Other Information

We make final decisions about complaints that have not been resolved by Manx Care or other service providers of Manx Care Services on the Isle of Man.

We have a three-step process for dealing with complaints.

Step 1 – When you first contact us

When you first get in touch with your complaint, there are some initial checks we do to make sure that we can help.

We look at:

• what and who your complaint is about and what you want to happen as a result of complaining to us,
• what steps you have taken already to get your complaint sorted out.

We need to have a good understanding of your complaint so if we need more information from you, we will let you know. We also explain more about our role and the kinds of things we can and cannot do, to make sure we are the right organisation to help with your complaint.

By the end of step one in our process, you will know:

• more about our role, what we can and cannot investigate, and how we work,
• whether your complaint is ready for us, if we can potentially investigate it, and what will happen next,
• who else might be able to help with your complaint, if we can’t.

How long will this take?

We aim to complete this step in our process within five working days of receiving your complaint. We’ll then let you know if we’re going to look at it in more detail, which is step two in our process. The rest of this guide has more details about the checks we do at step one.

Step one in detail

We look at what and who your complaint is about

The organisations we can investigate, and the types of complaints we can deal with, are set out for us by law.

When you contact us, we look at which organisation you want to complain about and whether we can investigate it. We then look at what you want to complain about, and whether the law allows us to look at those issues.

We can investigate complaints about:

• Manx Care health and social care services
• other health and social care services provided by service providers who are commissioned by and deliver Manx Care services on the Island and are paid for by Manx Care.

These are some of the things we cannot look into:

• healthcare that is not Manx Care funded
• the Isle of Man Constabulary
• Members of Tynwald
• commercial and some contractual issues
• actions or decisions made by any Court
• employment matters.

We’ll talk to you about what you want to happen as a result of complaining to us. We’ll explain our role and the types of things we can do, as well as the things we can’t do. This is so you can see what we might be able to achieve and whether this will resolve your complaint.

These are some of the things we can do and some of the things we can’t do.

What we can do

We can ask an organisation to do certain things to put things right. This can include acknowledging its mistakes and apologising to you.

We can ask an organisation to look again at a decision it has made, but only if it is clear that it made mistakes, acted unfairly, or didn’t follow its process when making it.

We can ask an organisation to take action to avoid the same mistakes happening again, like reviewing its policies or procedures, guidance or standards.

What we can’t do

We can’t make an organisation:

• fire or ‘strike off’ someone,
• pay compensation, in the way that courts and tribunals can.

We can’t make an organisation cancel or change a decision it is entitled to make as part of its responsibilities (about a benefits claim for example), or replace its decision with our own.

We can’t make an organisation change its policies or procedures, guidance or standards, or replace these with our own.

We look at what steps you have taken already to get your complaint sorted out

As we are the final stage for unresolved complaints, we would usually expect you to complain to the organisation you are unhappy with first. This is so the organisation has the chance to look into your concerns and, where needed, put things right for you. Once you have a final response from the organisation you’re unhappy with, if you don’t feel your concerns have been resolved, you can then complain to us.

If you haven’t complained to the organisation yet, we can help by:

• Pointing you in the right direction to help you get started.
• Putting you in touch with an advocate – someone who can help you to put your complaint to the organisation you’re not happy with.

We may also be able to help if you have complained to the organisation already and:

• haven’t had a response by the deadline it gave you, or
• are unsure if you have received a final response.

For example, we can ask the organisation for an update on your complaint or we can ask it to do more to deal with the issues in your complaint.

If your complaint has not yet been all the way through the organisation’s complaints process, we will let you know what stages are left and what you need to do.

What happens next?

If our checks show that we cannot investigate your complaint at this time, we will explain why and let you know who else might be able to help with your complaint.

If our checks show that we can investigate your complaint, and that it is ready for us, we will let you know we are going to look at it in more detail.

This is step two in our process. We will explain what to expect at step two and we’ll give you a reference number for your complaint. We will also tell you when we think we will start step two.

Step 2

The following is about step two in our process - how we decide whether to investigate your complaint.

What to expect: a quick guide to step two

After our initial checks on your complaint, we take a closer look at it to decide if we should carry out an investigation.

This part explains the different reasons why we can’t always investigate the complaints that come to us. If we decide not to investigate your complaint, we will make sure we clearly explain why.

The caseworker handling your complaint will contact you to introduce themselves.

We will read all the information we have about your complaint. We make sure we understand in detail what has happened so far, what you remain unhappy about, how this has affected you (or other people), and what you want to happen as a result of complaining to us.

We will discuss your complaint in detail and will explain more about our role and the types of issues we can look at during an investigation. We do this to make sure you have a clear idea about what to expect from us.

We will also let you know if we need any more information from you (for example, any other documents you may have from when you complained to the organisation), and whether we need to speak to the organisation to get more details.

Occasionally, we may need to get some expert advice (for example, from a medical professional who has had nothing to do with your complaint), or carry out some research, to make sure we have a detailed understanding of the issues. If we need to do this, we will let you know what we are doing and how long that will take.

Our job is to look at all of the facts and to be unbiased and fair to both you and the organisation.

So what does this step look like?

When we have a full understanding of your complaint, we will then look carefully at five key questions.

We look at:

• Who brought the complaint - whether you have suffered personally or been affected in some other way because of what happened, or whether you are making the complaint for someone else.
• Timings - when you first became aware of the problem.
• Whether legal action is open to you.
• Whether there is another organisation that is better placed to deal with your complaint.
• What led you to complain: what did the organisation do wrong, what happened because of this, and what has been done to respond to your concerns?

By the end of step two, you will know:

• if we can resolve your complaint without the need for a formal investigation,
• whether or not we are going to investigate your complaint, and how we reached this decision,
• what will happen next if we are going to investigate your complaint,
• what other options you might have if we are not investigating your complaint.

How long will this take?

We will usually complete step two, and give you our decision about whether we will investigate your complaint, within 20 working days of receiving it through our website, or by email or letter.

The rest of this guide has more details about how we decide whether to investigate a complaint.

Step two in detail

1. We look at who is bringing the complaint to us

We have to make sure the right person is making the complaint. By law, the person who has been affected should make the complaint to us unless this is not possible. You can make a complaint for someone if they cannot do so themselves, for example, if they are a young child or do not have the ability to make a complaint. You can also make a complaint for someone who has died.

If it’s your complaint, you may want to ask somebody else, like an advocate or representative, to support you. This is absolutely fine but we will need to check to make sure you are happy for them to make your complaint for you.

If you are making a complaint for somebody else, we will discuss this with you to make sure they have given you permission to do this.

There are time limits for making your complaint to us. The law says you need to make your complaint within a year of becoming aware of the problem.

2. If your complaint is within 12 months of the complaint arising.

Normally, if we receive a complaint outside these time limits, we cannot investigate it. However, the law does give some flexibility on this and in some circumstances we may still be able to investigate. If you were not able to complain to us in time, we will talk to you about what happened, so we can understand why you did not complain sooner.

We will look at how much time has passed, and whether that means it is still possible for us to carry out an investigation. We will discuss this with you to make sure we take everything into account. If we think that we cannot investigate because of these time limits, we will clearly explain our decision and how we reached it.

3. We look at whether legal action is open to you

We need to look at whether you could get an answer to your complaint by taking legal action - like going to court or a tribunal about the problem. The law says we cannot investigate a complaint if you have (or had) the option to do this. However, the law also says we can be flexible, and so we will look at what the right option should be to get an answer to your complaint.

There are also some things that can only be done by taking legal action, like appealing a cut to benefits.

If we can see that there is (or was) a possible legal route to answer your complaint, we will talk to you about that. We will make sure we understand your concerns and what you want to happen as a result of your complaint. We will also take into account factors such as how much it might cost you to take legal action, and how long it might take.

If it looks to us like legal action would answer your concerns, or be able to give you the outcomes you are looking for, we may decide this is a better option for you.

4. We look at whether there is another organisation that is better placed to deal with your complaint

Some complaints can be looked at by us, and also by other organisations. This includes organisations like the General Medical Council, General Dental Council, or other Regulatory bodies.

If we see that another organisation could also look at your complaint, we consider whether that organisation is better suited to giving you an answer to your complaint and whether it can provide the outcomes you are looking for. We do this to make sure that we can offer you the best possible route to resolving your complaint.

If we think this might apply to your complaint, we will talk to you about that. We will clearly explain what the other organisation does, how it works, and how we think it may be able to offer you a more appropriate route to get an answer to your complaint.

We will also speak to the other organisation to get its views on whether it’s better placed to look at your concerns. We look at whether there is another organisation that is better placed to deal with your complaint.

5. We look at what led you to complain

There are typically three questions we look at here. Before we propose to investigate your complaint, we have to be able to answer ‘yes’ to each of these:

Question 1: Does it look to us like the organisation may have made mistakes or given a poor service?

We are not carrying out an investigation at this stage, so we only need to see some indication that there is something for us to look into. If we cannot see any indication that the organisation made mistakes, acted unfairly or gave a poor service, we would not investigate and we will clearly explain why and how we reached that conclusion.

If it looks like the organisation may have made mistakes, acted unfairly, or given a poor service, we then look at what effect this has had.

If the answer is yes –

Question 2: Does it look to us like the mistakes or poor service have caused suffering or affected you or somebody else in some other way?

When we talk to you about your complaint, we will make sure we understand what happened and how you (or the person you are complaining for) have suffered or been affected.

If we can’t see signs that you, or the people involved, have suffered or been affected in some other way, we would not investigate and we will clearly explain why and how we have reached that conclusion.

If we can see signs that you, or the people involved, have suffered or been affected in some other way, we then look at what the organisation has done already to respond to your complaint.

If the answer is yes –

Question 3: Does it look to us like potentially there is more that needs to be done to address the issues?

We look at what the organisation has done already to respond to your complaint, what action it took (if any), and whether this has already put things right.

We will talk to you about this, to get your view about what the organisation has done to resolve your complaint and why you remain unhappy.

If we can see that what happened has had an impact, which the organisation has not yet fully addressed, then it’s likely we will have good reason to investigate.

If we think that the organisation has already put matters right and has responded appropriately to the issues, we would not investigate and we will clearly explain why and how we reached that conclusion.

Sometimes when we are looking at what’s happened, we might see that your complaint has actually not yet been all the way through the organisation’s complaints process, or that there is clearly more that the organisation could do to respond to your complaint.

If this is the case, we will talk to both you and the organisation to see what more can be done. If necessary, we won’t propose to investigate until the organisation takes more action itself.

If you are not happy after that, you should come back to us and we will look again at the issues.

What happens next?

We’ll do a last check on your complaint before we decide whether or not to propose to investigate. This includes these important practical questions:

Can we resolve your complaint now without the need to investigate?

We always check to see if there is a quicker way to get an answer to your complaint. If we think this is possible, we will speak to you and the organisation about a possible solution.

Are we sure that our proposed investigation will meet your expectations?

We will always make sure that we discuss with you what we can and cannot do in our investigation, and whether this will meet your expectations of what you would like to see at the end.

Are there other issues that mean we cannot carry out an investigation at this time?

We look at whether we could get enough information to help us come to a firm conclusion. For example, if a lot of time has passed, records might have been destroyed.

We also look at whether other investigations or hearings are happening that may affect our investigation. For example, if there is an inquest or if another organisation is looking at something that is linked to your complaint, then we may decide to wait and see if this deals with your concerns.

We will discuss these possible issues with you, so you can see what we are thinking.

Our decision

If we propose to investigate your complaint

We will let you know and the organisation too, so it has the opportunity to comment on the issues you have raised. Following your and the organisation’s comments on our proposal, we will decide whether to confirm our investigation. We will also let you know if there is any part of your complaint that we have decided we will not look at during our investigation. If there is anyone specifically named in your complaint, we will make sure they are aware of our investigation as well.

If we do not propose to investigate your complaint

We will explain why and what information we used to reach that decision.

We will contact you to go through our decision in the way you have asked us to, and we will send you our decision in writing too.

We will also let you know how you can give us feedback about our service. This includes how you can ask for a review of our decision if you think we have got something wrong - for example, if you think we missed some important information when we were making our decision.

The rest of this guide has more details about how we decide to investigate a complaint.

Step three in detail

We make final decisions about complaints that have not been resolved by Manx Care or service providers commissioned by Manx Care on the Isle of Man.

We have a three-step process for dealing with complaints. An investigation is the final step in our process, but not all the complaints that come to us go through to this step.

What to expect from our investigation

How we carry out an investigation may differ depending on what the complaint is about.

But each investigation must follow these five key stages:     

1. Starting our investigation.
2. Gathering the information we need.
3. Evaluating the information we’ve gathered.
4. Explaining our provisional views.
5. Communicating our final decision.

Our role is to look at all of the facts and to be unbiased and fair to both you and the organisation.

By the end of our investigation, you will:

• know exactly what we have been investigating and what information we have gathered,
• have had the opportunity to comment on what we are seeing during our investigation ,
• have our final decision on your complaint and know how we reached it,
• know what we expect the organisation you complained about to do to put right any mistakes or poor service we have found, and by when.

How long will this take?

We complete most of our investigations within 20 days, or if they are complex we aim to have these resolved within three to six months.

For detailed information relating to each step of the investigation, this can be found under this tab in the link titled: ‘A detailed guide to our investigation’.

Stage 1 - Starting our investigation

We start by reading all the information we already have on your complaint and will then contact you to discuss our plans for the investigation in more detail.

We will check our understanding of the complaint with you: what the key issues are, how these issues have affected you (or other people), and what you are expecting from our investigation.

We will then let you know:

• exactly what issues we will look at,
• how we plan to gather the information we need,
• who we think we need to contact for an expert opinion on the issues (including any specialists such as medical professionals or legal advisers),
• how long we think our investigation will take.

We will also check how you would like us to keep you updated during our investigation.

We will talk to the organisation you have complained about too. We will explain what your concerns are and what we are investigating, and we will ask the organisation to give us all the relevant information.

We will make sure that both you and the organisation understand what we will be investigating. We will look at any comments the organisation has given us. Occasionally we receive comments that may mean we decide to change what our investigation looks at, or we may decide not to investigate. For example, the organisation may give us information which shows it has now resolved your complaint. If this happens, your caseworker will discuss this with you and explain what happens next.

By the end of this stage, you will:

• know exactly what we will be investigating and how we plan to do that,
• know how long we expect things to take,
• know how we will keep you updated during our investigation.

Stage 2 Gathering the information we need

At this stage we make sure we get all the information we need to fully cover the issues we are investigating.

We will go through the information that you and the organisation have already given us. If we see any gaps, we will make sure we find the best way to get all the information we need.

The way we do this varies from case to case. Mostly we will look at documents or carry out phone interviews, but sometimes we will carry out face-to-face interviews with you, staff at the organisation you have complained about, or other relevant people. We may also visit the organisation to make sure we get everything we need, for example, if we need to examine large files or get a better idea of how the organisation carries out its work.

Our staff who investigate Manx Care complaints have a good level of experience and knowledge about health and social care services through their training and experience and some are qualified in these areas. That’s why we speak to the relevant health and social care professionals.

We will consider any medical information or evidence you send to us when seeking advice. This may include information you wish to provide from other clinicians. We are also likely to request relevant medical records and information, such as your complaint file, from the organisation.

Throughout this stage we will keep you updated about what information we are getting and what this means for our investigation.

We will share facts with you and discuss what we are seeing. We will also let you know if we need to get more information and tell you when we think we will have all the information we need.

By the end of this stage, you will know:

• what we have been doing to investigate your complaint,
• what information we have gathered, what it is telling us so far, and what other information we may need,
• our next steps and how long these might take.

Stage 3 - Evaluating the information we’ve gathered

What should have happened?

To help us understand what should have happened, we look at how the organisation was expected to act at the time of the events. We look at any standards, legislation or relevant guidelines that were in place at the time.These set out what we expect from organisations when they carry out their work and how they should respond when things go wrong. You can find them on our website.

What did happen?

We will carefully consider whether the organisation has made mistakes, provided a poor service, or not acted properly or fairly. To do this, we will always take account of what information you have given us about what happened and the impact this had on you (or other people), and balance this with other information we have gathered and the organisation’s comments.

If we see that what happened fell below expectations for what should have happened, we then look at how that affected you. If we see that the organisation has fallen well short of what was expected of it, it is likely that we will say that the organisation got things wrong.

However, if we can see that the organisation has only fallen slightly short of what was expected (for example, it did not respond to letters in the time expected but did respond soon after), we may decide that was not enough to mean that, overall, the organisation got things wrong.

What the impact has been

If we see that the organisation did get things wrong, we will then look at what affect this has had on you (or other people).

Whether the organisation has already put things right

If we find that you have suffered or been affected in some other way, we will then look at what the organisation may have already done to put this right. This is a really important part of our considerations. If we think that the organisation has already acknowledged and responded to some or all of the problems we have found, we will take this into account in our final decision.

We will continue to keep you updated about our investigation. We may need to talk to you or the organisation to get more information or get your views as we evaluate the information we have gathered.

We will consider all of the information that you and the organisation have provided in order to start forming our provisional views of your case. At this time we have not made a decision about your complaint, and are happy to consider any further evidence you provide.

By the end of this stage, you will:

• know when we have gathered all the information we need to cover the issues in our investigation
• be up to date on what we are doing to reach our provisional views
• know when we are ready to start forming our provisional views on your case, and what happens next.

Stage 4 - Explaining our provisional views

We will form our provisional views on your complaint so far and let you know when we will be ready to share it with you and the organisation, so you know when to expect them. If we need to get more information before we can form these views, we will contact you.

When we share our provisional views with you we will let you know what we have found so far. At this stage we have not yet reached a decision on your complaint and will consider any further information that either you or the organisation wants to provide. You and the organisation will also have a chance to comment on our provisional views before we reach a decision. Our views are confidential and cannot be shared with anyone outside of those assisting you with your complaint.

They will clearly explain:

• what happened,
• what should have happened,
• whether we believe the organisation got things wrong,
• whether we believe this affected you (or other people) negatively or caused suffering,
• whether or not this has been put right.

Within our provisional views we will explain the decision that we’ll make if we don’t receive any further information from you or the organisation. This will be to fully uphold, partly uphold or not uphold your complaint:

If we fully uphold your complaint: this means we agree with your complaint. It means we found the organisation made mistakes or provided a poor service, and that this has caused you to suffer or affected you in other ways, and that the organisation has not yet put this right.

If we partly uphold your complaint: sometimes we may find that the organisation did get some things wrong, but not all the things you complained about. Or we might feel that the mistakes it made did not affect you negatively. If this is the case, we might partly uphold your complaint and we’ll explain clearly why we have decided this.

If we don’t uphold your complaint: this means we found the organisation acted correctly in the first place, or that it did make mistakes but has already done what we would expect to put things right for you.

If our provisional views are to uphold or partly uphold your complaint we will also explain the recommendations we might make to the organisation to put things right. These could include:

• acknowledging its mistakes,
• apologising to you,
• taking action to prevent the same mistakes happening to someone else and to make services better for everyone.

When we get your feedback, and any from the organisation too, we will decide whether we need to do more work on our investigation. If we do carry out more work we will let you know what we are doing and if necessary we will share the provisional views again. In any event we will make sure we respond to any feedback you gave us and say how we have taken it into account.

By the end of this stage, you will:

• know when we will share our provisional views with you,
• know how we will share them with you,
• have a clear understanding of what we investigated and what our provisional views of your case are,
• see what recommendations we have suggested, where appropriate,
• have the opportunity to feed back to us about our provisional views,
• clearly see what we are doing to take all feedback into account.

Stage 5 - Communicating our final decision

Once we have considered all the feedback and carried out any more work we need to, we will complete our work on your investigation and send our decision to you, the organisation, and any other person or organisation who was involved in the complaint.

We are required to share our reports with the Department of Health and Social Care, Manx Care and the other service provider (where applicable). This step is to ensure the organisation can make improvements to services and that the Department of Health and Social Care are able to check any recommendations have been fulfilled.

This is the end point of our investigation.

By the end of this stage, you will:

• know our final decision on your complaint,
• have a clear understanding of how we made our decision, what information we used, and how we took into account any feedback we received on our provisional views,
• know what action we may have asked the organisation to take

This information explains how to ask us for a review of our decision. You can ask for a review of our decision letter if you are the complainant or the organisation complained about.

The Health and Social Care Ombudsman (the “HSCOB”) makes a decision on each complaint. We do this by taking into account all the available facts and evidence and the views and opinions of both the person making the complaint and the organisation being complained about.

When we consider a complaint, we expect the parties to accept the way we work and our authority to make a decision about the complaint. We will work with complainants and those complained about to make sure the facts of the complaint are accurate and we have enough evidence to make a decision.

It is then for us to weigh up the evidence we have and make a decision. Your complaint may be upheld in full, some upheld or not upheld. We may also decide not to take your complaint forward for investigation.

Asking for a review

If you want to ask for a review, we would appreciate you making this know as soon as is possible.

If you are the organisation complained about, it is important that the review request comes from the Chief Executive (or equivalent) or someone authorised to act on their behalf.

The HSCOB generally looks at all review requests. They will only change a decision if you:

• send new information, and/or

• demonstrate information we used was wrong, and/or

• demonstrate we made a mistake

AND

• it has an impact on the original decision. The HSCOB will not change a decision simply because you disagree with it.

The HSCOB will not change a decision simply because you disagree with it.

New information

If you have new information that we have not seen and feel it could affect our decision, send it to us. The information should be readily available and it is for you to send it. You must explain why you think the new information changes our decision. You must also explain why you did not send this to us sooner, for example, when we sent you our provisional decision.

We may share the new information with the organisation complained about, or the complainant if you are the organisation asking for a review. We do this to give the parties the chance to consider it before the HSCOB makes a final decision on the complaint and issues their response to your review request.

Inaccurate information

If you feel our decision was based on evidence that contains facts that were not accurate, you must explain why and send us information to support your view. The information should be readily available, and it is for you to send it. You must also explain why you did not send this to us sooner, for example, when we sent you our provisional decision.

Mistakes

We are committed to quality, but very occasionally we make a mistake that is down to human error. For example, when working out a time period. The circumstances of each complaint vary, but if you think we have made a mistake, explain it to us, sending any information you have to support your view and we will take another look at it.

Timescales

You should send us your review request and all the supporting information within six weeks of the date of our decision letter. We will not accept review requests made later than six weeks, unless you can show there were special circumstances that meant you were unable to do so.

If you think you will not be able to meet the timescale for any reason, you should contact us as soon as possible to discuss this with us.

If you are waiting for a response to a Freedom of Information request, or a Subject Access request that you consider is crucial to the review of our decision, do not delay sending your review request. You should send it with the information you have and tell us when you made your information request, to which organisation, when you expect a reply and why you think it is relevant to your review request.

If you are unsure about your request for review or how to make it, please contact us to discuss this before you send it.

What happens to your request?

The HSCOB considers all review requests, except where there is a conflict of interest. The HSCOB’s response will tell you whether they uphold the original decision, has changed the decision, or has reopened the complaint for further investigation. This is will be their final decision on your complaint.

The HSCOB aims to respond to review requests on a timely basis.

The HSCOB will publish an Annual Report which will contain information about how many review requests we receive.

Petition of Doleance  

If you want to challenge the HSCOB’s final decision, you will only be able to do this using judicial review proceedings. Petition of doleance review is a form of court proceeding where the Court reviews whether a decision or action by the HSCOB is lawful. You may want to take legal advice before deciding whether this is appropriate in your case.

Health and Social Care Ombudsman Body
PO Box 18,
Douglas,
IM99 1UT

E-mail: HSCOB@gov.im