The DHSS travelling road show arrived in Douglas yesterday evening (Thursday) and triggered a lively debate between DHSS Minister, Eddie Teare MHK, his accompanying team, and the 50 odd members of the public who attended the meeting.

The meeting was chaired by recently ‘elected’ MLC, David Callister who gave a brief introduction before inviting the Minister to make his short presentation.

Mr Teare highlighted the strategic issues facing the department in the coming years; not least the aging population. He said these issues are being exacerbated, in the short term, by an anticipated economic slowdown and a reduction in our share from the revenue sharing arrangement with the UK, with a resultant squeeze on finances.

He explained that the DHSS’s objectives included protecting and sustaining the health and social care provision in the Island over a ‘long time horizon’. However, he pointed out that DHSS gross expenditure was now over £424m per year, equivalent to £5303 per person per year, and had grown by over 100% in the last 10 years; and the majority of the expenditure was on fixed costs.

He asked the rhetorical question - is this sustainable?

He put to the meeting that the challenge facing the Island was to decide how we are going to fund health and social services into the future. Would service delivery remain free at the point of delivery, as at present, or would some form of charging, as in other jurisdictions, such as Eire and the Channel Islands, need to be introduced. Would more benefits need to be means tested?

He explained that the public’s expectations, for the services they are receiving, is rising, which has a knock-on effect on costs; and they also face the dilemma of trying to find the money to invest in illness prevention, whilst maintaining the services for people already needing treatment and care.

It isn’t a simple case of getting more people to contribute the costs by increasing the population, he said, as it has been calculated for every additional 500 people and extra £1m is needed just to stand still.

He pointed out that many Doctors and staff were approaching retirement age - many of whom specialized in more than one area, which is rarer now - and the IOM is facing competition for replacements from the rest of Europe.

Other costs are increasing above the rate of inflation, drugs and energy in particular, he said, and Hospice is looking for an additional £600k support.

Social Security costs, including pensions, are also rising and there is need to keep them under review, he said, to make sure they could be sustained. Child benefit alone, he stated, costs £18.5m per year.

Having painted this fairly gloomy outlook he then said it was over to the audience - for them to have an opportunity to express an opinion, on some of the issues, and perhaps also suggest some of the solutions. He said it wasn’t necessary for people to give their names.

The first topic discussed was pensions and a lady suggested the DHSS contact the Adam Smith Institute for some ideas as they have successfully helped Chile. She suggested that £1000 a year should be invested for each child, and although it may cost £1m a year to fund, in the long-term, it should prove more cost effective than the current system.

Mr Teare pointed out that as the IOM has a reciprocal pension arrangement with the UK, which benefits the ‘transfer’ of residents between the two jurisdictions, any scheme would need to be similar to the UK’s.

Mr Teare was asked about the National Insurance people pay, as only income taxes and VAT had been discussed so far.

Mr Teare explained that actuaries have determined that the NI fund is ‘stable’ at the moment; and to a later question about public sector pensions said they are looking at investing to build up assets to help fund pension payments in the future.

It was then suggested to Mr Teare he look at how the health service is run in France, which it was claimed is very well run and provides a quality service. Mr Teare responded by saying that there is a charge at the point of delivery and do we want that in the IOM?

“You are the Minister, do you want it?” came the rebound question; but Mr Teare just said he couldn’t “push water uphill”.

The role played by drugs and alcohol in society, and the costs both financial and to the ‘health’ of the nation drew several contributions.

Perhaps employers should be ‘educated’ to be ‘nicer’ to their employees as a ‘happy’ worker would be less likely to be ‘stressed’ etc, less inclined to take drugs or to drink excessively, was one suggestion.

DHSS political member Dudley Butt MLC responded tongue-in-cheek that it sounded as though employers are responsible for the Island’s drink and drug problems. On a serious note, he said that he had got in trouble before, for saying, at previous public meeting, that the Drug & Alcohol Strategy was a failure. He stated that research has shown people in the IOM drink 20% more than in similar jurisdictions elsewhere and it is a serious problem that the DHSS is trying to deal with. He said it is intended to open up a ‘proper’ drug and alcohol unit in due course.

It was pointed out by a member of the audience that it has been calculated that ½% of the population has a drug a problem and that it costs £45k to treat one patient therefore any delay in introducing a service was not a good cost/benefit.

Mr Butt replied that he is aware that they can save £7 for every £1 spent in this area.

Onchan Commissioner, Derek Crellin and Braddan Commissioners’ Chairman, Margaret Hodge raised the issue of anti-social behaviour being linked to alcohol, the increased amount of drunkenness, and the easy access to alcohol.

Both Mr Teare and Mr Butt acknowledged the problems, and that the way alcohol is promoted, aprticularly in supermarkets, is an issue to address; as is the tendency of the younger generation to see getting drunk as normal.

A Cross Roads for Carers ‘representative’ asked Mr Teare if he will match the support offered in the UK; which is currently 76% compared to 44% in the IOM.

Andrew Swithinbank, Director of Social Services explained that the DHSS is trying to avoid duplicating services provided by the voluntary/private sector and are working on a three year plan. This, he said, will enable them to help each other and make best use of budgets.

The issue of how to pay for care in old age was hotly debated and it was pointed out that there is a crisis in care in Eire as old people are being denied insurance; either through insurance companies refusing insurance or the premiums being unaffordable.

Mr Teare said they are employing ‘blue-sky thinking’ with regards to this issue, and that nothing is set in stone; and that they are trying to focus on solutions that may be acceptable to everybody.

Questions over the regulating of care homes to prevent ‘customers’ being ripped off or poorly treated drew the response that a new Bill was expected in the next parliamentary session. It was pointed out that this was needed soon to hopefully avoid a similar scandal involving adult care that had occurred with child care.

Changing subject, it was asked if the contract with North West Hospitals, for supplying services to Manx patients, was available for scrutiny by the public.

Norman McGregor Edwards, Director of Health Strategy and Performance, stated that it was no secret but, as it was made up of several contracts about a foot thick, if the questioner could be more specific then they could show them the appropriate part.

In answer to further questioning, he explained that the contract set out that Manx patients were entitled to exactly the same standard of care and priority as UK patients - and if there is a hint that this is not the case it would be a very serious issue; - as the IOM pays approximately £6m a year for this service.

Braddan Commissioner and Chairman of the Liberal Vannin Party, Kate Beecroft put to Mr Teare that he had said that he expected funding difficulties for 2-3 years, yet many of the problems he had discussed had a much longer time frame. So she wondered if he was expecting the funding difficulties to last longer than 2-3 years.

“No” he replied, it was not an issue of the current ‘financial climate’ but more one of choosing to plan ahead. He said it may seem unusual for a politician to be looking beyond the next 5 years but he believes the DHSS need to look to the next generation.

It was suggested that extra revenue could be generated by charging more reasonable rates for private patients at Nobles. If it was less than £1600 a day perhaps more people would use the service, as it was claimed that the private wards are often nearly empty.

Mr McGregor Edwards said that the charges were in line with the UK and are fair, and that they are used to offsets the costs of running the NHS.

Braddan Commissioner, Andrew Jessopp put it to Mr Teare that the Chief Minister had recently stated on Manx Radio, when discussing pensions, that the government could afford anything yet he was saying we couldn’t - so who was right?

Mr Teare said the financial situation had worsened since then and the IOM had been caught up on the wave of global economic difficulties.

Mr Jessopp countered by saying the UK and IOM economies are still growing so where is the shortfall in income.

Mr Teare said the growth in income has slowed and that we are now in a new financial era.

Mr Jessopp suggested that perhaps if extra income was required the cap on NI and income tax could be reviewed; but Mr Teare said, although there may be support for hypothecated taxes, he was sure people would rather see a more efficient use of the income already generated first before raising taxes. This was an acceptable response.

An audience member stated that perhaps the Government has a distorted set priorities if it can justify spending £5m on a roundabout, at the QB, when funding was needed by the DHSS.

Mr Teare said he couldn’t answer for the Department of Transport.

It was inquired what had happened about the review of the structure of the DHSS.

Mr Teare explained that when he had joined the DHSS it had been in his mind to restructure but he now sees benefits in keeping the department as it is. However, a reorganisation had taken place to remove some of the strain on the Chief Executive.

The issue of benefits was discussed, particularly for people on low incomes hit by above inflation rises in the cost of fuel and food.

Mr Teare said an extra £6m had been made available in this year’s budget and is being paid out. He added the DHSS is waiting for information from the MEA, about their increases, before deciding what action can be taken to ameliorate the situation.

Darrin Oldham, Deputy Director of Social security explained that the government’s objective is to target benefits to those most in need and it is planned that the poorest OAPs in the IOM should be 10% better off than their UK counterparts. He continued that it is the intention to keep pace with the UK; but it is down to how much the Island can afford.

David Callister asked the audience to vote on a couple of occasions, one of which was on means testing benefits, but the audience responded by asking which ones. In the end a specimen vote on child benefit appeared inconclusive either way.

He did not bother pursuing a vote on paying for prescriptions as he quickly got the message the proposal wouldn’t get much, if any, support.

Mr Teare also suggested that free eye tests are under threat but it was pointed out to him, by a lady from Manx Blind Welfare, there are benefits of having people tested for free, as issues could be identified and treated sooner.

Screening was dealt with by Chief Executive, David Killip who explained that it was included in GP contracts; but that they are concentrating on the areas that have proved to be effective.

Andrew Jessopp and Mrs Hodge both raised the issue of oral health, particularly in light of the recent ‘failed’ consultation on fluoridation of the water supply.

Mr Jessopp wanted to know what the DHSS planned to do now and whether the NHS dentist recruitment was as successful as being claimed by the department. Mrs Hodge wondered if the DHSS had conducted any research to see if there is any correlation between the incidence of dental caries and the increasing problem of obesity.

Mr Teare said that the fact that 9 times more children, in the IOM, ended up having extractions under general anaesthetic, than in Manchester, demonstrated that some thing had to be done; not that he said what current thinking is in the department. He said that the waiting list is down to 1400 people but that the recruitment of more NHS dentists had resulted in more people, who had gone private, wanting to go back into the NHS.

As for Mrs Hodges question, he said you only have to look at the size of people walking along Strand Street to see what Mrs Hodge was talking about; but no research had been carried out.

It was suggested that perhaps he should review all the ‘sweeties’ etc on sale and display as you enter the hospital as a starting point.

A couple of other points were made along the way, one slightly embarrassing one for the Minister, by a young lady in a wheel chair, who wondered whether they had deliberately chosen the venue, that was difficult to access, to prevent questions from disable people on disability issues.

A shame faced Mr Teare said they would take note of that for future meetings.

Another lady said she wished to say, although the Minister wouldn’t like it, that they practised euthanasia at Nobles Hospital. She claimed that her mother, who had been strong, had been put down in front her and her sister; and she wanted the public to be aware of this.

Mr Teare accepted what she had to say but didn’t comment further.

Overall the evening was very well received by the people in attendance, several saying they had been heartened by what they had heard from the Minister and his team. Others hoped, after the recent P R blunders that the Department would conduct these meetings more often.