Tertiary & remoteness · Islands Observatory

07 · Tertiary care & remoteness — what living behind a sea crossing costs a health system

Public lensWhen your hospital can't provide a treatment, you fly. The system pays for the seat, the hotel and the specialist — and when the weather closes the airport, you wait. This page counts those costs and flights where anyone has published them — and shows exactly where the numbers are missing.

Politician lensThe airbridge is measurable: IoM's flight-cancellation rate has run at roughly twice Jersey's every year since 2018. Yet no jurisdiction publishes weather-closure data, no Scottish board publishes transfer costs, and the IoM's new 5-year air-ambulance contract values are undisclosed. Five ready-made information requests are at the bottom of this page.

Management lensTwo levers appear across all six systems: repatriate activity (Shetland's MRI suite: 842 scans in year one, credited with travel savings — same logic as IoM's tertiary strategy) and manage the corridor (contract design for weather-resilient transfer capacity). The benchmark: Western Isles keeps 93% of unscheduled admissions local.

Headlines

Isle of Man tertiary spend — the detail behind the £26.3m

Isle of Man mental-health placements off-island — 2020 to 2025

Flight cancellations — the weather tax, 2018–2025 (CAA cancellation stats · all-cause · IoM & Jersey only — Guernsey and the HIAL island airports are not monitored)

Cancellation = non-operation announced <24h either side of scheduled departure; weather is not separated out, but winter spikes at island airports are a serviceable weather signal. 2020–21 rates distorted by COVID schedule collapses. IoM 2023: 5.18% (524 flights) — the year the airbridge story broke into Tynwald. Source: CAA Annual Punctuality Full Analysis 2018–2025.

Isle of Man — scheduled patient transfer spend (FOI series)

Elective/scheduled transfers only — excludes emergency air ambulance. 2024-25 incomplete at FOI date (Mar 2025); actuals likely higher. Source: Manx Care FOI 4458173, 12 Mar 2025. On top of this sits £26.3m of tertiary provider spend (Manx Care Annual Report 2024-25, p.73) and the air-ambulance contracts below.

Emergency airbridge — GNAAS missions from the FOI log

The tertiary tier at a glance — IoM first

Remoteness exposure profile — components, deliberately not a score

Why no single number?An honest "remoteness risk score" is not possible yet: the biggest input — how often weather actually severs the corridor — is unpublished for four of the six islands. Rather than invent weights, this table shows each component with its real value or its gap. A column full of dashes is itself the risk statement.

The askEvery dashed cell below maps to a specific information request (bottom of this page). Once HIAL/Ronaldsway weather logs and board transfer costs are released, a properly-weighted exposure index becomes possible — and defensible.

Method noteComponents are incommensurable (a % local-care share vs a cancellation rate) and coverage is asymmetric, so any composite would be dominated by imputation choices. Component-level comparison is the analytically honest form; an illustrative index can follow the FOI returns.

The weather-data gap — no one publishes airport closures

Methodology & data governance notes

Sources. Every displayed figure carries a source string (document + date) reachable by hover, tap or inline chip. The consolidated data layer (observatory_data.js) is generated by script from extraction CSVs in the observatory library; nothing is hand-typed into pages. Primary sources: government/board annual reports and accounts, Audit Scotland/KPMG annual audits, HIS inspection reports, C&AG/JAO reports, DHSC Assessments of Manx Care, Tynwald Hansard and written answers, ONS/NRS/PHS statistics, CAA punctuality statistics, and FOI responses held in the library.

Comparability. Jurisdictions differ in definitions, targets, reporting windows and population bases. Basis lines are mandatory on comparison rows; 3-year rolling averages (small populations) are marked and never silently mixed with single-year rates; derived figures (per-capita, per-1,000, inversions) are labelled derived; DERIVED Sankey nodes state their derivation.

Gaps. Missing data is displayed, not hidden: red chips = no comparable public figure exists; blue chips = published somewhere we have not yet extracted (each maps to a roadmap item). Gaps are findings.

Views. The Public view uses plain language and does not draft formal requests; Politician and Management views expose question/FOI wording and benchmark framing. The view switch changes emphasis, never the underlying numbers.

Corrections. Errors: observatory@coalfinch.com. Build log and change history: see the Roadmap page.