The new health minister says he would welcome a national debate about whether some health care should in future be provided off-Island.
Howard Quayle faces a major challenge to put right shortcomings highlighted in an external review of the health service.
A report into three key areas at Noble's Hospital uncovered serious issues, including some said to present 'immediate risk'.
Problems included a shortage of theatre staff, lack of leadership and too few cases for some specialists to maintain their competence to UK standards.
On the positive side, staff were praised for their commitment and dedication.
The report also called for greater clarity as to what the Island should and can provide.
Mr Quayle says a hospital serving a population of less than 100,000 would not normally offer the range of services available at Noble's.
But he says for an Island population, the picture is more complicated:
Link to report: http://www.wmqrs.nhs.uk/download/483/WMQRS-IoM-ED-TA-CC-report-V2.1-20140408_1396968129.pdf