• HEALTH POLICY & PRACTICE
• NEUROSURGERY
• CLINICAL NEUROLOGY
• NEUROPHYSIOL, CLINICAL

The Isle of Man is a British Crown Dependency in the Irish Sea (figure 1). The population is about 85 000; half were born on the island (true Manxies) and half are ‘come-overs’ (80% from the UK, 20% elsewhere). Manxies are very proud of their independence and resilience. This is exemplified by the Manx flag (figure 2) featuring the three legs of Man (ny tree cassyn in Manx). The Manx motto is Quocunque jeceris stabit (‘Whithersoever you throw it, it will stand’).

The Manx National Health Service (NHS) is broadly similar to those of the UK’s nations. The island has about 40 general practitioners (GPs), who serve as gatekeepers of access to secondary care. There is one main hospital (Noble’s), with 314 beds, just outside the capital city, Douglas. Noble’s is comparable to a small district general hospital in the UK. There is one community hospital at Ramsey in the north of the island.

Much secondary care is delivered by consultants who are resident on the island. Several specialist services (including neurology) are provided by visiting consultants, most of whom are based in Liverpool. There is a weekly 2-day visit by one of two experienced consultant neurologists (Dr Wojciech Pietkiewicz and the author) from the Walton Centre for Neurology and Neurosurgery in Liverpool. The neurologists alternate their visits. Typically, the neurologist flies to the island early on Wednesday morning and returns on Thursday …