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Tynwald Sitting 12 December 2006 12 December 2006

Question 11 | Question 12 | Question 13 | Question 14 | Question 28 | Question 29 | Question 30 | Question 31

The question number refers to the question order specified in the official Tynwald Question Paper. To read the answers, scroll down this page or select a link to a question from above.

Question NumberSubjectQuestion from
10Waiting Lists Ophthalmic and OrthopaedicMr Hederson, MHK
11Rise in fees for Residential HomesMr Hederson, MHK
12Restricting the prescribing of certain cancer drugsMr Lowey, MLC
13Ambulance QuotasMr Houghton, MHK
14Palatine Health CentreMr Karran, MHK
28Waiting ListsMr Hederson, MHK
29Private Insurance SchemeMr Hederson, MHK
30Nursing Home FeesMr Hederson, MHK
31Drug and Alcohol UnitMr Karran, MHK

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Question 10

For Oral Answer: The Hon Member for Douglas North (Mr Henderson) to ask the Minister for Health and Social Security -

Will you as a matter of urgency have your Department commence waiting list initiatives for ophthalmic and orthopaedic surgery waiting lists, given they are probably the longest of any waiting lists in the Health Service?


Mr President,

As you are aware from reports earlier in the year, Waiting List Initiatives in Orthopaedics and Ophthalmics have already been undertaken. Orthopaedic Waiting List Initiatives are continuing both in Out-patient and In-patient joint replacements.

The Orthopaedic team have continuously performed one extra joint replacement operation per week for the past 12 months. In November this year, we have increased this to two joints per week in order to try to cope with the demand for surgery. We will also be performing a further six joint replacements in free theatre time, which has been allocated to Orthopaedics.

We have performed approximately 25 extra Out-patient clinics in Orthopaedics, which whilst reducing the wait for clinic, also regrettably increases the wait for the In-patient waiting list.

It is our intention to continue with these Waiting List Initiatives and thereby limit the time waited for Orthopaedic interventions. We are currently reviewing how the Ophthalmic Waiting Lists may benefit from further use of resources to reduce both Out-patient and In-patient waiting times.

Ophthalmic waiting list initiatives have been undertaken in Out-patient clinics. Whilst this reduces the clinic wait time, the conversion from Out-patient to In-patient treatment is approximately 43%, and therefore the impact is seen on the In-patient waiting times.

The Department is, of course, subject to constraints in delivering services within available resources.

Question 11

For Oral Answer:The Hon Member for Douglas North (Mr Henderson) to ask the Minister for Health and Social Security -

What has your Department done in relation to some private nursing/residential home fees being increased to £695.00 per week since October Tynwald 2006, and what undertakings have you carried out that you committed to at that session?


Mr President,

May I first clarify that this matter only concerns nursing homes operating in the commercial sector and not residential homes.

Following the commitment I gave to this Honourable Court at its October sitting, I wrote within a week to the Chairman of the Isle of Man Nursing Homes Association requesting that the homes’ operators defer any intended fee increase until the further work commissioned by the Office of Fair Trading, in direct response to issues raised by the Nursing Homes Association, had been concluded. Within my letter I reiterated the great concern as to the effect upon nursing home residents generally as a consequence of the expressed intention of certain homes’ operators to increase their fees again during the month of November. I also stressed the importance of continuing constructive communication between the Nursing Homes Association and the Department. However, I believe that to ensure the next meeting between the proprietors of nursing homes and the Department is a successful one, it can only realistically take place once the Office of Fair Trading has completed its additional work.

Notwithstanding my request, two of the proprietors of the Island’s nursing homes have subsequently increased their fees to £695 per week and one has increased theirs to £690 per week.

These levels of fees cannot be achieved from the present levels of social security benefits alone and have naturally caused further great concern to the residents affected and their families. The advice from the Department is that such concerns should in the first instance be raised with the management of the relevant home. For legal reasons, the Department’s advice can go no further than that.

Whilst it had been the practice for officers of the Department’s Social Security Division to hold annual meetings with representatives of the Nursing Homes Association, with a view to assessing future income support levels for those persons resident in nursing homes, I am advised that this approach is no longer appropriate and that it is hoped that a more scientific methodology may be established. I feel unable to comment further on this until the Office of Fair Trading’s latest report is received and considered by the Council of Ministers.

The Department has no plans to increase the current levels of income support whilst the Office of Fair Trading investigation continues.

Question 12

For Oral Answer: The Hon Member of the Council (Mr Lowey) to ask the Minister for Health and Social Security -

  1. Is it your intention to restrict the prescribing of certain cancer drugs, by consultants on cost grounds as from 1st January 2007;
  2. If so, who authorised it and when;
  3. Why was this decision not made public?


Mr President,

The answer to the Hon Member for Council’s question is simply no.

There is currently no policy to restrict the prescribing of certain medicines supplied by the Department solely on the grounds of cost.

Question 13

For Oral Answer: The Hon Minister for Douglas North (Mr Houghton) to ask the Minister for Health and Social Security -

  1. How many ambulances does the Department use on front line duties; and
  2. Is each ambulance crewed by at least one paramedic and if not why?


Mr President,

In answer to both parts of the Hon Member’s Question, I can inform the House that the Ambulance Service has four ‘Front Line’ Ambulances, all normally manned ‘on a shift basis’ by a Paramedic and an Ambulance Technician.

Three of those Ambulances are ‘on call’ 24 hours a day, every day of the year, with the fourth being ‘on call’ between 8.30 in the morning and 8.30 in the evening, every day of the year.

Question 14

For Oral Answer: The Hon Member for Onchan (Mr Karran) to ask Minister for Health and Social Security -

When looking at the re-location of the Palatine Health Centre, why did you not seriously investigate the purchase of land opposite the prison as such a facility would minimise the inconvenience to the existing patients of Palatine Health Centre, so that they could still walk to a Douglas location?


Mr President,

The land, which is situated opposite the prison, is zoned for business development. It is not owned by Government and therefore the combined cost of acquiring the land, (which is not for sale) and the capital costs for a new health centre would exceed the financial provision for this scheme as outlined in the Isle of Man Budget 2006 – 2007.

I can advise that in discussions with the person who owns that land regarding potential sites for a new health centre, two existing buildings (alongside Victoria Road) were put forward by him for consideration. Both sites were discounted for a number of reasons which included financial costs, internal layout and location.

For the last five years the Department has endeavoured to find an alternative site for the Palatine Clinic. In finding a solution, we have to work within financial constraints and many options were explored. None proved viable.

The patients who are registered with the Palatine Clinic live in the catchment area from the area from Baldrine in the North, Greeba Bridge, in the West and Santon in the South of the Island. The Department did not take the decision to move the health centre to Braddan lightly. We are well aware that the move will be an advantage to some and a disadvantage to others. However, the greater good, in health care provision, as agreed with the practice doctors, would be served by providing a modern health centre on a Greenfield site in Braddan.

To those patients that are disadvantaged we advise as follows:

On 1 February, 2005, the DHSS opened a new surgery on Kensington Road. This building is about 1,000 metres from the Palatine Clinic. Prior to the proposed move of the Palatine Clinic to Braddan, we intend to relocate the Loch Promenade Health Centre to a much larger building on Chester Street car park. This building is also about 1,000 metres from the Palatine Clinic. (The site opposite the prison is about 1,400 metres from the Palatine Clinic).

Both of these practices, along with the Kensington Practice in old Nobles, will be encouraged to register patients who do not wish to travel to Braddan.

It is intended as part of our Strategic Plan for the future to keep the Palatine Clinic building for a new two doctor practice when the demand due to growth of the population levels of the Island so dictates.

Question 28

For Written Answer: The Hon Member for Douglas North (Mr Henderson) to ask the Minister for Health and Social Security -

What are currently the length of waiting lists in the Health Service for all the various specialties in order of the longest list first, and the reason why this is the case for each speciality and in particular the ophthalmic and orthopaedic clinics?


In general terms, the majority of Waiting Lists are generated by the demand outweighing the resource which is available to us. We are constantly reviewing ways of addressing the lengthy waiting lists and will continue to do so.

Each specialty has a defined amount of both Out-patient clinic time and theatre operating time. These are extremely costly and valuable resources which we must ensure are fully utilised. As part of the Healthcare Commission report, we will be reviewing our monitoring of these resources.

The number of DNAs, those who did not attend their appointment, unfortunately remains a constant statistic which, to a large extent, is in the hands of the public. We need to ensure we are informed of a cancellation and therefore can re-allocate appointments for both clinics and operations in the most efficient and effective way. Unfortunately, the Island suffers from high rates of DNAs compared to UK NHS Trusts.

The most valuable indicator for a speciality is the referral rate from the General Practitioners. Unfortunately, the IT system we currently have does not easily provide referrals rates, and therefore it is very difficult to automatically and easily substantiate the statement that the root cause is that demand is growing. In order to prove this assumption, many specialties undertake manual counting of referrals and therefore there is an indication that the demand is increasing.

Waiting times relate to “routine” surgery; all urgent cases are operated on within strict deadlines, dependant upon clinical need and diagnosis.

Where resources will allow us the opportunity to reduce the waiting time for surgery, we will continue to do so.

As and when any further resources become available, more substantial reductions would be seen in these waiting lists.

Question 29

For Written Answer: The Hon Member for Douglas North (Mr Henderson) to ask the Minister for Health and Social Security -

Will your Department, as a matter of urgency, assess how Guernsey has established a private insurance scheme which covers every applicable Island resident, if required, for long-term residential/nursing care and if a similar, appropriate vehicle could be used here for all or a majority of our community and especially the less well off?


The Department fully reviewed the position regarding options for funding the health care element of the costs for nursing care during 2005. This review included consideration of the scheme in Guernsey whereby they levied a 1% National Insurance charge in order to fund elements of long term care. The review reported to the Council of Minister in August 2005.

The Council of Ministers agreed on 9th February 2006 that as a matter of policy, nursing care should be provided free on the Island and that with reference to the funding implications, the Department should follow the normal budgetary bidding process.

The Minister proposed a resolution which was agreed by Tynwald on 26th April 2006, to the effect that Tynwald would:

  1. To support the Department of Health and Social Security in its policy intention to provide assistance to those in nursing homes with the costs of nursing care, in accordance with the principle of the Coughlan judgement in the United Kingdom; and
  2. That having regard to the public concern in respect of a possible significant increase in nursing home fees in the near future, the Department takes account of the outcome of the ongoing OFT investigation into Isle of Man nursing homes charges when assessing the levels of financial support which it would be appropriate to provide to residents of such homes.

Accordingly, the Department has placed a bid in the Estimates for the financial year 2007/2008 for funds to allow the phased introduction over three years of free nursing care.

It should be noted that in this context free nursing care refers to that element of care that can only be provided by a nurse and that the personal care element of care and the other costs of care, often referred to as ‘hotel costs’, are not affected.

The Department awaits the outcome of the budgetary process for 2007/08 before we can make any further progress with this matter.

Question 30

For Written Answer: The Hon Member for Douglas North (Mr Henderson) to ask the Minister for Health and Social Security -

Will your Department as a matter of urgency undertake a review to establish at the very least that residents in nursing/residential homes receiving nursing care will have that element of their care fees paid in all cases by the Department, enabling a more realistic and affordable fee structure for residents and their families?


The current situation is that, pending the conclusion of additional financial analysis relating to nursing homes being undertaken by the Office of Fair Trading on behalf of the Council of Ministers, the Isle of Man Nursing Homes Association was asked to defer any intended fee increase. The latest information available to the Department is that certain homes have raised their fees.

The DHSS has no plans to increase the current levels of income support, while the Office of Fair Trading investigation continues.

If a resident, or their representative, has concerns about an increase in their fees, they should, in the first instance, discuss this with the home’s management.

In relation to the ‘nursing care’ element of care following a review of this issue in 2005, the Council of Ministers agreed in February 2006 that the Department should seek funding through the budgetary process to allow for the phased contribution of ‘free nursing care’ commencing in the financial year 2007/08.

The Department now awaits the outcome of the budgetary process for 2007/08 before we can make any further progress with this matter.

Question 31

For Written Answer: The Hon Member for Onchan (Mr Karran) to ask the Minister for Health and Social Security -

Has there been any movement to find the revenue funding which will be required to open the Drug and Alcohol Unit which Tynwald has approved?


The current position is that we have very limited facilities on the Island to allow for in-patient treatment of individuals with acute drug and alcohol problems. This necessitates a number of people being placed off-Island at significant expense, with placement off-Island often exacerbating their problems. It was determined that an eight bed in-patient facility with associated facilities for day treatment and able to accommodate a base for the community team would provide a comprehensive service to the Island’s residents. This was endorsed as Part I of the Drug and Alcohol Strategy.

Whilst capital funds were available for the refurbishment of Ard Aalin to operate the unit, there was a requirement for additional resources of 11 w.t.e. nurses and £520,000 in order to operate the in-patient beds.

Whilst existing community staff are now based within the unit, the Department does not have the resources to allow it to meet the additional requirement for staff and revenue.

Consequently, the Department has submitted a bid within the current estimates round for the financial year 2007/08 for the necessary revenue and staffing to operate the Drug and Alcohol unit. The Department has accorded this a very high priority.

Until such time as the budget for 2007/08 is agreed in accordance with the agreed process, the Department will not be in a position to be able to take any further action on this matter.

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