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External Quality Regulation

External Quality Regulation

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The External Quality Regulation project was established within the Health and Care Transformation Programme to support the Department of Health and Social Care (DHSC) with a consistent approach to baseline assessments of health and care services delivered or commissioned by Manx Care.

Recommendation 3 of Sir Jonathan Michael’s Independent Review of the Isle of Man Health and Social Care System called for the services to be assessed regularly by independent, external regulators, at the minimum every 5 years reporting to the DHSC and Manx Care.

Assessment collaboration and benefits

The ongoing communications and engagement between the project stakeholders, has been invaluable throughout the process, from the planning the assessments timeline to collaborating on the methodology and is crucial to the quality and success of the assessments being delivered.

Regulation is fundamental for any modern health and care system to protect the public from harm and to provide confidence in supporting a culture of continuous improvement.

It is used to share best practice, educate, acknowledge good performance and assist in making improvements in the quality of health and care to achieve an integrated, person-centred, high-quality and sustainable health and care system on the Island.

Nuances, recommendations and reports

The assessment frameworks and principles are based on those utilised in England, although adapted to accommodate the specific requirements of the Isle of Man.

The baseline reports highlight notable areas of practice and recommendations for areas of improvement for the service to develop action plans and mitigate any risks whilst the actions are implemented. Where areas for improvement are reported, a subsequent monitoring assessment may be commissioned.

The action plans are the responsibility of Manx Care to create in partnership with the services to deliver the changes with support of the DHSC to provide remediation and assurance with the agreed timescales.

As the islands services are not registered with the external regulators, a rating is not provided and any enforcement action to be taken as a result of assessment findings, belongs to the DHSC.

Each baseline assessment report is published on the DHSC External Quality Regulation website.

The future

Investigation work is progressing and discussions are ongoing to determine which regulators are able to carry out independent baseline assessments of services yet to be assessed.

Private services that do not receive Manx Care funding will not be assessed during these initial baseline assessments. If a service is registered under Regulation of Care Act 2013 (ROCA) they will continue to be inspected by the DHSC Registration and Inspection Team.

Health and care transformation is the number one priority to shape what regulation on the Isle of Man might look like in the future. The baseline assessments can be used to work with Manx Care to agree priorities and deliver improvements to support the Isle of Man government deliver their Island Plan 2022.

Concerns or complaints

Individual complaints from people using services should be directed via the Manx Care complaints process as normal. 

If you are employed in a service and have concerns about the quality of care being delivered, this can be shared directly to the DHSC by email for review and appropriate escalation. All information will be treated confidentially.

More information

DHSC EQR Team can be contacted for further information:

Last updated: 10 October 2023

The Care Quality Commission (CQC)

The Care Quality Commission (CQC) register, inspect and regulate health and social care services in England and were identified as one of the best placed organisations to undertake the initial baseline assessments. Their expertise in regulation and inspection supports the development of independent external assessments. 

A Service Level Agreement (SLA) was signed and CQC were commissioned to assist with recommendation 3 and conduct baseline assessments in adult social care (ASC), primary medical services (PMS - including GPs, dental care, minor injuries and out of hours) plus acute (hospital based) and community services and Hospice care.

CQC were able to assess the majority of the services Manx Care deliver or commission, however there are some that CQC do not regulate and therefore fall outside of their scope.

CQC engagement and activity

Work with CQC on the island was undertaken in three phases.

The initial scoping exercise mapped out the bespoke end-to-end process to fit services on the Island.

CQC staff and specialist advisors held a series of workshops and face to face meetings across Manx Care, DHSC and commissioned services to understand what engagement was required and how CQC would apply its current assessment methodology to the nuances of health and care on the Isle of Man.

Question and Answer (Q&A) sessions were held to communicate directly with the providers, CQC and DHSC regarding the assessments.

A Dental, General Practice and Acute pilot assessment was conducted and the assessment framework shared to be disseminated for feedback.

Phase 1: Validation, scoping exercise, methodology workshops and engagement (July – November 2021) 

Phase 2: Discovery, self-assessment, framework co-production and Pilots (December 2021 – March 2022) 

Phase 3: The initial baseline assessments (April 2022 – March 2023).

What the CQC inspectors assess

Prior to an assessment taking place the DHSC, Manx Care and CQC have been in communication with the service to prepare the documentation for the assessments and discuss the CQC assessment process. There have been no unannounced assessments at any service.

Inspectors assess services to ensure they provide safe, effective, compassionate and high-quality care, taking into consideration the specific requirements of the Island.

Observations and analysis 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

Any assessment day is ‘business as usual’ and management and staff should work as they normally would. Staff can explain clearly to patients and service users who the inspectors are.

As part of the assessment process CQC have contacted people using the services, employees working in the services that observe care, individual care pathways, records, documentation, policies, the locations where people are cared for and assess employee records. This information helps to form the baseline of the level of care being delivered and we encourage this as an opportunity to share your views.

Inspectors followed the 5 key lines of enquiry - Safe, Caring, Responsive, Effective and Well- led and each area was assessed with its own bespoke co-produced framework including the feedback from local area specialists.

If CQC are concerned about people’s immediate safety during a visit, an escalation process is followed, to report the findings to the DHSC and Manx Care to investigate the matter further as outlined in the Manx Care Act 2021.

CQC assessment timeline

Adult Social Care – 24 April to 12 August 2022

  • 43 x Adult Care Homes, Adult LD Care Homes & other Social Care Services

Dental Surgeries – 4 to 15 July and 29 November 2022

  • 13 x Dental Surgeries

General Practice Surgeries – 26 July to 8 November 2022

  • 13 GP Surgeries

Hospice End of Life Care – 31 October to 4 November 2022

Integrated Mental Health – 1 to 4 August 2022 and 31 January to 1 February 2023

Acute (Hospital) and Community Services

  • Comprehensive 3 to 6 October 2022
  • Manx Care Well-led 24 to 28 October 2022

The Well-led assessment of Manx Care is an assessment of; leadership and governance at board and executive team level, overall organisational vision and strategy, organisation-wide governance, management, improvement, organisational culture and levels of engagement.

CQC are a regulator of health and social care in England and do not have enforcement powers on the Isle of Man.

CQC assessment reports

Reports produced by CQC are at provider level for acute/secondary care and location level for all other services. When the factual accuracy process with services and internal CQC quality review is complete, the report is shared with the DHSC and the Manx Care Board. Reports cover CQC’s findings against the five key questions detailed in the assessment frameworks.

Adult Social Care assessment reports

GP Surgery assessment reports

Dental Practices assessment reports

Hospice Care assessment report

Acute and Community Services comprehensive report

Manx Emergency Doctor Service MEDS report

Manx Care Well-led assessment report

Integrated Mental Health assessment report

Isle of Man Inspection Programme Overview report

Manx Care Quality and Strategy 2023 – 2025


Ofsted is the Office for Standards in Educations, Children’s Services and Skills and is a non-ministerial department of His Majesty's government, reporting to Parliament.

Ofsted has been identified and commissioned to conduct the baseline assessments and a Service Level Agreement (SLA) was signed in April 2023 to assist with the continuation of Sir Jonathan Michael’s recommendation 3.

Ofsted are responsible for evaluating and reporting on the quality and effectiveness of the services within the remit of Children’s and Families including the Children’s Residential Care, the Children’s Secure Unit and Social Care and Work Services.

Both Ofsted and the Isle of Man Government are also members of the National Preventative Mechanism (NPM) that monitors and reports on places of detention under The Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). This is an international human rights treaty designed to strengthen the protection of people deprived of their liberty. 

Ofsted are a regulator of children’s and families services in England and do not have the powers to regulate health and care on the Island, any enforcement that may be required remains the responsibility of the DHSC. 

Ofsted engagement and activity

Discussions with Ofsted began early in 2022 with an initial scoping exercise mid-way through the year to map out how the assessments would be approached to work efficiently with the islands services.

A series of online meetings have been held since the initial meeting and a familiarisation visit held at the start of April. Face to face meetings were held with the Children’s and Families Teams and the Ofsted lead inspectors to understand how Ofsted can apply its current assessment methodology to the nuances of health and care on the Isle of Man. 

What the Ofsted inspectors assess

Details of the Ofsted assessment frameworks have been shared and worked on in collaboration with the services, in preparation for the assessments.

The Ofsted inspectors will use the appropriate evaluation criteria as set out in the frameworks:

The inspectors will focus on the experience of the children and young people, including the impact of leaders and managers, whilst taking into consideration the specific requirements of the Island.

There will be no unannounced assessments at any service.

An assessment day is ‘business as usual’ and management and staff should work as they normally would. Staff should explain clearly to service users and families who the inspectors are.

Should Ofsted become concerned during an assessment, an escalation process will be followed, to report such findings to the DHSC and Manx Care to investigate the matter further as outlined in the Manx Care Act 2021.

Ofsted assessment timeline 

Ofsted will begin the assessments at the end of April in the Children’s Residential Care and the Children’s Secure Unit, following shortly afterwards with the Social Care and Work Services in the proceeding months.

Ofsted assessment report

The report is based on the frameworks across the themes and scope of the assessments used to evaluate the services. It contains key strengths, recommendations for improvement and development and in the case of serious or widespread weakness, suggested areas for priority action.

Ofsted Children's and Families services report

Manx Care Summary of Ofsted Headlines and Services Response

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