Health and social care on the Isle of Man is the responsibility of the Department of Health and Social Care. Healthcare in Isle of Man is free for residents and visitors from the UK, and there is a reciprocal health agreement with the UK. For several years, it has required a supplementary vote to balance its budget at the end of each year. [1] The Reciprocal Health Agreement only covers three months from the point of arrival in the UK. [2]
Sir Jonathan Michael conducted a review of arrangements for health and social care services on the Isle of Man which was published in May 2019. He recommended that they should be delivered "at arm's length" from the government and that arrangements for clinical support from the NHS in England should be improved. [3] The chief executive of the Department of Health and Social Care and his deputy resigned. [4]
In 2013, about £178.4 million was spent on healthcare. £138 million came from the Manx government and about £40 million from income National Insurance contributions, prescription charges and private patient fees. About £80 million was spent on Noble's hospital. [5] In March 2018, Sir Jonathan Michael was asked to conduct a review of the service because of concern that current funding levels are "unsustainable". The Council of Ministers estimated that funding would have to be increased by 23% – an additional £60 million by 2022/23. [6]
The fourteen general practices have a list system. Patients have to register with a GP. Temporary residents from the UK can use the service without charge. The practices on the island have an average of 1900 patients per GP. A digital facility for patients to make GP appointments and view their own health information online was launched in September 2017. [7] The Manx Emergency Doctor Service is available when the practices are closed, from 6 pm to 8 am and at weekends and bank holidays. [8]
Dentistry services are available on a similar basis to those in the UK, with charging on a banded basis and exemptions for children, students, pensioners, pregnant women and people in receipt of Income Support, Income Based Job Seekers Allowance or Employed Persons Allowance, war disablement pensioners and blind people.[ citation needed ]
Annual eye tests are provided free to Isle of Man residents. NHS vouchers are available towards the cost of spectacles.[ citation needed ]
Manx prescription charges have been set at £3.85 per item since September 2010, less than half the charge in England. People get free prescriptions who have chronic conditions, as well as people who are: under 16 years old, under 19 years old and in school full-time, pregnant, on public assistance, prisoners, on a pension and under 75 years old, or over 75 years old. [9]
In April 2018, there was an announcement that NHS dentists on the island were at full capacity and that it could take years for new patients to be registered. [10]
There are two hospitals on the island, the main one being Noble’s Hospital, with 314 beds, giving about four beds per 1,000 residents, around the European average, but considerably higher than in the UK. [11] Tertiary services are provided by the English NHS. The much smaller Ramsey Cottage Hospital has 31 beds and is situated in the town of Ramsey, on the north of the island.
The Isle of Man Ambulance Service is based at Cronk Coar on the Noble's Hospital site. It has nine accident and emergency vehicles, four patient transport vehicles and rapid response vehicles. [12]
Since 24 May 2019, [13] it is lawful to have an abortion during the first 14 weeks of pregnancy at will, then until the 24th week, so long as criteria specified by the act are met, and then onwards if there is a serious risk of grave injury or death. Abortion is governed by the Abortion Reform Act 2019. [14]
Before 1948, there was a Mental Hospital Board which was responsible for Ballamona Hospital under the Poor Relief Acts and three voluntary hospitals: Ramsey Cottage Hospital, Noble’s Hospital and the Jane Crookall Maternity Home on the island. Each had its own management committee, and there was a Hospitals Contributory Scheme. White Hoe Hospital was run by the Corporation of Douglas. There were proposals, by the Corrin Trustees who had collected funds, to establish a hospital in Peel but they were halted by the outbreak of war. Domiciliary services were provided by district nurses, employed by the twelve district nursing associations. There were also two infant welfare health visitors and seven infant welfare clinics.
The Isle of Man Medical Society had begun preparing for the establishment of the NHS in 1946 and asking the Manx government to establish a process. The two existing government bodies mostly closely involved were the Local Government Board and the Health Insurance and Pensions Board – which became the Board of Social Services in 1947 – submitted a report in April 1947. [15]
The free health service started on the island on 5 July 1948, just as in the United Kingdom, but without any legislation. 5 July on the island is, coincidentally, Tynwald day, a public holiday. It was clear that the board would have to collect National Health Insurance contributions from that date to ensure reciprocity with the United Kingdom.
The Mental Hospital Board was renamed the Health Services Board under the Health Services Board Act which was passed on 15 June 1948 and took on responsibility for the Cronk Ruagh Sanatorium and White Hoe Isolation Hospital. The voluntary hospital management committees continued but were now overseen by and responsible to politicians – something they did not welcome. One-third of their members were now appointed by the board, to be responsible to the board, and their accounts and activities were subject to monthly scrutiny. They were assimilated in 1963.
The Isle of Man Health Services Act was not passed until 10 August 1948. It was agreed that the term "people of the Isle of Man" could and should be interpreted as including anybody physically present on the island at the time so that visitors – mostly from the UK – would be covered. In return, the English NHS agreed that Manx patients could be sent, as necessary, for free treatment in English hospitals, and for other treatment not available on the Island.
32 general practitioners, 40 chemists, 16 dentists and 10 opticians joined the service at its inception. There were 28 specialist hospital doctors: 9 full-time, 12 part-time, and 7 visiting from England. For the first nine months of operation to 31 March 1949 the costs came to £197,200. The estimate for the first full year to 31 March 1950, was £454,668. By 1954 the board was under pressure to reduce its expenditure by 20%. The board responded by insisting that this would require reductions in the service which would have to be determined by the government. The National Health Service Act 1950 widened the board's powers to introduce charges, and in November 1950 a charge of 6d. per prescription form was introduced. This caused all but six of the chemists to withdraw their services for a fortnight. In December 1950 the board introduced a range of exemptions from charges. Charges for dental treatment were introduced in 1950 and, in 1952, charges for spectacles at 10/- a lens, and the whole cost of an approved frame.
There was considerable administrative support from the English NHS. The Manchester Prescription Pricing Bureau dealt with the invoicing of prescribed medicine. [16] A prescribing committee was established of whose six members four were doctors and one a chemist. Charges for prescriptions were increased in April 1953 to 1/- per form.
In 1954, the board took responsibility for the Welfare Food Scheme. Orange juice, cod liver oil, and vitamin tablets were distributed through the ten infant welfare clinics. They were free to all children under five, and to expectant and nursing mothers in necessitous circumstances. In the year to March 1956 25,884 bottles of orange juice, 4,776 bottles of cod liver oil, and 594 packets of vitamin tablets were distributed. It also ran the Cheap Milk Scheme. From 1951 this was subject to a means test. In 1955/6, this was a household income not exceeding £5 a week, with the addition of 6 shillings for each dependent member. There were 176 beneficiaries, including six nursing or expectant mothers. A Home Help Scheme was also established and by 1959 there were 25 Home Helps.
The School Dental Service provided free treatment for children of school age, and they were originally not eligible for free treatment from other dentists except in an emergency.
The Isle of Man looks to be the first place in the United Kingdom and Crown Dependencies to allow assisted dying to give terminally ill people much-needed choice and protection at the end of life, after passing the law in 2023. [17]
Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable at home. However, in recent years it may equally refer to those from developed countries who travel to developing countries for lower-priced medical treatments. With differences between the medical agencies, such as the Food and Drug Administration (FDA) or the European Medicines Agency (EMA), etc., which decide whether a drug is approved in their country or region, or not, the motivation may be also for medical services unavailable or non-licensed in the home country.
Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.
Health care in Ireland is delivered through public and private healthcare. The public health care system is governed by the Health Act 2004, which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programme continues. In addition to the public-sector, there is also a large private healthcare market.
NHS Wales is the publicly-funded healthcare system in Wales, and one of the four systems which make up the National Health Service in the United Kingdom.
NHS Scotland, sometimes styled NHSScotland, is the publicly funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland, supported by seven special non-geographic health boards, and Public Health Scotland.
Health and Social Care (HSC) is the publicly funded healthcare system in Northern Ireland. Although having been created separately to the National Health Service (NHS), it is nonetheless considered a part of the overall national health service in the United Kingdom. The Northern Ireland Executive through its Department of Health is responsible for its funding, while the Public Health Agency is the executive agency responsible for the provision of public health and social care services across Northern Ireland. It is free of charge to all citizens of Northern Ireland and the rest of the United Kingdom.
Charges for prescriptions for medicines and some medical appliances are payable by adults in England under the age of 60. However, people may be exempt from charges in various exemption categories. Charges were abolished by NHS Wales in 2007, Health and Social Care in Northern Ireland in 2010 and by NHS Scotland in 2011. In 2010/11, in England, £450 million was raised through these charges, some 0.5% of the total NHS budget. In April 2021 the charge was raised to £9.35 for up to a three-month supply of each item. In 2022, for the first time since 2010, the charge was not increased.
Emergency medical services in the United Kingdom provide emergency care to people with acute illness or injury and are predominantly provided free at the point of use by the four National Health Services (NHS) of England, Scotland, Wales, and Northern Ireland. Emergency care including ambulance and emergency department treatment is only free to UK residents and a charge may be made to those not entitled to free NHS care.
Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences have developed between these systems since devolution.
The NHS Business Services Authority (NHSBSA) is an executive non-departmental public body of the Department of Health and Social Care which provides a number of support services to the National Health Service in England and Wales. It was created on 1 October 2005 following a review by the Department of Health of its "arm's length bodies". It began operating on 1 April 2006, bringing together five previously separate NHS business support organisations.
The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde. Primarily funded by the government from general taxation, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal English residents and residents from other regions of the UK, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).
Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use. The body is one of four forming the UK National Health Service as health is a devolved matter; there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England.
Healthcare in Wales is mainly provided by the Welsh public health service, NHS Wales. NHS Wales provides healthcare to all permanent residents that is free at the point of need and paid for from general taxation. Health is a matter that is devolved, and considerable differences are now developing between the public healthcare systems in the different countries of the United Kingdom, collectively the National Health Service (NHS). Though the public system dominates healthcare provision, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay.
The National Health Service (NHS) is the conglomerate name for the publicly funded healthcare systems of the United Kingdom, comprising NHS England, NHS Scotland and NHS Wales. Health and Social Care in Northern Ireland was created separately and is often locally referred to as "the NHS". The original three systems were established in 1948 as part of major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay. Each service provides a comprehensive range of health services, provided without charge for people ordinarily resident in the United Kingdom apart from dental treatment and optical care. In England, NHS patients have to pay prescription charges; some, such as those aged over 60, or those on certain state benefits, are exempt.
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the National Health Service in England as set out in the Health and Social Care Act 2012. It directly commissions NHS general practitioners, dentists, optometrists and some specialist services. The Secretary of State publishes annually a document known as the NHS mandate which specifies the objectives which the Board should seek to achieve. National Health Service Regulations are published each year to give legal force to the mandate.
The Isle of Wight NHS Trust is an NHS trust which provides physical health, mental health and ambulance services for the Isle of Wight. The trust is unique in being the only integrated acute, community, mental health and ambulance health care provider in England. It runs St Mary's Hospital and the Isle of Wight Ambulance Service.
Dentistry provided by the National Health Service in the United Kingdom is supposed to ensure that dental treatment is available to the whole population. Most dentistry is provided by private practitioners, most of whom also provide, on a commercial basis, services which the NHS does not provide, largely cosmetic. Most adult patients have to pay some NHS charges, although these are often significantly cheaper than the cost of private dentistry. The majority of people choose NHS dental care rather than private care: as of 2005, the national average proportion of people opting for private care was 23%. NHS dentistry is not always available and is not managed in the way that other NHS services are managed.
Private healthcare in the UK, where universal state-funded healthcare is provided by the National Health Service, is a niche market.
Noble’s Hospital is a hospital on the Isle of Man. It is one of only two hospitals on the island, and as of 1 April 2021, is run by Manx Care; having previously been run by the Department of Health and Social Care
The immigration health surcharge was introduced by the Cameron–Clegg coalition by the Immigration Order 2015, made under the provisions of the Immigration Act 2014, to deal with the issue of medical tourism involving the NHS in England. Once the surcharge is paid people are entitled to use the NHS in a similar way to UK residents.
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