External Quality Regulation

Recommendation 3 of Sir Jonathan Michael’s Independent Review of the Isle of Man Health and Social Care System called for health and social care services provided directly or indirectly by Manx Care to be inspected regularly by independent, external quality regulators, with a report to the Manx Care Board and to the Department of Health and Social Care (DHSC). It was also recommended that the inspections are determined against agreed defined standards that provide assurance yet require the enforcement of the recommendations and support a systematic approach to a continuous improvement.

Following the recommendation, the Care Quality Commission (CQC) in England was identified as being able to assist recommendation 3 and conduct initial baseline inspections of the majority of services in adult social care (ASC), primary medical services (PMS) (including GPs, dental care, minor injuries and out of hours) and the hospitals. DHSC commissioned CQC to carry out these baseline inspections, a service level agreement (SLA) was signed in July 2021 to conduct this work.

The Care Quality Commission register, inspect and regulate health and social care services in England. Their expertise in regulation and inspection to support the recommendation when approached, made them the best placed organisation to undertake a baseline inspection of services provided and/or commissioned by Manx Care and furthermore support the development of an ongoing approach to independent external quality inspections.

The work on the Isle of Man is being undertaken in three phases. There was a period of engagement undertaken by DHSC with the services and key stakeholders on the framework up until the inspections began. CQC have undertaken pilots of the ASC and dental inspection methodology on the Isle of Man at the end of February. The GP and core service pilots have also taken place. 

Details of the three phases can be found below. 

Phase 1: Validation and scoping exercise (July – November 2021) 
This phase involved workshops to map the end to end methodology for delivering inspections across the Island and focused primarily on service-wide and location-level baseline assessments..  

Phase 2: Discovery and self-assessment (December 2021 – March 2022) 
The assessment framework has been  adapted in co-production with services to help them understand what intelligence is available, how they can hear about people’s experiences of care, and understand the quality of care being delivered by services, from services.   

Engagement work commenced with the services in connection with the Provider Information Requests (PIR). 

The DHSC in conjunction with CQC will consult on the framework by: 

• learning what data is available,  
• managing  provider information requests, 
• delivering webinars,  
• undertaking pilot inspections. 

Phase 3: The inspection phase (April – November 2022). This is the inspection phase where CQC will undertake a baseline assessment of the services commissioned and provided directly and indirectly by Manx Care on behalf of DHSC.  

The current timeframes (correct at 17 October 2022 and subject to change) are:  

• The Adult Social Care inspection schedule ran from 25 April to 12 August 2022.
  • 9 x Adult Care Home
  • 27 x LD Adult Care Home
  • 7 x Other Social Care Service

• The Dental inspection schedule ran from 4 July to 15 July.
  • 13 x Dental Practices

• The General Practice inspection schedule began on 26 July and will run to 31 October.
  • 13 x GP Practices

• The Mental Health Sector inspection ran during the week commencing 1 August.

• The Acute (Hospital based services) and Community Services Sector inspection schedule began on the 3 October. The Well-led inspection is due to begin week commencing 24 October.

The Well-led inspection will also be undertaken by CQC of the Acute and Community Services, which is an assessment of: the leadership and governance at board and executive team level; the overall organisational vision and strategy; organisation-wide governance, management, improvement; and organisational culture and levels of engagement.

• The Hospice Care Sector inspection will begin week commencing 31 October.

DHSC have been working across Manx Care to co-develop the assessment frameworks and establish the necessary guidance, so that all services who are being inspected know what to expect and feel supported and confident in the process, as well as understanding its purpose.

This information will be shared with services directly via regular newsletter bulletins and the DHSC microsite. If you are a service provider or member of staff and want to receive the bulletin or please email externalqualityregulation@gov.im including your name and email address to be added to the mailing list. We would encourage all staff working in health and social care across the Isle of Man to sign up, as the information won’t just be aimed at managers. Alternatively, should you wish to opt-out of receiving the bulletin please contact the EQR team on the above email address. 

All services provided directly and indirectly by Manx Care are to be inspected. Although CQC are able to inspect the majority of these services, there are a small number not ordinarily regulated by CQC in England and therefore out of their scope. These include day services for learning disability and older people, community ophthalmic, community pharmacy and some children and family services. Investigation work is underway with other regulators to determine whether they are able to inspect those services that currently sit outside of the scope of CQC. 

Private services that do not receive Manx Care funding will not be inspected by the CQC during these initial baseline inspections. However, if they are registered under Regulation of Care Act 2013 (ROCA) they will be inspected as usual by the DHSC Registration and Inspection Team and further discussions are already progressing to include the inspection of all independent services in the future. 

DHSC have asked CQC to help ensure that services provide people with safe, effective, compassionate and high-quality care, taking into consideration the specific requirements of the Island.

Their observations and analysis will consider all aspects of services including:

• patient safety
• effective governance processes
• the level of compassion and dignity afforded to people using services
• the outcomes following people’s care, treatment and support.

Inspectors will be gathering the views of the people who use services, the employees who work in the services and will observe care, individual care pathways, records, documentation, policies and the places in which people are cared for.

CQC will also inspect employee records in regards to: Mandatory Training, Disclosure Barring Service (DBS) checks, Professional Certificates, evidence of Employment History, References obtained (Yes or No), Indemnity Insurance expiry dates if applicable, photographic Identification, professional registration reference no & date (where applicable), Start Date, Last Appraisal/ Performance review date, Qualification Type and certificate date.

All of this information will help to create the baseline assessment of the overall level of care being delivered.

Adult Social Care

Dental Practices

GP Practices

Frequently Asked Questions

Health and Care Transformation Programme

Care Quality Commission (CQC)

CQC Mythbusters

Regulation of Care Act 2013

Press release – 13 August 2021

Press Release – 31 March 2022 

Press Release – 25 May 2022