussion Point 6: No new workstreams without investment Discussion Point 7: Mandate Priorities Discussion Points Cont. Discussion Point 8: Increased Controls Discussion Point 9: Hold Urgent and Critical Care at current funding Discussion Point 10: Hold Social Care Contract uplifts at 2.5%

Discussion Point 11: Elective Care Reduction Discussion Point 12: Clinically-led controls Next Steps • Conversation today • Tynwald Members Engagement - Tuesday 4th Feb • Paper and documents for approval – 13th Feb • Tynwald debate = 18th March • Operational delivery planning • New Performance Framework • National conversation on long-term funding of health and care Thank you Mandate 2025-2026 Approach to £357m = Manx Care Operational Response Indicative Activity Plan (IAP): On-Island Care Potential Impact on Demand & Capacity: On-Island Care Mandate 2025-2026 Approach to £357m = Manx Care Operational Response Potential Impact on Elective Waiting List Volumes: On-Island Care Mandate 2025-2026 Approach to £357m = Manx Care Operational Response Indicative Activity Plan (IAP): On-Island Care by Specialty Mandate 2025-2026 Approach to £357m = Manx Care Operational Response Indicative Activity Plan (IAP): On-Island Care by Specialty Mandate 2025-2026 Approach to £357m = Manx Care Operational Response Indicative Activity Plan (IAP): On-Island Care by Specialty Mandate 2025-2026 Approach to £357m = Manx Care Operational Response Indicative Activity Plan (IAP): Off-Island Care (Tertiary)

Interim Chief Officer: Professor Tim O’Neill
Freedom of Information Team First Floor Belgravia House Circular Road Douglas IM1 1AE

Our ref: 4552182 5 June 2025

Dear ###

We write further to your request, received 31 March 2025, which states:

"Please provide copies of any presentations or documents used at briefings between Manx Care and the DHSC - from the 1st January 2025 to the 1st February 2025"

We wrote to you on 01 April 2025 asking for clarification on your request scope, you replied 02 April 2025 confirming;

“A presentation would be, for example, where a meeting is held and a presentation given (usually in the form of a powerpoint or similar). Presentations are usually used to share information and as a focal point for the discussion, highlighting key or important points of the meeting in question with the aim of leading to a decision of some sort. A briefing is similarly structured but is more often used to convey information about decisions reached or actions taken, along with the background, rather than seeking a decision. There is clearly a lot of overlap in these descriptions, but you will note this is not to do with correspondence shared, which is the subject of a separate FOI request so shouldn't need to be replicated here.

I would be interested in the minutes of these meetings as well, although I can put in a separate FOI request for this if this is needed.

I would be surprised if there were more than a handful of such presentations or briefings in the 1 month period in question and I assume that given the particular focus of the Department and the time period these would focus on service cuts / changes or the development of the Mandate. I am particularly interested in these two items, which is the reason for the narrow date range of the request.”

Our response to your request is as follows: we have enclosed copies of some of information, provided links to some published information and detailed any exemptions where

[Response truncated — full text is 22,241 characters]