Financial · Clinical · Operational · Off-Island — how are we doing compared with HCJ, Guernsey HSC, NHS Wales & England and what can we learn
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Reviews and Recommendations
Direct numerical comparison without reading caveats is misleading.
Use the Technical view for methodology notes, data quality flags, and source caveats before drawing conclusions.
Governance data sources. Review recommendations and implementation status drawn from published review reports and FOI disclosures. Avoidable mortality: OECD/Eurostat cause list, age-standardised rate per 100,000 under-75s, ESP2013 weighting. Action register reflects known recommendations only — unpublished reviews not fully captured.
Direct numerical comparison without reading caveats is misleading. Switch to Technical view for methodology notes and data quality flags.
Technical notes. Population-health indicators here are sourced from a mix of national statistics agencies (ONS for England, National Records of Scotland / Public Health Scotland for the Scottish island authorities) and jurisdiction annual reports (Jersey, Guernsey, Isle of Man). Life expectancy figures are not all for the same period, and some Scottish figures are single-sex only (denoted M/F) where only one sex's period life table has been published at authority level for the latest release. Treat cross-jurisdiction comparisons as directional, not exact. Avoidable mortality is the exception: Isle of Man, Jersey, Guernsey and England/ONS all confirm use of the same OECD/Eurostat 2019 joint cause list, age-standardised to the 2013 European Standard Population, under-75s only — these four figures are directly comparable, not merely directional.
⚠ Isle of Wight and Isles of Scilly excluded: This comparator set focuses on small self-governing or quasi-autonomous island health systems (Crown Dependencies + Scottish island council areas) against England as a large-scale reference. IoW and Scilly are NHS England-run systems within the English structure, so they don't add an independent governance comparator in the way Jersey, Guernsey, Shetland, Orkney and the Western Isles do.
If you are struggling, help is available right now. Samaritans: 116 123 (free, 24/7, all islands) · Isle of Man Lifeline: 0808 808 8000 · www.samaritans.org — relevant to the Suicide & Self-Harm Mortality row below.
Population Health — Select Jurisdictions
Cells with a highlighted top border and pointer cursor have a full history — hover for a mini trend, click to add to the comparison chart below.
— Data gaps reflect publication, not absence of a health system: where a cell is empty, the relevant authority has either not published the metric at the same level of detail, or it was not located/verified for this build. Scottish island figures for avoidable mortality, suicide, immunisation and screening are published by Public Health Scotland / ScotPHO / NRS at council-area or board level but were not yet extracted into this comparator.
— Jersey life expectancy — two estimates in conflict: the 83.1-year figure shown (2021–23) comes from this project's Tier-1 comparator workbook. A separate research pass produced ~80.0 years for the same period, proxied from mean-age-at-death data and explicitly flagged by its own source as an approximation pending confirmation against a formal Jersey period life-expectancy table. The two have not yet been reconciled — treat the Jersey figure as provisional until Jersey's own Mortality Report LE table is checked directly.
— IoM avoidable mortality — direction of travel: 2023's rate (204.9) interrupts a long-run decline since a 2008 peak, and reverses 2022's series low (194.4). Isle of Man Mortality Report 2023 (Figure 23) plots a full 2006–2023 trend but only publishes 2022/2023 in tabular form; earlier years (shown dashed on hover/compare) are chart-read estimates, ±10–15 per 100,000.
— Suicide & self-harm — small numbers, and a methodology break: annual counts across all three islands are in the single digits to low twenties, which is why the Isle of Man, Jersey and Guernsey each show 3-year rolling averages (plotted at the window's midpoint year) rather than single-year figures. England & Wales changed its standard of proof from criminal to civil on 26 July 2018 — shown as a dashed segment from that point on hover/compare, and not directly comparable pre/post. Guernsey's figure depends on inquest outcomes: confirmed vs. a higher maximum if all currently open inquests are later classified as suicide. IoM's 2020 registration-year count (24, crude rate 28.2) is a known outlier — the year-of-death count for the same period was 19.
— Infant mortality — mixed confidence: the Jersey (~1.3) and Guernsey (~3.4) figures come from third-party demographic aggregators, not the official Jersey/Guernsey mortality reports used elsewhere in this comparator — treat as indicative only pending direct verification. England's figure (3.9, 2024) is official ONS data. No IoM figure was located this pass.
— Childhood immunisation and vaccination: only England is populated here. The Isle of Man, Jersey and Guernsey do not appear to publish comparable childhood immunisation coverage figures. A fuller immunisation cluster (6-in-1, MMR, PCV, MenB) plus child oral health and dental access sits in the Primary Care ▸ Children's Health tab.
— Weather & transport resilience: ferries and flights carry staff, supplies and locum cover, not just patients travelling off-island — so weather disruption is directly relevant to service resilience, but it's one of the least consistently published figures across these jurisdictions. IoM's ferry reliability figure is genuinely comparable across its two points (98% calendar 2024 → 94% latest 12 months) since both use the same all-cause reliability measure; CalMac's two figures use different methodologies (weather-cancellation % vs. punctuality-point-loss) and are shown as separate facts, not a trend. Flight time, ferry and air rows above are approximate/typical-journey context rather than officially published statistics with the same confidence as the mortality series.
Direct numerical comparison without reading caveats is misleading. Switch to Technical view for methodology notes and data quality flags.
Budget comparison caveats. IoM: £15.6m deficit vs £347m mandate target. Jersey: £30.7m overspend vs £286.2m original Government Plan (but only £2.5m vs £333.4m revised approved budget after in-year reserve allocations). Guernsey: £6.4m overspend vs £234.8m original budget (£416k vs adjusted £235.6m). Jersey original budget excluded £47m of reserves allocated in-year; comparisons should specify which baseline is used. IoM 2024-25 budget = mandate target; excludes DHSC additional claims (£3.6m) and prior supplementary vote.
Budget vs Actual — Latest Year (2024 / 2024-25)
Total Expenditure — latest reported year
Manx Care (IoM) Actual
£362.4m
2024-25 outturn
▲ £15.6m over mandate (4.5%)
HCJ Jersey Actual
£333m
2024 NRE (excl. depreciation)
▲ £30.7m over original plan (10.7%)
Guernsey HSC Actual
£242m
2024 actual expenditure
▲ £6.4m over original budget (2.7%)
Spend per capita
IoM — Per Capita Derived
~£4,314
£362.4m ÷ ~84k pop.
Jersey COFOG total: ~£4,933
Jersey — Per Capita Derived
~£3,213
HCJ NRE ÷ 104,540 pop.
HCJ only; COFOG total = £4,933
Guernsey — Per Capita Derived
~£3,736
£242m ÷ 64,781 pop.
Not published — derived here
⚠ Comparability: IoM and Jersey figures cover different scopes. IoM £362.4m is the Manx Care operating outturn only. Jersey £333m NRE is Health and Care Jersey only (excl. depreciation); the wider Jersey COFOG health total is £515.7m (incl. outpatient subsidies, public health, GP contracts). Guernsey £242m is the Committee for Health & Social Care net revenue expenditure. Population denominators are estimates/mid-year figures and introduce additional uncertainty. Jersey 2023 COFOG analysis shows health at 29.4% of all government spend — highest of 34 OECD comparator nations.
— NHS Wales / NHS England not shown here: NHS Wales 2023-24 total expenditure was £9.9bn for a population of ~3.17m (~£3,125 per capita) — not comparable with island single-body figures. NHS England operates at a different scale entirely (£191bn RDEL). Both are included where individual KPIs allow comparison.
Operating Expenditure Trend — IoM Mandate & Jersey HCJ NRE (£m, nominal)
⚠ Fiscal year mismatch: IoM years run April–March; Jersey years are calendar years. They are plotted on shared year labels for readability only — the periods do not align exactly. IoM 2026-27 is an approved budget (not outturn).
Manx Care mandate (IoM)HCJ NRE (Jersey)Budget / plan
Budget vs Actual — Overspend as % of Original Budget
Cost Improvement Programmes
Organisation
Year
CIP Target
CIP Delivered
Notes
Manx Care
2024-25
£6.3m (2%)
£13.4m (3.9%)
Exceeded target; £11.8m cash-releasing
Manx Care
2023-24
£4.5m (1.5%)
£8.5m
£7m cash + £1.5m efficiency
Manx Care
2022-23
£4.3m (1.5%)
£9.9m (3.5%)
Mainly offset funding pressures
HCJ Jersey
2025
£9.4m
£13.1m
Exceeded target by £3.7m
HCJ Jersey
2024
FRP target
£6.75m recurrent
Part of 3-yr £25m recovery plan
— Guernsey CIP data not extracted: HSC submitted £10m additional budget request for 2024; only £4m approved. Structural deficit context noted in budget documents but no published CIP programme equivalent found.
Direct numerical comparison without reading caveats is misleading. Switch to Technical view for methodology notes and data quality flags.
Technical caveats. ED 4-hour standard: IoM target is ≥76% (not the NHS 95% constitutional standard); Guernsey target is ≥95%; NHS Wales and England standard is 95%. Figures are therefore not directly comparable in terms of target compliance. Cancer: IoM 62-day standard lowered to ≥70% by 2024-25 (was ≥85% in 2022-23 and 2023-24). NHS England met the 70% standard in 2024-25 (71.4%); IoM did not (52.1%). Diagnostics: IoM reports % of patients waiting ≥6 weeks; NHS England reports % receiving test within 6 weeks — metrics are inverses. IoM 58.4% waiting ≥6 weeks = ~41.6% receiving within 6 weeks (NHS England: 81.6%). Waiting lists: IoM cannot measure full RTT; reports two stages separately. Jersey measures 52-week waits from referral to first outpatient only. Metrics are not equivalent.
⚠ Target mismatch: IoM target is ≥76% (local mandate, not NHS 95% constitutional standard). Guernsey target is ≥95%. NHS Wales and England standard is 95%. Compliance rates are shown relative to each body's own standard, not on a common scale.
⚠ Stroke response (IPR March 2024): Only 36% of CVA/stroke patients arrived at hospital within 60 minutes of call (target 100%; YTD mean 49%). This is a significant clinical governance concern not captured in the headline mandate KPIs. No equivalent cross-jurisdiction metric is available for comparison.
Manx Care — ED 4hr
66.5%
2024-25 (Noble's + RDCH)
✗ Target ≥76% — not met
Guernsey MSG — ED 4hr
89%
2024 (median annual)
Target ≥95% — not met; best of peers
NHS Wales — ED 4hr
64.2%
March 2026
✗ Target 95% — not met
NHS England — A&E 4hr
75.0%
March 2025
✗ Target 95% — not met (ambition 78%)
IoM — 12hr ED breaches
4.4%
Noble's 2024-25
▲ Worsened from 2.8% (2023-24)
NHS Wales — 12hr breaches
10,939
March 2026 (monthly count)
▲ +11.5% vs prior month
IoM — Stroke within 60min IPR Mar-24
36%
March 2024 · target 100%
YTD mean 49% · significant miss
IoM — Avg time in ED IPR Mar-24
265 min
March 2024 · target ≤360 min
✓ Within standard
IoM — 12hr trolley waits IPR Mar-24
421
2023-24 YTD total · target: 0
March alone: 43
ED 4-Hour Performance — IoM Trend (% admitted/transferred/discharged within 4 hours)
⚠ Noble's vs system total: Noble's Hospital alone: 57.8% (2024-25). RDCH (Ramsey): 99.8%. Combined system figure: 66.5%. The 95% NHS constitutional standard has not been met in England since July 2015.
Ambulance Cat 1 Mean Response — Cross-Jurisdiction (minutes)
⚠ Methodology break: Jersey switched from Red 1/Red 2 to ARP (Cat 1/Cat 2) in October 2022 — pre/post figures are not comparable. NHS Wales changed ambulance categories from July 2025. IoM and Jersey Cat 1 figures post-2022 use ARP methodology (broadly comparable). All targets: ≤7 minutes mean.
⚠ In-year vs full-year gap (IPR March 2024): The IPR for March 2024 shows 28-day FDS at 79% in that specific month — meeting the 75% target. However the 2024-25 full-year figure is 62.5% (not met). This indicates that performance can exceed the target in individual months while the annual average remains below it; monthly reporting from the IPR should not be read as representative of annual performance. The 62-day cancer standard (referral to treatment) was 68% in March 2024 vs an 85% target (YTD mean 49%) — well below standard throughout 2023-24.
⚠ Standard changed mid-series: IoM 62-day standard was ≥85% in 2022-23 and 2023-24 assessments; reduced to ≥70% in 2024-25 — figures before and after are not comparable on a pass/fail basis. NHS England uses ≥70% and met it in 2024-25 (71.4%). IoM did not meet the relaxed standard (52.1%). Jersey does not publish equivalent cancer waiting time metrics in the same format.
IoM — 28-day FDS
62.5%
2024-25 · target ≥75%
▼ Worsened from 66.9%
NHS England — 28-day FDS
78.9%
March 2025 · target 77%
✓ Target met
IoM — 62-day standard
52.1%
2024-25 · target ≥70%
▲ Slight improvement from 51.5%
NHS England — 62-day
71.4%
March 2025 · target 70%
✓ Target met
NHS Wales — 62-day
57.0%
Feb 2026 · target ≥75%
✗ Target not met
IoM — 31-day (decision→treat)
85.5%
2024-25 · target ≥96%
▲ Improving from 79.6%
Cancer 28-day Faster Diagnosis Standard — IoM Trend
⚠ Attribution gap: DHSC Assessment 2024-25 states: "Current performance reporting does not show whether 62-day breaches were mainly due to on-Island or off-Island delays." On-island diagnostics and off-island tertiary treatment are both potential contributors. Guernsey does not publish equivalent cancer waiting time KPIs in this format.
⚠ Metric inversion: IoM reports the % of patients waiting ≥6 weeks (lower is better, target ≤1%). NHS England reports % receiving test within 6 weeks (higher is better, target 95%). To compare: IoM 58.4% waiting ≥6 weeks ≈ 41.6% within 6 weeks. NHS England: 81.6% within 6 weeks ≈ 18.4% waiting ≥6 weeks. NHS Wales uses an 8-week target and reports median wait separately.
IoM — Diagnostics ≥6wk wait
58.4%
2024-25 · target ≤1% waiting ≥6wks
▼ Improved from 66.1% (2023-24)
NHS England — within 6wks
81.6%
March 2025 · target 95%
▲ Improved from 78% (March 2024)
NHS Wales — median wait
4.6 wks
Feb 2026 · target ≤8 weeks
Median met; 29.8% breach 8wk target
NHS Wales — ≥8wk wait
38,500
Feb 2026 pathways (29.8%)
Target: zero breaches
Diagnostic Waits — Cross-Jurisdiction Comparison (% receiving within 6 weeks, derived where needed)
⚠ Derived figures: IoM figure is inverted from published % waiting ≥6 weeks. NHS Wales converted from 8-week metric. These are approximations for comparison only.
IoM Diagnostic Wait by Modality — 2023-24 YTD (% waiting >6 weeks) IPR Mar-24
⚠ Demand exceeds capacity by 27.7%: IPR March 2024 notes that overall diagnostic demand exceeded capacity by 27.7% in March 2024. Ultrasound is the primary bottleneck. The figure for "% requests completed within 6 weeks" (89.2% in March 2024) counts only requests actually delivered — it excludes the backlog waiting to be seen, making it appear better than the waiting list metric (60% waiting >6wks).
Modality
WL (YTD total)
% Waiting >6 weeks
RAG
Ultrasound (Non-Obs)
2,797
74%
▲ Major breach
Bone Densitometry
157
37%
▲ Above threshold
Computed Tomography (CT)
758
34%
▲ Above threshold
Magnetic Resonance Imaging (MRI)
418
29%
▲ Above threshold
All modalities (combined)
4,130
60%
▲ Target ≤1%
Source: Manx Care IPR March 2024 (2023-24 year-to-date). Total diagnostic requests in year: ~101,413. Modalities not shown (nuclear medicine, mammography, fluoroscopy, NBSS, XA) had insufficient waiting list data in extracted text.
— Guernsey diagnostics: Guernsey radiology: 95% within 6- and 8-week targets in 2024 (96% in 2023). CT 96%; MRI 98%; Nuclear Medicine 100%. Ultrasound 88% (temporary dip to 60% in August). This is markedly better than IoM diagnostics performance — however Guernsey's radiology contract covers a smaller scope (MSG only) and may not include all diagnostic modalities.
— IoM radiology only: DHSC Assessment 2024-25 notes IoM reports radiology only; data for other diagnostic test types (e.g. endoscopy, neurophysiology) is in development.
⚠ Deteriorating trajectory (IPR March 2024 → Annual Report March 2025): At April 2024 (IPR data), 16,547 patients were waiting for a first outpatient appointment with 5,671 waiting >52 weeks. By March 2025 (Annual Report), this had grown to 17,829 total and 6,835 waiting >52 weeks — a 20% increase in long-waiters in 12 months. Average wait from referral to first outpatient appointment was 49 weeks at April 2024. The daycase list also grew: 359 waiting >52 weeks from decision-to-treat (April 2024).
⚠ RTT cannot be measured — IoM: Verbatim from DHSC Assessment 2024-25: "Manx Care cannot currently measure total wait times from referral to treatment due to system limitations. Instead, it reports on two stages of a care pathway: (i) referral to first outpatient appointment, and (ii) decision to treat to definitive treatment. Furthermore, waiting list data may not be reliable because full clinical validation has not yet been completed, meaning reported demand may be overstated."
IoM — Outpatient >52wk waiters
6,835
At 31 March 2025 · target: 0
▲ Up from 5,600 (prior year)
IoM — Total outpatient list
17,829
At 31 March 2025
▲ Up from 16,619
Jersey — Outpatient >52wk
1,307
2025 · target <333
▲ Up from 812 in 2024
Guernsey — Inpatient WL
2,207
Year-end 2024 (contract patients + others)
▼ Down 21% from 2,799 (2023)
NHS Wales — RTT >52wks
105,600
Pathways · Feb 2026
▼ Lowest since Nov 2020
IoM — Urgent GP refs in 6wks
47.2%
2024-25 · target ≥85%
▼ Worsened from 53.4%
IoM Manx Care — Outpatient Waiting List by Specialty (May 2026 snapshot, patients waiting)
⚠ Snapshot data, May 2026: From Manx Care Waiting Times Report (published May 2026). Excluded from this report: Endocrinology, Diabetic Medicine, Clinical Oncology (monitored on separate system). Bar colour = median wait band. RTT Rules not yet applicable.
<13 weeks13–26 weeks26–52 weeks>52 weeks
Patients waiting >52 weeks — per 1,000 population (cross-jurisdiction)
⚠ Metric differences: IoM and Jersey both report first outpatient appointment waits; NHS Wales reports full RTT pathways (referral to treatment). These are different stages of the care pathway. Guernsey reports inpatient waiting list size only, with no >52-week breakdown, so is excluded from this chart. All figures are the most recently published year-end data available per jurisdiction.
Manx Care (IoM) — Mar 2025HCJ Jersey — 2025NHS Wales — Feb 2026 (RTT)
Waiting list size vs >52-week waiters — IoM trend (outpatient)
⚠ RTT measurement gap: Pre-2024 IoM outpatient waiting list data is not available in a consistent format for trend analysis; figures from IPR April 2024 and Annual Report March 2025 are the two available comparable data points. The list grew by 7.7% in 12 months; >52-week waiters grew by 20.3%.
Total outpatient list>52-week waiters
% of outpatient waiting list waiting >52 weeks
⚠ Different denominators: IoM % is of the first-outpatient waiting list. NHS Wales % is of RTT (full pathway) volume. Jersey total waiting list size is not published; % cannot be calculated. Proportions are directionally useful but not strictly comparable.
IoM (outpatient list)NHS Wales (RTT pathways)
— Jersey comparison note: Jersey >52-week count (1,307 in 2025) refers to first outpatient appointment waits only, per ARA 2025. IoM figure of 6,835 is also for first outpatient only. Both populations differ materially (IoM ~84k; Jersey 104,540). Population-adjusted rate: IoM ~81.4 per 1,000 pop; Jersey ~12.5 per 1,000 pop. Direct comparison requires identical case-mix and referral rate assumptions.
— Guernsey comparison: Guernsey MSG reports an inpatient waiting list of 2,207 (down 21% from 2,799 in 2023) and a combined inpatient/outpatient compliance rate of 62% seen within contractual time (target >95%) — but the contractual time standards differ by specialty and are not equivalent to the IoM/Jersey 52-week measure. No Guernsey >52-week figure is published in comparable form.
IoM's safety record is mixed. Serious incidents stayed within the annual threshold for 2023-24 (30 vs <36 limit) and there were zero medication errors in most months. However E.coli bacteraemia exceeded its annual threshold (90 cases vs <72 target), antibiotic stewardship was persistently below standard, and one never event occurred during the year. Data from the IPR (March 2024) and 2024-25 Annual Report are shown together.
Data sources: Safety KPI cards draw from two sources: (1) Manx Care IPR March 2024 (Final v3.0) covering 2023-24 in-year performance; (2) DHSC Assessment of Manx Care 2024-25 Annual Report. These are different reporting periods — 2023-24 (IPR) and 2024-25 (Annual Report). Where both years are available, they are labelled. Guernsey data from Secondary Healthcare Contract KPIs 2024. Jersey does not publish an equivalent integrated safety report.
Serious Incidents & Never Events
IoM — Serious incidents 2023-24 IPR
30
YTD total · threshold <36
✓ Within annual threshold
IoM — Serious incidents 2024-25
37
Annual total · threshold ≤36
▲ Exceeded threshold by 1; up from 30
IoM — Never events 2023-24 IPR
1
YTD (surgical care group)
Declared SI at SIRG 12 March 2024
IoM — Never events 2024-25
0
Annual total · target: 0
✓ Target met (improved from 1)
IoM — Medication errors (harm) 2023-24 IPR
4
YTD total · threshold <25
✓ Well within threshold
IoM — Falls (harm) per 1,000 bed days 2023-24 IPR
0.2–0.3
Monthly range · threshold <2
✓ Consistently within target
Infection Control
⚠ E.coli annual threshold breached (2023-24): IPR March 2024 shows 90 E.coli bacteraemia cases YTD against an annual threshold of <72. This is a governance flag — the threshold was exceeded for the full year. C.Diff came close to its threshold (29 of 30 cases). These are hospital-acquired infection figures; community-acquired cases are excluded.
IoM — C.Diff 2023-24 IPR
29
YTD total · threshold <30
▲ At threshold limit (March: 2 cases)
IoM — E.coli 2023-24 IPR
90
YTD total · threshold <72
✗ Annual threshold breached (+25%)
IoM — MRSA 2023-24 IPR
1
YTD total · target: 0
Threshold 0; 1 acquired case
Guernsey — HAI (C.diff / MRSA) 2024
4 total
All classified unavoidable
All 4 cases deemed unavoidable by MSG
Clinical Process Standards
IoM — VTE risk assessment within 12hrs 2023-24 IPR
90%
March 2024 · target ≥95%
YTD mean 91% — below target
IoM — VTE prophylaxis prescribed IPR
99%
March 2024 · target ≥95%
✓ Consistently above target
IoM — Antibiotic 48-72hr review IPR
83%
March 2024 · target ≥98%
YTD mean 81% — persistent miss
IoM — Hand hygiene IPR
99%
March 2024 · target ≥96%
✓ Target met
IoM — Duty of Candour compliance IPR
100%
March 2024 · target 100%
✓ Target met
IoM — Learning from Death reviews IPR
98%
YTD 2023-24 · target ≥80%
✓ Met for 12+ consecutive months
Pressure Ulcers
⚠ Pressure ulcer trend — IPR 2023-24: Monthly threshold is ≤17 new/deteriorated grade 2+ pressure ulcers. The March 2024 figure of 9 is within range, but YTD total was 176 (at a ≤17/month threshold, the expected annual ceiling is 204). The IPR notes cases include both ward-acquired and deteriorated ulcers. Category 3/unstageable cases trigger Root Cause Analysis investigations.
Pressure ulcers grade 2+ (March 2024) IPR
9
Monthly · threshold ≤17
✓ Within monthly threshold
Pressure ulcers grade 2+ (YTD 2023-24) IPR
176
YTD · annual ceiling ~204 (≤17/month)
YTD mean 14.7/month
IoM — Inpatient falls (harm) 2024-25
0.4
Per 1,000 bed days · target <2
✓ Target met (slight rise from 0.2 in 2023-24)
Mortality
Improving mortality trend at Noble's Hospital: IPR March 2024 shows total hospital deaths declining over three consecutive years: 329 (2021-22) → 279 (2022-23) → 235 (2023-24). The Learning from Death programme has maintained ≥98% level-one review completion for over 12 consecutive months. Age distribution of deaths peaks in the 75-90 year range consistent with population demographics.
— HSMR / SHMI not available: Manx Care does not publish a Hospital Standardised Mortality Ratio (HSMR) or Summary Hospital-level Mortality Indicator (SHMI) equivalent. Raw death counts from the IPR are reported here. NHS England trusts are benchmarked against expected mortality rates; no equivalent benchmarking framework exists for IoM, Jersey, or Guernsey.
Mixed picture across jurisdictions. Manx Care's CAMHS waiting list fell significantly (from 1,205 to 905) after investment in staffing. Jersey's CAMHS generic pathway meets its target (32 days vs <36-day target) but the neurodevelopmental pathway is 71 weeks — massively over the 13-week target. IoM's crisis response and post-discharge follow-up both meet standards.
Technical notes. Mental health service structures differ substantially between jurisdictions (CAMHS pathway definitions, crisis-response target windows, and caseload thresholds are locally defined, not a shared clinical standard). Treat the figures below as within-jurisdiction trend indicators rather than a common cross-jurisdiction scale.
IoM — CAMHS waiting list
905
At March 2025
▼ Down from 1,205 (Apr 2024)
IoM — Crisis response ≤1hr
89.2%
2024-25 · target ≥75%
✓ Target met
IoM — Post-discharge follow-up 3d
97.9%
2024-25 · target ≥90%
✓ Target met
Jersey — CAMHS generic wait
32 days
2025 · target <36 days
✓ Target met
Jersey — CAMHS neurodevel. wait
71 weeks
2025 · target <13 weeks
▲ Up from 55 weeks in 2024
Jersey — Crisis assessed ≤4hrs
94.4%
2025 · target ≥85%
✓ Target met
⚠ Data quality — IoM mental health: Verbatim from DHSC Assessment 2024-25: "waiting list data for mental health services is currently being developed to improve its accuracy." The MH service caseload (5,390) is within target range (4,500–5,500) but reliability is uncertain.
— Guernsey mental health KPIs: Not extracted from the Guernsey Secondary Healthcare Contract KPIs (which focuses on MSG/acute hospital). Community and mental health data would require separate Guernsey HSC reporting documents.
— Scottish island boards: No comparable mental health waiting-time or crisis-response figures were located at Shetland/Orkney/Western Isles board level for this build.
Direct numerical comparison without reading caveats is misleading. Switch to Technical view for methodology notes and data quality flags.
Technical notes. "Patients per GP" mixes headcount and FTE measures depending on source and is not adjusted for part-time working. Guernsey and Jersey primary care (GP and dental) operate on a private fee-per-visit basis with partial state subsidy, rather than an NHS-style registered-list/capitation model — ratios shown for these jurisdictions describe a structurally different system, not a data gap in the same sense as a missing IoM figure.
⚠ Headcount vs FTE: Figures below mix registered-patient headcount ratios (IoM) with FTE-adjusted ratios (England) and an unverified estimate (Jersey). They are directionally useful but not a clean like-for-like comparison.
Patients per GP
Isle of Man 2024
2,689
Up from 1,851 in 2011 (+45%) · 1,848 in 1999 (+45.5%)
89,262 registered patients · 33.2 FTE GPs (down from 47.0 FTE in 2011)
England Dec 2024
~2,309
43.3 FTE GPs per 100,000 · range 2,020 (SW) – 2,560 (London)
FTE GP numbers fell ~5–15% since 2015 depending on measure used
Jersey Unverified
~1,000
"100+ GPs" vs 104,540 pop. — source doesn't confirm scope
Treat as indicative only, not a clean comparator
Guernsey Structural
—
Primary care fully private, fee-per-visit (partially subsidised)
No central patient-list system — ratio not meaningful in same terms
IoM GP Workforce vs. Patients per GP — 1999–2024
⚠ This is a supply story, not just a population story: the registered patient list grew only 15% over 26 years (77,628 → 89,262), while the number of FTE GPs actually fell 21% (42.0 → 33.2, and down from a peak of 47.3 in 2009). The rising ratio is being driven mainly by fewer GPs, not more patients. 2020's FTE count was taken at 30 June (not the usual 31 March) as data collection was disrupted by the COVID-19 lockdown. From the 2025 edition, the publisher of record changed from DHSC to Manx Care.
Source: Isle of Man in Numbers annual statistical digest, Table 9.4/16/18/19 (Dept. of Health & Social Security / DHSC / Manx Care), 1999–2024. Every year cross-checked against at least one other edition where source years overlap; no numeric discrepancies found beyond documented rounding (2007/2008 FTE) and the 2020 collection-date change.
Access & Referral Performance
IoM — Urgent GP referrals seen ≤6 weeks
47%
Target ≥85% · IPR
Measures referral-to-specialist speed, not GP booking itself
England — Good overall GP experience
75.4%
GP Patient Survey 2025 · +1.5pp on 2024
69.6% good experience contacting practice (+2.3pp)
England — Contact success rate
96.4%
Made contact same day, next day, or after 2+ days
GP Patient Survey 2025
Guernsey — Access (qualitative)
—
Described as easy/short-notice access via private system
No quantified satisfaction survey found
Primary Care Model — Structural Comparison
Organisation
Funding model
Registration
Notes
Isle of Man
NHS-style contract via Manx Care
Patient list registration
14 GP practices
England
NHS capitation (Carr-Hill formula) + QOF
Patient list registration
National GP contract
Jersey
Mixed — partial States subsidy + patient fees
Varies by practice
No central register found
Guernsey
Private fee-per-visit, partially reimbursed via Employment & Social Security contributions
No central list
No NHS-style equivalent
— Data gaps: Guernsey's GP headcount and a verified primary-care-only Jersey GP count were not found in public sources. Neither jurisdiction publishes a GP patient satisfaction survey comparable to England's.
GP Continuity of Care
Isle of Man
Jersey
Guernsey
England
Always/almost always see preferred GP or clinician
—
—
—
19%
GP Patient Survey 2025
Sometimes see preferred GP or clinician
—
—
—
43%
GP Patient Survey 2025
⚠ Continuity concern: Combining "always" and "sometimes," fewer than half of England patients with a preferred GP or clinician see them consistently — the first time this has fallen below half since the GP Patient Survey began. Continuity is linked to better medication adherence, higher screening/immunisation uptake, and fewer A&E attendances.
— No comparator: No continuity-of-care survey was found for IoM, Jersey, or Guernsey.
⚠ Reform in progress: IoM figures below reflect a major 2025/26 contract change, not a gradual organic trend — treat the before/after figures as marking a policy intervention, not steady-state performance.
NHS Dental Waiting List — Isle of Man
Waiting list May 2025
6,463
Avg wait: 551 days (adults), 518 days (children)
Waiting list Nov 2025
~1,500
After new GDS contract — 5 of 7 providers signed up
▼ ~77% reduction since May 2025
Additional investment
+£700k/yr
Increased Unit of Dental Activity (UDA) value to providers
Ramsey service expansion
+900
New patient capacity, replacing Grove Mount Dental Practice
Grove Mount handed back its NHS contract
Dentists per Population
Isle of Man Gap
—
No published total NHS dentist headcount found
5 of 7 General Dental Service providers on new 2025/26 contract
England 2024/25
42 / 100,000
24,655 dentists with NHS activity
Varies significantly by ICB region
Jersey Gap
—
Dental Fitness Scheme provides partial subsidy
No headcount or waiting-list data found
Guernsey Structural
—
Dental care fully private
No NHS-style system or waiting list concept
⚠ England access context: The Commons Health and Social Care Committee described a "crisis of access" to NHS dentistry in 2023; the Nuffield Trust concluded in 2024 that "universal dental care has likely gone for good." A 2025 consultation on contract reform (aiming for 700,000 more unscheduled care appointments) is being phased in from 23 June 2026.
— Data gaps: No verified total NHS dentist headcount for IoM despite detailed waiting-list data being available. Jersey and Guernsey dental access/headcount data were not found in public sources.
Adult NHS Dental Access
Isle of Man
Jersey
Guernsey
England
Adults seen by an NHS dentist within 24 months
—
Not published
—
No NHS-style scheme
—
No NHS-style scheme
40%
Jun 2025
— Structural note: Jersey and Guernsey have no NHS-style dental registration scheme, so a "seen within 24 months" figure doesn't apply in the same way. IoM does not publish this statistic despite tracking its dental waiting list closely.
⚠ Clustered indicators: Child-specific measures are grouped here separately from the adult/whole-population GP and Dentistry views, since they draw on different surveys (public health oral health surveys, immunisation programmes) with different age bases and reporting cycles.
⚠ Definitions differ: IoM's 26.6% is described as "decayed, missing or filled teeth"; England's NDEP reports dentinal decay (22.4%) and a broader enamel-or-dentinal measure (26.9%) separately — the IoM figure sits closest to England's broader measure. IoM's own report describes itself as "~3 percentage points above the UK average," using a baseline not specified in the source.
— Local context: One IoM dental practice alone had around 780 children waiting to register. The Smile of Mann supervised toothbrushing and fluoride varnish programme has since been expanded to primary schools in response.
⚠ Measles risk: WHO/UKHSA's herd-immunity target for measles is 95% coverage. England's 89% MMR uptake sits below this threshold; England recorded 2,911 confirmed measles cases in 2024 — the highest annual total since 2012.
— No comparator: No published childhood immunisation coverage figures were found for IoM, Jersey, or Guernsey.
Direct numerical comparison without reading caveats is misleading. Switch to Technical view for methodology notes and data quality flags.
Technical notes. Theatre utilisation: Manx Care reports % of planned sessions delivered (≥85%); Jersey reports elective theatre utilisation (>85%); Guernsey reports % of sessions starting and finishing on time (≥85%). These are different metrics. DNA rate: IoM ≤7.6% target; Jersey <8% target. Guernsey adult FTA rate ≈6% (just within <6% target). Delayed transfer of care (DTOC): Guernsey reports days per month above target (<100 days/month); IoM reports super-stranded patients (≥21 day LOS); not directly comparable. Vacancy rate: IoM notes its 18%+ figure is overstated due to CIP-related establishment reductions.
⚠ Antibiotic stewardship miss (IPR March 2024): 48–72 hour senior medical review of antibiotic prescriptions was 83% in March 2024 (YTD mean 81%) against a ≥98% target — a persistent and significant gap. The IPR noted this as a continuing "cause for concern." This metric is not included in the 2024-25 Mandate KPI set and is therefore not tracked in the Annual Report.
IoM — Bed occupancy (acute adult) IPR Apr-24
91.1%
April 2024 · target ~92%
Overall (incl. non-acute/child): 61.7%
IoM — Theatre utilisation
84.8%
2024-25 · target ≥85%
▲ Improved from 76.9%
Jersey — Theatre utilisation
76.3%
2025 · target >85%
▲ Improved from 63% (2024)
Guernsey — Theatre timing
75%
2024 (start/finish on time) · target ≥85%
▼ Down from 82% in 2023
IoM — DNA rate
9.7%
2024-25 · target ≤7.6%
▼ Improved from 11.0%
Jersey — DNA rate
9.6%
2025 adults · target <8%
▼ Improved from 11% (2024)
Guernsey — FTA rate (adults)
6%
2024 · target <6%
Marginally at threshold
Delayed Transfers of Care — Guernsey MSG (days per month, target <100)
⚠ Major escalation: DTOC has grown from 91 days/month (2018) to 338 days/month (2024). At year-end 2024, 18 patients were in hospital awaiting discharge (12 beds consistently occupied). Guernsey is developing a Supported Living and Ageing Well Strategy. Equivalent IoM metric is "super-stranded" patients (≥21 day LOS: 100/month average in 2024-25, slight improvement from 107).
Agency Staff Costs as % of Total Pay Bill
⚠ Different denominators: IoM figures are from DHSC Assessment KPI tables. NHS England figure is NHS-wide (all trusts). Not directly comparable due to different base populations and mix of staff types. Guernsey and Jersey agency spend data not extracted in comparable format.
HSC increased +31 FTE in 2025. Full HSC breakdown requires manual review of States Accounts 2024 Appendix VII
Jersey (Public sector)
9,560 headcount
—
—
Public sector total; health workers not isolated. Private ed/health/other sector: 7,370 headcount (not comparable)
NHS England
—
—
—
Leaver rate 10% (lowest in decade); agency 2.3% of pay bill; workforce grew 2.6% YoY to Jan 2025
— Workforce data gaps: Comparable FTE-per-1,000-population or nurse-per-bed metrics could not be constructed from available sources. Each jurisdiction uses different workforce classification systems. Detailed Guernsey HSC staffing breakdown requires Appendix VII of States Accounts 2024 (PDF truncated during extraction).
Demographics & Primary Care Access
Dependency Ratio — Total / Old-Age (% of working-age population)
Isle of Man 2021 Census
58.3% / 33.1%
Youth dependency 25.2% · working-age (15–64) = 63.1% of pop.
Over-65s now 22.0% of residents, up from 21.7% (2016)
Jersey 2024
52.5% / 30.1%
Old-age dependency up from 23.1% (2014)
Projected to reach 64.2% by 2040 (nil migration)
Guernsey 2024
55.9% / 33.5%
Average age 44 (2023), rising ~1 year every 5 years
Highest old-age dependency of the four
England / UK ONS/World Bank 2024
57.9% / 30.8%
Total dependency includes all under-16 and over-64
Lowest old-age dependency of the four
⚠ Definitions vary: "Total" dependency ratios use slightly different working-age cutoffs and methodologies across sources. Old-age dependency ratio (second figure in each card) is the most directly comparable metric across all four jurisdictions — all measure population 65+ against working-age (15/16–64).
▲ FTE GPs fell 21% since 1999 — see Primary Care tab for full 1999–2024 trend
England Dec 2024
~2,309
43.3 FTE GPs per 100,000 · range 2,020 (SW) – 2,560 (London)
BMA cites UK-wide figure of 2,241
Jersey Unverified
~1,000
"100+ GPs" vs 104,540 pop. — source doesn't confirm this excludes hospital doctors
Treat as indicative only, not a clean comparator
Guernsey Gap
—
No published GP headcount found
3 GP partnerships, 9 surgeries — no patient-list data
— GP ratio gaps: Guernsey's GP headcount and a verified primary-care-only Jersey GP count were not found in public sources. Jersey's commonly cited "100+ GPs" could not be confirmed as excluding hospital-based or private specialist doctors — shown here with a caveat rather than presented as clean data.
Appointment Access & Satisfaction
IoM — Urgent GP referrals seen ≤6 weeks
47%
Target ≥85% · IPR
Measures referral-to-specialist speed, not GP booking itself
IoM — NHS dental waiting list
~1,500
Nov 2025, down from 6,463 (May 2025)
▼ New contracts cost Manx Care +£700k/yr
England — Good overall GP experience
75.4%
GP Patient Survey 2025 · +1.5pp on 2024
69.6% good experience contacting practice (+2.3pp)
Guernsey — Access (qualitative)
—
Described as easy/short-notice — private fee-per-visit system
No quantified satisfaction survey found
— No like-for-like access survey: England's GP Patient Survey has no equivalent in IoM, Jersey or Guernsey. IoM's 47% figure measures urgent GP-to-specialist referral speed, not ease of booking a GP appointment — it is not directly comparable with England's contact/experience survey results. Jersey has no published patient satisfaction or appointment-wait data.
Care Quality — Safety Indicators (Manx Care 2024-25)
Never Events
0
2024-25 · target: 0
✓ Target met (1 in prior year)
Serious Incidents
37
2024-25 · target ≤36
▲ Up from 30 in prior year
Inpatient falls — harm
0.4
Per 1,000 bed days · target <2
✓ Target met
Guernsey — HAI (C.diff/MRSA)
4
2024 · target: 0
All 4 classified as unavoidable
IoM Mandate — objectives met
34/75
2024-25
45% of mandated objectives achieved
Direct numerical comparison without reading caveats is misleading. Switch to Technical view for methodology notes and data quality flags.
Technical notes. IoM tertiary spend data: from Manx Care Annual Report 2024-25 Appendix (p.73-75). Point of Delivery (PoD) breakdown is based on NHS tariff categories. March 2025 figures for Christie Hospital and Wrightington Wigan & Leigh NHS Trusts were estimated at time of writing (average of monthly costs to Feb 2025) — final figures available June 2025. Mental health placement counts include patients in long-term placements who may be counted in multiple years; 38 unique patients over 2020-2025 cumulative. Jersey off-island data: qualitative only from P.A.C.3/2025; no financial total for Jersey tertiary expenditure extracted.
IoM Tertiary Provider Spend — 2024-25
Total tertiary spend (actual)
£26.3m
2024-25 outturn
▲ £4.2m over budget (19.1%)
Tertiary budget
£22.1m
2024-25 plan
As % of Manx Care total: 7.3%
High-cost patient count
25
Patients ≥£100k each
Combined ~£4m (15% of total)
Drug spend (tertiary)
£5.0m
2024-25 actual
▲ £1.6m over budget (46%)
ICU/Critical Care
£2.5m
2024-25 actual
▲ 49% increase vs 2023-24
IoM Tertiary Spend by Point of Delivery — 2024-25 (£)
⚠ Estimation: March 2025 figures for Christie Hospital and Wrightington Wigan & Leigh NHS Trusts are estimated at the time of publication (average monthly costs to Feb 2025). Radiotherapy/proton beam treatment is reported under Diagnostics PoD, not a clinical category — slightly overstates diagnostics spend.
IoM Mental Health Off-Island Placements — 2020 to 2025-26
⚠ Counting caveat: Patients in long-term placements may be counted in more than one year's annual snapshot. Total unique individuals across 2020-2025: 38 patients. Annual counts therefore exceed unique patient count. 2025-26 cost data not yet available at time of Tynwald written answer (July 2025).
Unique patients 2020-2025
38
Cumulative total (unique individuals)
Annual snapshots total more due to long-term patients
Cumulative cost 2020-2025
£18.5m
5-year total (derived)
Avg ~£3.7m/year
Most recent year (2024-25)
24 patients
£3.6m cost
▲ Up from 22 patients in 2023-24
Forensic placements
7
2024-25 (court-ordered / prison transfer)
Low/medium/high secure settings
Under-18s off-island (2024-25)
2
Avg stay 23 days
8 unique under-18s across 2020-2025
Avg adult stay (2024-25)
299 days
Down from 357 days (2022-23 peak)
Long-term residential nature of placements
IoM Off-Island Mental Health Placements — Annual Cost & Patient Count
Jersey Off-Island Tertiary Care
Jersey has 50+ arrangements with English hospital groups for tertiary care. An Off-Island Tertiary Governance Committee was established in August 2024 to review these, with the aim of rationalising to the highest-value relationships. Tertiary care was a service-line overspend of £2.4m in 2024 (before reserve allocation). Jersey's Chief Officer of HCJ cited "rising costs of social care and mental health packages, tertiary care contracts and activity for off-island care, and high-cost drugs" as primary unfunded risk categories.
— Jersey total tertiary spend not extracted: A financial total for Jersey's off-island tertiary expenditure was not published in the P.A.C.3/2025 report in equivalent form to IoM's £26.3m figure. Service-line overspend (£2.4m) understates total spend; accessing Jersey's full tertiary spend would require HCJ management accounts.
— Guernsey off-island referrals: Guernsey SS2 KPI (off-island referrals requiring scrutiny) averaged 9 per month in 2024 — up from 5/month in 2023. Most were procedural with referrals subsequently approved. No financial total for Guernsey off-island care expenditure was extracted.