Healthcare/ Manx Care Overspend and underspend pattern


Five‑Year Pattern Summary

Year                                             Overspend                      Trend

2021–2                                       ~£9.9m           High start-up pressure

2022–23                                   ~£17m                              Rising

2023–24                                ~£22.2m                  Peak overspend

2024–25                                  £15.6m        Improvement but still large

2025–26                                   £19m                              Rising


Total overspend since Manx Care was established: ~£75–85 million. Previously DHSC had been underspending and overspending for atleast 10 years prior to the setup of Manx Care, however Manx care was setup to with a view to change this

The overspend is structural, not accidental.

Demand and cost growth are outpacing the island’s funding model.
Workforce shortages and off‑island care are the biggest recurring pressures.
Even with tax increases and supplementary votes, the system remains financially unstable.

There is also underspend on community services, when primary and community care are stretched:

More people end up in hospital
Elective work gets delayed
Off‑island referrals increase
Costs escalate

Manx Care’s overspend is not because the organisation is badly run. It is because the system design is financially fragile:

Small population
High fixed costs
Imported specialist care
Workforce shortages
Rising demand
Limited tax base

What could be done

Funding & tax
Decide openly what level of healthcare we want and raise or reallocate enough money to fund it.

Service model

Shift care out of hospital into GP, community, and prevention, so demand on acute services falls.

Workforce
Cut agency dependence by making permanent roles on the island genuinely attractive and sustainable.

Off‑island care
Renegotiate contracts, tighten referral criteria, and build local capacity where it’s cheaper long‑term.

Governance & accountability
clarify roles (DHSC and Manx Care etc), and intervene early when overspends appear.

Data & public honesty
Publish clear data and have a public conversation about trade‑offs: tax, services, or both.

Long Term Year‑on‑year overspends of £10–£20m show the gap between what’s promised and what’s funded. That’s structural, not accidental. More older people, more chronic disease, more complexity without a big shift into prevention and community care, demand will keep outpacing capacity.