Each year, the Department of Health & Social Care (DHSC) sets Manx Care a "Mandate" — a funding agreement that says how much Government money Manx Care gets to run Island health and social care services, and what it's expected to deliver in return. It's the single biggest source of Manx Care's money, paid for by Isle of Man taxpayers and National Insurance contributions. This node shows only the originally-approved amount — where Manx Care went on to spend more than that, the extra is shown separately as "Extra money approved in-year" (see note ⑫).
A media-reported figure of around £404m for 2025-26 covers a wider, gross scope than the £361.8m Mandate figure shown here. This chart shows the Mandate — the funding agreement between DHSC and Manx Care — consistently across all years, not the wider figure.
Alongside the Mandate, Manx Care earns some money itself: staff accommodation charges, retail (e.g. hospital shops), social care charges, and income from treating private patients. This came to £17.6m in 2024-25, up from £15.9m (2023-24) and £14.8m (2022-23) — small next to the Mandate, but real and separately reported. Not fabricated: sourced from Manx Care's audited Annual Report financial statements each year.
CIP stands for Cost Improvement Programme — money saved each year through smarter, more efficient working (better rostering, procurement, reducing waste), not cuts to services. Manx Care has beaten its savings target in every year shown: £9.9m delivered vs £4.3m target (2022-23), £8.5m vs £4.5m (2023-24), £13.4m vs £6.3m (2024-25). CIP figures are shown in cash terms for the year they were delivered, regardless of the constant-prices toggle.
The "Constant prices" toggle removes the effect of inflation so you can compare years fairly, using the Isle of Man CPI (Statistics Isle of Man, IoM Historic Data Sets, December 2025; financial-year averages, rebased to 2024-25=100). With it on (the default), every year's figures are restated in 2024-25 pounds, so you're seeing real growth after stripping out inflation. 2025-26 uses a partial-year average (April–December 2025 only) since the full year isn't over yet. Switch it off to see the original cash amounts exactly as published in Manx Care's own reports.
The panel on the right shows how 2024-25 spending splits by clinical service area, from Manx Care's own Annual Report (p.62). These named categories add up to £267.6m, but Manx Care's own report gives a "Clinical Care Groups" subtotal of £328.6m for the same set of services — a £61.0m gap that isn't itemised anywhere in the published report. We checked this against the original PDF page image to rule out an extraction error: it's a genuine inconsistency in Manx Care's own published table (which also repeats one row — "Women, Children & Family Services" — twice, with two different prior-year comparison figures). We're showing the numbers exactly as published rather than adjusting them to make them reconcile. This breakdown only exists for 2024-25; earlier and later years aren't shown at this level of detail. Figures here are always shown in cash terms, regardless of the constant-prices toggle.
For 2024-25 only, we've split "Medicines, equipment & running costs" into three real, separately-sourced parts: £26.3m on off-Island (tertiary) care — treatment Manx Care sends to UK hospitals because it isn't available on-Island — £413,822 on patient transport (arranging and funding those journeys), and £125.7m of everything else in that category. Earlier and later years don't have this split published, so they show one combined "running costs" figure instead — a genuine difference in available detail, not a rounding choice. Off-Island care is Manx Care's least predictable cost: it rose in 2024-25 partly due to a 3.9% NHS tariff increase.
The lower panel on the right (2023-24 and 2024-25 only) comes from DHSC's own internal Financial Plan, which budgets Manx Care's money across six categories: payroll, agency/contracted/temporary staff, supplies, transport, grants, and infrastructure. Two things to know before comparing it with the main chart: it's the originally approved budget, not actual spend — Manx Care doesn't publish outturn at this level of detail — and it covers DHSC as a whole, which is overwhelmingly Manx Care but also includes a small DHSC-retained residual (strategy, governance, grants to charities — around £11m a year). Because it's an earlier budget vintage, its total won't match the revised in-year budget used in the stats bar above (e.g. £312.1m for 2024-25 here vs £346.8m there) — both are real, correctly-labelled figures, just from different points in the year. Always shown in cash terms, regardless of the constant-prices toggle.
In every year shown here, Manx Care spent more than the Mandate originally set aside. When that happens, the shortfall can't just be spent — Tynwald (the Isle of Man's parliament) has to formally approve extra in-year funding, usually called a Supplementary Vote, before it can be covered. This node is our own calculation of that gap (actual net spend minus the originally-approved Mandate), and it lines up closely with the confirmed figures where we could find them: Manx Care's own Annual Report describes a £30m Supplementary Vote approved in October 2023 covering that year's £31.1m operational deficit, and a £15.3m combined Supplementary Vote position for 2024-25 covering a £15.6m operational deficit (the small differences are because the approved Vote also nets in small underspends elsewhere in DHSC, which this Manx-Care-only chart doesn't include). For 2022-23, Manx Care's report describes an £8.8m "deficit"/"overspend" but we didn't find the specific "Supplementary Vote" wording in that year's document, so we can't confirm the same formal mechanism applied — the node is shown on the same basis regardless, but treat that one year's label as our calculation rather than a confirmed quote.
The ribbons connecting each funding source to each spending category are modelled proportionally: money isn't earmarked source-by-source in the underlying accounts (a pound from patient charges isn't tracked separately from a pound from the Mandate once it's spent). Only the column totals — each source's total income, each category's total spend — are real, reported figures; the individual source-to-category ribbon widths are a standard sankey-diagram convention for splitting a shared pool, not a further data point.
For 2025-26, only the Mandate funding target (£361.8m) has been published — the financial year isn't complete and Manx Care's Annual Report for it isn't out yet. The staff-pay / running-costs split you see for that year is an estimate, based on 2024-25's proportions, not a reported actual. CIP and per-person figures for 2025-26 aren't shown for the same reason.
Uses a constant population estimate of approximately 84,000 across all years shown, for comparability — it isn't adjusted year to year, since we only have a precise mid-year population estimate pinned to 2024-25. Treat year-to-year per-person changes as indicative of spend growth, not population change. Per-person figures follow the constant-prices toggle like the main chart.
These are illustrative modelled projections, not approved Government budgets. Real Manx Care/DHSC budgets are set one year at a time (occasionally three, via Operating Plans) — nobody has approved, or could meaningfully approve, a 2054-55 health budget today. The projection extrapolates recent growth trends forward using a fixed annual rate per category (see the assumptions panel when projections are switched on), compounded every year.
Small rate differences compound into large sums. At the default ~5.1%/yr, the 2024-25 baseline of roughly £362m becomes an illustrative ~£600m by +10 years, ~£980m by +20, and past £1.6bn by +30 — over four times today's figure. A modeller's choice between, say, 4% and 6% growth would swing the 30-year figure by hundreds of millions of pounds. Treat the shape of the trend as the useful information, not the precise long-range £ figure.
What the model does not, and cannot, capture: changes in Government funding policy or Tynwald's own priorities; new medical technology or treatments changing the cost or shape of care; economic shocks, recessions, or unusual inflation spikes; changes in Isle of Man population (a static ~84,000 estimate is used throughout, per note ⑩ — no population growth or ageing is modelled); capital investment needs (Manx Care doesn't hold its own capital budget, so none is projected); and whether the assumed CIP/efficiency savings rate — based on only three years of actual data — can really be sustained for a decade or three.
The off-Island care growth premium is our own modelling addition, not a sourced Government assumption — flagged as such in the assumptions panel. Use these projections to explore "what if recent trends continue" scenarios and to stress-test how sensitive the long-run picture is to the assumptions, not as a financial plan or a substitute for Government's own budgeting process.
Manx Care Annual Reports 2021-22 to 2024-25; DHSC Mandates to Manx Care 2021-22 to 2026-27; DHSC Assessments of Manx Care 2021-22 to 2024-25; Manx Care Operating Plans 2024-25 to 2026-27; DHSC Department Plans 2022-23, 2023-24 and 2025-26; DHSC Financial Plan 2024/25 (Table 1, category-level Manx Care and DHSC budgets); Statistics Isle of Man IoM Historic Data Sets, December 2025 (CPI, for the constant-prices toggle). All published by the Isle of Man Government (gov.im), Tynwald (tynwald.org.im) and Statistics Isle of Man under the Open Government Licence.