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Tynwald Sitting 11 July 2006 10 July 2006

Question 3 | Question 27 | Question 28 | Question 29 | Question 30 | Question 31 | Question 32 | Question 33 | Question 34 | Question 35 | Question 45 | Question 46

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
3Pensions and Benefits IncreasesMr Henderson, MHK to Chief Minister
27Opthamology Waiting ListsMr Singer, MLC
28Orthopaedic Waiting ListsMr Henderson, MHK
29Budget ManagementMr Gill, MHK
30Paramedics Pay TT WeekMr Houghton, MHK
31Dental Health CareMr Karran, MHK
32Dental Health Treatment ExpensesMr Karran, MHK
33Salaried Dental Practices Value for MoneyMr Karran, MHK
34NHS DentistsMr Karran, MHK
35NHS ConsultantsMr Karran, MHK
45Requirements for BenefitsMr Teare, MHK
46Medical Negligence ClaimsMr Karran, MHK

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Question 3 - Mr Henderson, MHK

For Oral Answer:The Hon Member for Douglas North (Mr Henderson) to ask the Chief Minister -

During this year’s budgetary process, will you agree to plans in a more meaningful increase to pensions, benefits and push for a more meaningful increase to the minimum wage, than this year’s derisory increases?


Mr President, In relation to social security benefits and pensions it is important that Honourable Members understand that for the most part these are financed from National Insurance contributions and not from general revenue. It is only those benefits which are financed from general revenue which impact upon the budgetary process.

The rates of those benefits and pensions financed by National Insurance contributions are, in accordance with the Reciprocal Agreement on social security between the Isle of Man and the United Kingdom, kept in parity with those in the UK. Therefore, any changes to the rates of so-called contributory benefits payable in the United Kingdom also have effect in the Island. The rates of contributory benefits payable in the UK are increased each year, generally in line with the increase in the United Kingdom Retail Prices Index. Thus, it is by reference to the movement in the UK RPI that the rates of contributory benefits payable on the Island are also increased.

As Honourable Members are aware, the Island has introduced extra-statutory schemes, namely the Pension Supplement Scheme, the Pension Premium Scheme and the Jobseeker’s Enhanced Allowance Scheme, as a means of enhancing the rates of certain contributory benefits payable on the Island, without offending the terms of the Reciprocal Agreement. Benefits payable under these extra-statutory schemes are also financed solely from National Insurance contributions. The annual uprating of benefits paid under these schemes is linked to the contributory benefits they supplement, therefore their rates are also increased by reference to the movement in the UK RPI. Any increase in the rates of contributory benefits, including those payable under these extra-statutory schemes, would have to be affordable from the National Insurance Fund. According to the United Kingdom Government Actuary, having conducted his most recent 5-year review of the operation of the Social Security Acts on the Island only last year, the Island’s National Insurance Fund is in a fairly stable position at present but does not have any excess which can be used to improve benefits.

Benefits which do not depend upon the payment of national insurance contributions are generally financed from general revenue and are either universal benefits or income-related benefits. With the exception of Child Benefit, universal benefits fall within the scope of the aforementioned reciprocal agreement with the UK, thus the rates of allowances payable, and any increases thereto, are kept in line with those payable in the UK. Child Benefit is the subject of a separate reciprocal agreement between the Isle of Man and the United Kingdom. Whilst the conditions of entitlement to Child Benefit on the Island mirror the provisions having effect in the United Kingdom, the Island is at liberty to set its own rates of Child Benefit. As I am sure Honourable Members are aware, these are presently greater on the Island than in the UK, and have been so for a good number of years.

Income-related benefits, that is Income Support, income-based Jobseeker’s Allowance, Family Income Supplement and Disability Working Allowance, are not within the scope of the reciprocal agreement and the Island is therefore at liberty to provide for its own rules of entitlement and rates of allowances. Much work has been done in recent years to raise the applicable amounts of these benefits, as well as increasing lump-sum payments such as the annual Winter Bonus, substantially ahead of inflation, following recommendations from Government’s Low Incomes Working Group.

Mr President, senior officers of the Treasury and the Department of Health and Social Security are maintaining a dialogue to ensure that, where it is possible, affordable and justifiable, increases in the rates of social security allowances beyond the normal inflationary increase are introduced and the cost of such measures are factored into the budgetary process. I am content to leave it to those respective Departments to bring forward proposals to the Council of Ministers for the uprating of benefits and allowances to be introduced from April 2007.

Question 27 - Mr Singer MHK

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

What plans does your Department have to reduce waiting lists for Ophthalmology Patients?

Answer (Answered by Mrs Craine, MHK)

Mr President, It is a one of the Department’s priorities to reduce the waiting times for patients waiting for Ophthalmic Surgery. The waiting times are a result of the consistent high demand for Ophthalmology which has been experienced in recent times.

In order to address this, the Department is reviewing the Waiting Lists for both outpatients and inpatients in order to maximise the capacity of existing resources devoted to Ophthalmology.

In addition, some limited additional resources are currently being devoted in the short term to out-patient clinics in Ophthalmology in order to provide additional appointments as part of a Waiting List Initiative.

Discussions are also taking place in order to ensure how this high demand may be addressed on a longer term basis.

Question 28 - Mr Henderson, MHK

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

What plans does your Department have to reduce waiting lists for Orthopaedic and back surgery?

Answer (Answered by Mrs Craine, MHK)

Mr President, The Department has already identified that the waiting times for Orthopaedics and Back Surgery are longer than we would wish.

In the short term additional out-patient clinics are being held which will reduce waiting times for patients with back problems. It is anticipated once this additional series of clinics have been held, the waiting time for a routine out-patient appointment with the Orthopaedic Consultant who has a special interest in backs, will be less than three months.

Additional resources are also being invested in providing additional joint replacements above those that can be carried out within existing resources.

The Department continuously reviews all Waiting Lists and devotes additional resources to areas as and when necessary to minimise waiting times.

Question 29 - Mr Gill MHK

For Oral Anwer: The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and Social Security –

What progress have you made together with your financial consultants to address the difficulties your Department faces in relation to budget management?

Answer (Answered by Mrs Hannan, MHK)

Mr President, As the honourable questioner may recall, the financial consultants concerned, PricewaterhouseCoopers (PwC), will ultimately report to the Social Policy Committee of the Council of Ministers, via a working group chaired by the Chief Secretary, which includes officials of the Treasury and medical representatives, as well as officers from the Department.

Presently, PwC have undertaken considerable research and data gathering, which is continuing, and have held meetings and interviews with various managers and service providers from throughout the Department. There have been up to eight PwC personnel on the Island at any one time, with the majority of these being health and social care professionals rather than accountants.

The analysis and assessment of the current financial year budget, addressing scope for savings, improved cost efficiencies and effectiveness together with organisation and process changes will be the subject of a report, the first draft of which is expected to be provided next week. Indeed the PwC partner with responsibility for the Government and Public Sector Unit within the company will shortly be visiting the Island to oversee the concluding aspects of the current work.

As well as looking at the scope for cost savings in this financial year, PwC will also work with the Department to implement actions to bring about those cost savings and efficiency measures that they identify.

Question 30 - Mr Houghton, MHK

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

Why were Nobles’ paramedics not paid for additional duties performed during the TT?

Answer (Answered by Mrs Craine, MHK)

Mr President, In answer to the Honourable Member’s question, I can advise that any official duties conducted by ambulance personnel as part of the arrangements for this years TT period were paid for at the appropriate rate. This included additional duties such as manning the air ambulance and providing extra cover at times of high demand, such as on Mad Sunday.

During the TT period staff do volunteer their services to other organisations during their days off, which include manning the TT race helicopters and acting as paramedic marshals around the course during either a practice or a race period.

Question 31 - Mr Karran, MHK

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

Regarding performance -

  1. what is the state of the nation’s dental health compared with the adjacent isles;
  2. is routine dental care available without excessive waiting; and
  3. do these practices comply with NICE [National Institute of Clinical Excellence] guidelines on dental recalls and, if so, how do they achieve this without a computerised recall system?

Answer (Answered by Mrs Craine, MHK)

Mr President, In answer to Part (a), whilst the Department has only been able to formally measure oral health in children via an epidemiological survey co-ordinated by the British Association for the Study of Community Dentistry, the indications are that, overall, the dental health of the people of the Isle of Man is similar to that of the people in the north-west of England, which is one of the poorer areas in terms of dental health of the United Kingdom.

The Department is determined to improve oral health where it can through a variety of preventative measures and is currently reviewing its Oral Health Strategy.

Part (b) of the Honourable Member’s question, the Department sees one main element of dental health as being “Access” to services. In that regard, the initiative taken to expand the Community Dental Service so as to provide a more comprehensive NHS service to the people of the Isle of Man has been instrumental in ensuring a high level of access to NHS dental care, particularly when compared to adjacent Isles. It is that proactive approach, together with the commitment of a number of independent contractors, which has resulted in a significant reduction in the number of patients waiting to register with an NHS dentist over the past two or three years compared to the current situation. The position is improving all the time and, with an expected increase in NHS availability currently being discussed with a number of independent contractors, it is anticipated that those patients currently waiting will be allocated an NHS dentist within the next three to six months. This situation would not have been possible without the commitment and dedication of those within the Salaried Dental Service and the co-operation of independent contractors.

Finally, I can confirm that all NHS dental practices on the Island are required to comply with NICE guidelines on dental recalls. Not all practices at present have a computerised recall system, in which case an effective manual system is in place.

Question 32 - Mr Karran, MHK

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

Prior to April 2006, fee paying adults contributed 80% of the cost of treatment, that this will remain broadly similar under the new system -

  1. what was the income to the salaried dental practices last year;
  2. what were the total for item of service, capitation and continuing care fees calculated by the Dental Practice Board; and
  3. what are the expenses for the salaried dental practices and how are they calculated?

Answer (Answered by Mrs Craine, MHK)

Mr President, In answer to the first part of the Honourable Member’s question, I can advise that the patients’ contribution collected during the year ended 31 March 2006 for the provision of general dental services by the salaried dental practitioners was £231,000.

In relation to the second part of the question, the total fees generated by that part of the Community Dental Service providing General Dental Services was £860,000.

Finally, I can advise that the expenses for the salaried dental practices fall into 3 main areas; salary costs, dental consumables and equipment and clinic running costs. Whilst the budget allocation is for the Community Dental Service as a whole, it is estimated that the cost attributable to the general dental provision element of the service for the year ended 31 March 2006 was in the region of £1.1 million.

Question 33 - Mr Karran, MHK

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

Has any Government body investigated whether salaried dental practices offered as an alternative to patients from traditional independent contractors give the same or better performance and value for money for the general public?

Answer (Answered by Mrs Craine, MHK)

Mr President, In answer to the Honourable Member’s question, I would first like to make it clear that the Department has run a Community Dental Service for many years utilising directly-employed, ie salaried, dental practitioners and support staff. Until four years ago that service was responsible mainly for the provision of dental care and treatment to children through the School Dental Service and to vulnerable members of the community or people with specific problems or needs.

In the early part of 2002, in response to a decision by a number of independent dental practitioners to reduce their NHS dental commitment in favour of private treatment, the Department took the decision to expand the Community Service so as to meet the NHS needs of the patients affected by the contractor’s actions. Since then, and whilst facing the same challenges as those faced by other jurisdictions, the Department has been successful in providing NHS care and treatment to an increasing number of patients who would otherwise have had difficulty in accessing such services.

The Department is pleased with the outcome of this initiative, as I am sure are those many patients who have benefited from it.

In relation to performance and value for money, whilst there has been no specific investigation by any Government body, the Community Dental Service is subject to the same scrutiny as the service provided by independent contractors or, indeed, any other services provided by Government.

I can point out, however, that the Dental Reference Service of the NHS Business Services Authority undertake, on the Department’s behalf, regular reviews of service provision within dental practices covering such areas as patient/clinical care, record keeping, treatment planning, facilities, quality control and continuing professional development.

In September 2005 the Community Dental Service was subject to such a review, the outcome of which was favourable overall with recommendations being made in relation to facilities and record keeping which have now been addressed.

I can assure Members that, as with all other services provided by the Department, performance levels and value for money within the Community Dental Service will continue to be monitored and addressed where necessary.

Question 34 - Mr Karran, MHK

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

Your Department’s website has a list of “NHS Dentists” which at best can be described as misleading as several names on the list have very limited NHS provision and others are wholly private and have been so for years - why is your Department condoning this misinformation about this service?

Answer (Answered by Mrs Craine, MHK)

Mr President, The list of NHS dentists which appears on the DHSS website is intended to set out details of those dentists who have a contract for the provision of NHS services, although it is accepted that the level of commitment can vary. There have been a number of recent developments which impact on the information contained on the website and, in that regard, I accept that the information provided is not entirely up to date. I can, however, confirm that arrangements have been put in place to ensure that those changes are implemented and the information set out is reviewed on a regular basis.

In relation to the comment by the Honourable Member that there are names of dentists on the website that are wholly private, and have been so for a number of years, I can advise that there is one dentist included who, whilst part of a practice which provided NHS dental services, did not personally have NHS patients. This situation will, of course, be rectified as part of the previously mentioned review.

I thank the Honourable Member for bringing this matter to my attention.

Question 35 - Mr Karran, MHK

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

  1. What controls has your Department over the quantity and quality of work carried out by NHS Consultants; and
  2. What controls does the UK Department of Health and Social Security have over its Consultants which differs from the Island?

Answer (Answered by Mrs Craine, MHK)

Mr President,

  1. The Consultants employed by the Department of Health and Social Security all undergo a very detailed and in-depth Job Plan Review on an annual basis. This enables both parties to agree the structure and content of the Consultants’ job and therefore the quantity and quality of work they undertake. Monitoring of workload analysis is reviewed on a monthly basis. The system of appraisal also exists to enable review of the Consultants’ work and its outcomes. The Clinical Audit system also provides independent review of the clinical work undertaken by all Consultants. The Clinical Audit Committee, which includes lay members, are able to be reassured as to the outcomes of each clinician, as reports are provided for the Committee. Should concerns be raised regarding the performance of a Consultant, the General Medical Council are able to assist us in various ways dependant on the issue.
  2. The UK and the Isle of Man have equivalent procedures in place to manage Consultant Staff.

Question 45 - Mr Teare, MHK

For Written Answer The Hon Member for Ayre (Mr Teare) to ask the Minister for Health and Social Security –

Since January 2002 has there been any amendment to the residency requirements to qualify for income related benefits, and, if so;

  1. what was the amendment;
  2. who authorised the change;
  3. how much in additional monies have been paid to 31st March 2006?


Other than a minor modification consequent to the application to the Island of certain parts of the United Kingdom Parliament’s Civil Partnership Act 2005 (which came into effect from 5th December 2005), there has been no change to the residency criteria in relation to eligibility for any of the income–related benefits administered by the Social Security Division since 1st January 2002.

Question 46 - Mr Karran, MHK

For Written Answer The Hon Member for Onchan (Mr Karran) to ask the Minister for Health and Social Security- In the last five years –

  1. How many medical negligence claims have been brought against Noble’s Hospital?; and
  2. How many have been settled out of Court?


In answer to Part (1) of the Question, in the last 5 financial years the number of medical negligence claims made against the Department was 68, all of these involved treatment at Noble’s Hospital.

In answer to Part (2) of the question, so far 23 cases have not been progressed or have been settled. 45 remain to be determined.

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