The man tasked with leading the new Manx Care organisation to deliver future health and care services to the Island’s population has told B365 the re-structure represents much more than a name change.
Speaking to Simon Richardson, Andrew Foster CBE, said that in the early stages people would notice very little, but in the medium term – patients and the public will see improved responsiveness and quality of services: “From that I mean clinical outcomes, survival rates, success of operation rates and the amount of time people stay in hospital, all things in which the Isle of Man doesn’t benchmark particularly well against comparable places at the moment.”
He said patient experience is at the heart of Manx Care’s ambitious programme: “One thing the Island has not been used to is co-design of services – involving patients and users in the way services are run. This can involve speed and quality of services and efficiency. We spend 20 per cent more on health care per member of the population than in the UK. Now, some of that is unavoidable, as we have a small service with proportionately higher overheads. But other parts can be put down to waste and duplication, things that can be improved. That is our medium- term ambition.”
Mr Foster said the Island can benefit from a totally integrated system involving all aspects of healthcare: “Often the patient experience can be like moving from one country to another as they shuffle from one service to another. If we can organise them into one seamless whole, we should be able to offer fantastic integrated care, and be one of the best of breed of healthcare services in the world.”
Mr Foster believes that given the huge spend the Manx system should be in a better place than it is at present: “With a budget of close to £300 million, that’s a really big organisation, and we need to make sure that for that buck we are getting the right bang. A significant part of achieving that will be comparing – not just with the UK – but any modern healthcare service, in terms of efficiency and clinical outcome quality.”
Mr Foster said that by being an arm’s length body from the Government and DHSC, Manx Care is operationally independent: “As such the money given to us at Manx Care will see us solely concentrating on delivering the best possible service we can. Under the previous arrangement the DHSC was also responsible for everything from strategy, policy and politics – dealing with complaints etc – a very distracting set of tasks which all need doing, but as the Jonathan Michael report said, it is best practice to separate out delivery of service from policy, and that is what this has given us.”
In terms of Manx Care’s relationship with the Department and government as a whole, Mr Foster concedes that when it comes to budgeting there may always be friction: “Inevitably there will always be friction between funding body and funding receiver, but I think part of what we can offer is a lot of self-funding. I’ve spent much of my time in healthcare since 2008 having to produce efficiency savings of between two and three per cent, which the Isle of Man has not had to do. So, if we were to simply repeat the lessons we have learned about how to make those savings, we are actually contributing to our own potential to invest in the future of services. Obviously, I’ve had that conversation with Treasury, and I wouldn’t say they are not sceptical, but they are attracted by the idea of us funding our own growth.”
A controversial topic in healthcare is privatisation, so does Mr Foster believe Manx Care will be a back-door route to the introduction of creeping privatisation to the service?
“That does not form any part of the core plan. The standard things in the UK that are opted out are cleaning, portering and so on – we do it in-house here. But there are other areas that the private sector is very important. Here I’m talking about digitisation. We do not have and would never have the skills in-house to produce something as complicated as going fully digital, which is a game-changer to health services. I think we will be forming close partnerships with the private sector in that, and there may be commercial type developments that are possible. Beyond digital there is nothing else on the table.”
Staff morale is another hot topic within the Island’s healthcare system, and for Mr Foster a key objective of Manx Care will be to improve it: “That is fundamentally where I personally come from. My track record has demonstrated an ability to improve staff satisfaction and motivation with the consequent result of producing better staff retention, less absence and sickness. Also, all the evidence shows that where staff are happier patients are happier. What you then get is better mortality rates, better health outcomes etc. It is a priority to work on staff engagement.”
Mr Foster is convinced that keeping healthcare at arms-length from government is an important principle: “If you want to improve the efficiency of specific services you ask the kitchen staff or porters etc. You don’t look in some textbook and tell them what to do. Ultimately morale I believe could change dramatically when people see they have much more say in the delivery of their services.”
So what was Mr Foster’s initial impression of the health service in the Isle of Man: “There are some things that shocked me,” he admitted. “There is very little information. Fundamentally, to manage anything you need data, and there is no routine collection of clinical data on the Island. The norm almost anywhere else in comparable services is to clinically code each activity. You can then look at clinical outcomes – by that I mean if it’s a cancer you can look at survival rates, an operation in hospital – how long the patient stays for; none of that is available here so it’s really difficult to improve the quality of services without information. That was a surprise to me and is something we aim to work on in the first six months.”
But, as he explained, there were also positives: “I have met a whole range of brilliant people who all work in health services and who do a fantastic job despite the constraints, and are massively appreciated by their patients, often going the extra mile by designing patient representative groups and so on. So, there is an awful lot of good out there to build on, which is very encouraging.”
Running a multi-service acute hospital for a population of only 84,000 is intrinsically difficult. In terms of scale Mr Foster admitted that as a rule of thumb it was normally necessary to have a population of around 250,000 people, which the Isle of Man is nowhere near: “As a result what we have to do is make the best of the services that are based on the Isle of Man in a single hospital plus use of tertiary services from the UK, along with community services spread around the Island, he explained”
Mr Foster added that waiting lists for some patients on the Island were much longer than in hospitals in the UK: “Waiting times for some specialities are up to three years for a first outpatient appointment. This is way in excess of what you would be used to in other countries, not just the UK. The situation has been exacerbated by the impact of Coronavirus, so we have to play catch-up. That is going to be done by extra efficiency – the way we do things. For example, the balance between face to face and virtual meetings has been a successful development in the past twelve months.”
So with a huge programme of change how long does Mr Foster think Manx Care will need to turn the ship around: “It’s quite difficult to give a precise answer to that, as we haven’t got the data I was talking about earlier. But I would certainly like to see a continuous line of improvement. All of the time I want to see a shortening of waiting times, an improvement in clinical quality, an improvement in patient experience. I would hope we can make significant progress in the first twelve months, so that by this time
next year we could point to improvements. However, realising the ambition of being the best healthcare system of its type in the world, I think we are talking about three to five years to get to something like that.”
An ongoing problem faced by the Manx healthcare system has been recruitment, something Mr Foster stresses is not exclusive to the Isle of Man. However, on a positive note he points to a huge uptake in interest in careers as nurses and doctors: “This will take some time to come through so what we have to do is to persuade people to stay in healthcare, to return to healthcare, and in the short-term will we have to bring in people from elsewhere to fill the gaps. The alternative is to pay premium rates to agencies. But there is a great opportunity to recruit our own people rather than hire them from elsewhere.”
For best practice Mr Foster believes the Isle of Man will need to broaden its net and look further than the UK – including the Scandinavian countries, Spain, Northern Europe and the US. But he’s confident that after the initial problems are ironed out the people of the Island can look forward with confidence.
Andrew Foster CBE, Chair Designate, Manx Care
Andrew was appointed Chair Designate in September 2020 having just concluded a number of executive roles for NHS England including Executive Lead for Leadership, Interim Managing Director of the Leadership Academy, chairing the work on Leadership Culture as part of the NHS People Plan and managing the programme to bring back retired staff to help with Coronavirus. He is a Non-Executive Director at Health Education England and Trustee of ENT UK.
Previously he was Chief Executive at Wrightington, Wigan and Leigh NHS Foundation Trust (WWL) from January 2007 to October 2019. His main interests have been quality and staff engagement with a particular desire to learn from the best health systems in the world. WWL developed a significant reputation for all round performance, whilst also achieving almost all major targets and enjoying financial stability. It won many national and regional awards including HSJ Provider Trust of the Year in 2014. It is rated ‘Good’ by the CQC in all domains, for all sites and for Use of Resources.
Before WWL, he spent five years as the NHS Director of Human Resources (Workforce Director General) at the Department of Health with principal responsibility for implementing the workforce expansion and HR systems modernisation set out in the NHS Plan of 2000. Previously he spent two years as part time Policy Director (HR) at the NHS Confederation. Andrew was also the Chairman of Wrightington, Wigan and Leigh NHS Trust from 1996 to 2001 and before that Chairman of West Lancashire NHS Trust and non-executive director at Wrightington Hospital NHS Trust.