Stop reviewing. Start doing.

Health and care are one system on this Island: the same beds at Noble’s that back up because of delayed discharge are the beds that lengthen every waiting list. So this page treats them together — the reviews and the screening, and what it takes to grow old here.

1 · Reviews, funding and leadership

Our health service has been reviewed ten times in seven years, and barely any progress has been reported. The newest, Peter Gent’s in May 2026, says what the first did: fix the flow, don’t just add beds — extra ward beds “fill almost immediately”. We’ve paid for the answers. What’s been missing is the conditions to act on them. (Every review is tracked, sourced and benchmarked against five other British islands in the Observatory’s healthcare explorer.)

I support the integrated health and care system, and its managers and clinicians deserve political backing to turn around decades of entrenched behaviour. Real fixes take time before they show: we fund the change, make it, then see the improvement. Anyone promising instant results is selling something. Three things have to be true first:

• Fair funding. You can’t announce the biggest change programme in the history of the Island’s health service and then hand it less money to run the service day to day. Transformation should have been funded above the reviews’ formula while the change was made; instead, 2026/27 is the first year funded on it. And fix the formula’s perverse incentive: as it stands, efficiency gains are taken straight back off the budget, so the service that saves money loses it. Let Manx Care keep what it saves and reinvest it — that’s what the workforce-pipeline point below is for.
• Leadership pointing in the same direction. The Department, Manx Care’s board and its clinicians have to want the same things. The Minister told Tynwald in July that accountability is “blurred right now”; an independent governance review this year found financial scrutiny duplicated across Manx Care, the Department and Treasury, with low trust between them. Back the professional managers and clinicians politically, and stop reorganising by review.
• Finish the handover. The split between the Department (strategy) and Manx Care (delivery) was never completed: the strategy, the governance, the contract between them, and the measures each will be judged on. The governance review returns to Tynwald in December 2026. Conclude it, publish it, then hold both sides to it.

What I’d do:

• Fix the flow before funding more beds. The block isn’t social care being full: it’s how long discharge takes — clinicians need confidence a care plan is genuinely in place, and patients wait on the ward while the public-or-private funding question is settled. In my own system-dynamics model of Noble’s, add ward beds and they refill almost at once, because the block is discharge, not admissions.
• Care arranged before finance. No one should block a ward bed while their care funding is decided: arrange the care, discharge, settle the money after. Manx Care and Government carry the cost while the decision is made; the family is assessed afterwards under the normal rules, and never handed a surprise bill for the wait.
• Ring-fence surgery beds. Planned operations get cancelled because elective beds are taken by emergency admissions, and every cancellation is a waiting list growing. Protect the beds surgery needs, so a bad week in A&E doesn’t empty next week’s theatre list.
• Discharge seven days a week, and a discharge-first culture. The Gent review found around two-thirds of admissions arrive out of hours, when senior decision-makers are less available — and discharge slows to a crawl at weekends. Senior cover seven days, and patients moved on the day they’re medically fit, with assessments and funding sorted in parallel, not first.
• A networked hospital: specialists visiting and by telemedicine, capacity and outcomes shared and benchmarked with Jersey and Guernsey, patients travelling only when they truly must.
• Published care pathways, in the open: see the route and take the steps you can yourself, not wait on Manx Care when you needn’t.
• A new deal for GPs: options to integrate into Manx Care, GP and hospital data joined up, and new contracts so GPs aren’t required to run a small business on top of practising medicine.
• Leadership clinicians trust, and pay benchmarked against NHS Agenda for Change and against Jersey and Guernsey, to recruit and keep the staff we’re short of. Same band, same pay, wherever you trained.
• Review consultant job plans for the service, not the individual: the independent reviews themselves have questioned whether job plans deliver the cover the service needs, out of hours above all. Publish the job-planning standard, and measure the system, not the clinician.
• Integrated women’s health: endometriosis, menopause and the mental health alongside them, on published pathways, not waiting lists.
• Review the role of community hubs in how care is delivered — whether more, from routine checks to rehabilitation, could be provided closer to home. A review with a deadline and a published answer, not a building promised before the evidence is in.

Invest in prevention:

• Bowel screening from 50, not 60: England, Scotland and Wales already screen from 50, and the US and Australia from 45. Bring our start age down from 60 to 50, backed by funded endoscopy capacity, at an estimated £150,000–£300,000 a year — catching a small but real number of cancers each year at the stage where nine in ten people survive instead of one in ten.
• Prevention wider than one programme: audit our screening offer line by line against the UK’s national programmes, abdominal aortic aneurysm screening for men over 65 among them, and close any gap the audit finds; follow the UK National Screening Committee’s evidence as it moves on prostate testing; and fund the unglamorous basics, blood pressure, diabetes and heart checks, that prevent the expensive emergencies.
• Build our clinical workforce deliberately: funded education-to-jobs routes for Manx clinicians, more resident doctors, anchored in the published 15-year Education and Manx Care workforce plan I’d insist on, and formal links with the Royal College of Surgeons of Edinburgh’s remote and rural surgical training pathway — the programme that staffs Scotland’s island hospitals — so specialists come from a network and generalists live here.
• Redirect what Manx Care saves into the doctors we’ll need: efficiency savings and cost recoveries found within Manx Care should be explicitly earmarked for funding a pipeline of home-grown doctors — the education-to-jobs routes above, building further on the Royal College of Surgeons of Edinburgh remote and rural link already committed to on this page, not a competing scheme — so every pound saved buys future workforce, not just a smaller deficit.
• Form an inter-island collaborative to benchmark ourselves against comparable islands and learn from each other — Orkney, Shetland, Jersey, Guernsey and Na h-Eileanan Siar (the Outer Hebrides).

A Manx Care & Civil Service Year: we ask school leavers to make decisions about careers in care without ever having seen one up close. I want to pilot a structured year — roughly 30 places to start — giving school leavers real, supervised experience of care as a profession across Manx Care and the wider Civil Service, ending with a recognised Care certification and a realistic route into a job. A pilot means exactly that: run it at a size we can run well, publish what it costs and where its graduates go, and scale it only if the results earn it.

• Pilot a Manx Care & Civil Service Year: around 30 places giving school leavers a real working year in care, a recognised Care certification at the end of it, and a route into a job — costs and outcomes published before any decision to scale.

Invest in mental health:

Suicide is rare, but every death is felt across our community, not just by the family nearest to it — and that doesn’t end when the headlines do. My focus is on what actually reduces risk. The drivers are well established, and they are present here: being shut out of work, relationship breakdown — especially in the weeks right after a separation — deprivation, and poor or delayed access to care. Prevention should be aimed squarely there, built on Public Health’s own data and published so the patterns can be seen and acted on, not guessed at.

One death by suicide is one death too many. I don’t think good policy and real feeling are in tension — the second is exactly why I care about getting the first right.

• Measure work and worklessness properly. The Island’s own suicide audit, covering 65 deaths between 2016 and 2021, found that a third of those who died were unemployed or unable to work — roughly a 4x over-representation against the working-age population — while registered unemployment sits at just 0.6%, Treasury Minister Dr Alex Allinson said in December 2025 — “hardly anyone unemployed,” as the Chief Constable separately put it to the committee. Both are true — and the gap matters, because the headline count only tracks people signing on, not the economically inactive or long-term sick, which is where real hardship, and real risk, concentrates. The Chamber of Commerce says around 1,000 jobs have been lost from key sectors — financial services, e-gaming, manufacturing and tourism — in the two years to March 2024. So where do those people show up in the figures? We cannot act on a constraint we do not measure.
• Treat separation as a crisis window. Relationship breakdown is already named in the committee’s evidence, and the pain — and the risk — concentrate in the weeks immediately after a separation, when someone can go from a shared home to a single room overnight. That’s a short, identifiable window where the Island already has contact points: family courts, GPs, relationship-support services. We should be using them properly.
• Invest in the adult mental-health service — and publish the metrics that matter. Not a raw waiting list, but the service measures that show whether the people who most need help are actually seen, and treated, in time. And commission stepped care, so that reaching out for help — you can self-refer directly — is met quickly, not with months of silence.
• Back the third-sector and peer-support groups already doing this work on the Island, including those listed below. They’re neighbours showing up for neighbours — strengthen them with funding rather than duplicating or absorbing what they already do well.
• Get the patterns into the open, quickly and safely — published more often and in more detail than today’s periodic review, the way Scotland’s island councils already do: real data for the people who’ll act on it, not a scare headline once a year. So risks can be spotted and acted on, not just written up after the fact.

2 · Growing older on this Island

Deaths have exceeded births here every year since 2016. That means care — how it’s funded and where it’s delivered — is becoming the Island’s central service question, and it’s also what blocks beds at Noble’s, which backs up outpatient and elective work, which is why waiting lists grow. It is one system.

What I’d do: more care delivered at home, with community support around it. Hospice funded the way our neighbours fund theirs: Jersey covers around 44% of its hospice’s costs and the UK average is about 36%; we cover roughly 24%. This spring that gap meant redundancies, and services moving out of Hospice and into Manx Care. Using Hospice’s own published numbers, I’m not convinced that actually saves anything: it raises roughly three-quarters of its running costs itself, so every pound of government funding unlocks about three more from the community. Move a service into Manx Care instead, and Government is funding the whole of it, not a quarter.

Before the third-sector funding review reports in September 2026, I want to canvass constituents directly alongside understanding the Manx Care model completely — properly, not from a press release. I don’t come to this entirely neutral. Hospice earns what it gets from this Island, and I want to stand up for it, not watch it asked to do more with less indefinitely. And because everyone already knows which way this is heading, I want that honesty matched with transparency: open, publicly accessible, costed care pathways, so families can see in advance what care looks like, where it’s delivered and what it costs, not find out only when they need it.

Summerland View is a genuine success story worth building on — I want a proper public discussion about why it worked, and where else the model could apply.

Worth exploring — retraining grants for the over-60s: the care workforce is short, and plenty of Islanders over 60 have decades of skills, and time, they’d willingly put to use. Retraining grants that helped over-60s move into paid, part-time support and rehabilitation roles — in care and community health settings — could meet a real workforce need and give older residents a productive, paid role at the same time. I’m not presenting this as a costed commitment; it’s an idea worth testing, starting with whether the demand exists on both sides — the services that would employ people, and the over-60s who’d take the roles.

• Explore retraining grants for the over-60s into paid, part-time support and rehabilitation work — test the demand on both sides in the open before committing public money.