The request sought background information and actions taken regarding the Health Services Independent Review Body (IRB) following a consultation query. The response disclosed DHSC officer feedback on alternative complaint investigation methods, the distinction between whistleblowing and complaints, and plans to implement a two-stage process with potential future oversight by the Tynwald Commissioner.
Key Facts
A simple two-stage complaints process will be implemented, rejecting a three-stage model as not aligning with best practice.
The Tynwald Commissioner for Administration may review complaints regarding maladministration by the IRB to address a current gap.
A new Government-wide whistleblowing policy is being created to clarify the distinction between protected disclosures and service user complaints.
Longer-term policy options include commissioning an external professional group or independent adjudicator for serious unresolved complaints.
Legislation is intended to be amended to allow the Tynwald Commissioner a role in reviewing IRB handling of complaints.
Data Disclosed
28/01/20
217/20
2022-01-11
2022-02-07
66
10
November 2021
April 2021
Employment Act 2006
Original Request
The Appointments Commission minutes dated 28/01/20 (ref 217/20) state "The Commission requested an update from the Cabinet Office any intentions regarding the Social Services Independent Review Body and Health Servicdes Independent Review Body". Please provide further information as the background and action taken.
Data Tables (24)
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Alternative
suggestions for
investigating/review
ing complaints
“an expert external review may be offered… In [redacted] view, a reliable, off Island professional group of investigators specializing in DHSC
complaints (such as [redacted]) could be commissioned to look at all unresolved serious complaints. [redacted] would have access to
reliable experts and be truly independent. [redacted] would be familiar with the complex nature of some complaints and, although
probably expensive, would make sensible recommendations for improvement at an early stage.”
This will be considered as a longer term policy options for an independent adjudicator.
Alternative
suggestions for
investigating/review
ing complaints
“The complaints procedures should align with and connect into professional standards and [professional] bodies. The role of these bodies
and references to them should be understood by staff and patients alike.”
Professional bodies' standards are generally set out in Codes of Conduct, which derive their authority from the statutory basis of
most professional regulatory bodies. There is an argument for the Regulations to include provision that referral to a professional
regulatory body must be considered and acted upon where a complaint indicates non-compliance with a Code of Conduct or other
professional requirement or expectation.
Alternative
suggestions for
investigating/review
ing complaints
“The role of whistle-blowers is not considered anywhere apart from in the motion.”
There is a new Government wide whistleblowing policy being created and due to be consulted upon which will apply consistent
standards across Government. Clarity needs to be given to staff on what should be treated a whistleblowing and what should be
treated as a complaint as they are 2 separate processes.
Whistleblowing is when anyone who provides a health or social care service raises a concern after witnessing an event. They may
have no direct personal involvement in the issue they are raising but want to speak up in the public interest where an act or
omission creates a risk of harm or wrongdoing. These issues are classed as protected disclosures under the Employment Act 2006
and, when reported, should follow the whistleblowing policy and process.
It is important to identify where a non-whistleblowing issue is raised by someone who provides services but the issue is raised in
the capacity of a service user (i.e. where a staff member is receiving services and has cause to compliant about their experience).
This should be handled as a complaint under the complaints policy and procedures.
Where an issue raised in a complaint overlaps with issues raised under the whistleblowing process, the complaint should still be
responded to as a complaint.
Alternative
suggestions for
investigating/review
ing complaints
"Should be 3 stage, local resolution, IRB, Ombudsman."
This suggestion does not align with best practice standards endorsed by the Ombudsman Association. A simple two stage process
will be implemented for handling complaints.
The Tynwald Commissioner for Administration could have a role in reviewing complaints about maladministration by the IRB as
this is a current gap. This will be discussed with the Tynwald Commissioner for Administration and consulted upon.
Alternative
suggestions for
investigating/review
ing complaints
"Actually there are 4 options not 3 - Ombudsman should be contracted from UK ombudsman assn so entirely independent.
Private included-Yes
Review whether processes correctly followed and verdict correct.
Should be ombudsman trained with legal and medical experience.
Reports to holder of complaint -DHSC or Manx care who share it with Minister/Tynwald
Gov contract to external provider for a binding decision on process and verdict."
This suggestion will be considered as part of longer term policy options for an independent adjudicator.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
An independent
adjudicator or
ombudsman to
replace the IRB
“[redacted] see no reason why the IRBs and other issues cannot be restructured in time for November 2021… If the complaint regulations
and the IRB situation is not resolved by November 2021 then [redacted] advice to future complainants would be to bypass the DHSC/Manx
Care complaints system and refer the complaint directly to the professional body… there should be no delay in appointing an Ombudsman
and this should be done by November 2021 even if using the Tynwald Ombudsman for this service is an interim measure. A check on
maladministration will improve the system immediately.”
“[DHSC] have inserted themselves into the complaints procedure issued in April 2021 which is a conflict of interest”
The current vires will allow a joint ombudsman to be formed with statutory timescales for responses and a process for reviewing
complaints set out in legislation. It is also the intention to amend the legislation to allow the Tynwald Commissioner to have a role
in reviewing complaints in relation to maladministration of the IRB's handling of complaints. This would provide a mechanism by
which complainants who experience maladministration causing injustice on the part of the IRB can refer their concerns to a truly
independent arbiter. This would focus principally on the way the IRB has conducted itself in procedural terms, not the substance
of the complaint referred to the IRB (e.g. a care and treatment matter etc.). Limited jurisdiction by the Tynwald Commissioner
would retain the IRB's integrity where its core function is concerned (the 'independent' consideration of health and care
complaints) but provide for administrative justice on the more narrow point of whether the IRB has conducted itself in line with its
statutory remit and responsibilities. This will be an interim measure on the journey towards a process that more closely reflects
statutory arrangements and best practice across the UK nations and internationally.
It is agreed that not all issues may be for service providers to resolve. In cases where an individual is unsatisfied with standards of
conduct, ethics or performance by an individual health professional, it may be for the respective professional body to investigate.
These include, for example the Nursing and Midwifery Council, the General Medical Council, the General Dental Council, the Royal
Pharmaceutical Society, and the General Optical Society. Where serious concerns about a registered healthcare worker are
identified, a referral to the appropriate professional regulator could be made by the complainant and should be made by the
service provider to whom the issue was reported.
The DHSC's role in the complaints will be reset as part of this review of legislation. The Department should not be an active player
in the complaints process in relation to services (as with the DHSC's role in England). It is not a provider of services and the
complaints procedure should only apply Manx Care and its commissioned agents.
An independent
adjudicator or
ombudsman to
replace the IRB
“The Governor [of the IRB] had not read or considered the complaint file properly. Offers to meet repeatedly were denied, the Governor
quoting process. Access issues were not considered by the IRB, their demands quoting internal procedure were impossible to navigate.
Demands that a bereaved complainant review a [redacted] medical records for a third time (which include colour scans of [redacted]
internal organs) is not acceptable on any level but forms the basis as to why my particular complaint was refused… complainants do not
have a right to attend staff panel hearings. In [redacted] case it didn’t get that far but complainants should have that right, perhaps with
the options of submitting questions to staff via the Governor/Panel…
The IRB procedure will be given more transparency by being set out in the Regulations and a statutory requirement for effective
publicity to be given to its procedures will also be included.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
An independent
adjudicator or
ombudsman to
replace the IRB
Please see below list of things that the [Parliamentary and Health Services Ombudsman] provide which the IRB do not.
Public website
Public telephone number
Public helpline
Willingness to discuss queries over the phone
Social media presence (twitter, Facebook, newsfeed etc.)
Annual public reports (currently only to DHSC)
Annual public Accounts (currently only to DHSC)
Annual public open meeting
Public consultations on their service
Internal complaints procedure on their service (IRB have none)
Public statement on their principles
Freedom of information requests (IRB currently claim exemption)
Data protection statements
Ability to investigate public hardship or injustice (IRB do not. They are silent on maladministration)
Leaflet provided at end of service provider process (DHSC advise contact IRB but provide no address etc.)
Internal medical advice (IRB use the director of public health).”
Feedback welcomed on their service (IRB ignore any critical feedback)
User friendly and modern documentation setting our your rights (IRB format has been the same for years and omits certain rights)
Disability /Equality statement
Control over who is employed by them (Comin appoint the IRB, the IRB have no control )
Staff holding relevant qualifications
Internal legal advice (IRB use AG office)
There will be a requirement for the joint IRB to give effective publicity to complaints arrangements within the Regulations, which
would cover having a webpage and telephone number. Other requirements in the regulations will cover a public reports to
Tynwald, contact details for the IRB to be provided by the service provider at the end of the local resolution process, more
professionals and qualified members of the IRB to cover the requirement for medical advice.
Whilst we agree in principle with this comment, some of the information is best practice operational suggestions. The joint IRB will
be encouraged to apply best practice advocated by the UK's Ombudsman Association to its operation. In the longer term, the aim
is to move towards a set up that is more similar to the PHSO but on a smaller scale and appropriate for the Isle of Man context.
An independent
adjudicator or
ombudsman to
replace the IRB
“The IRB are not qualified and do not deal with maladministration, public injustice etc. This is the role of the Tynwald Ombudsman. The IRB
are also not qualified to deal with issues on Candour. The ability of the Ombudsman to review was clearly stated in 33/06… An
Ombudsman should be appropriately qualified with ombudsman qualifications”
It is agreed that the IRB are not currently qualified as they are lay members. It is intended that the revised, joint IRB will be set up
differently with more qualified professionals as members.
There is a duty of candour procedure set out in Regulations for service providers to follow. Any duty of candour incidents that
result in complaints would be reviewed as complaints. Any that are not resolved at local resolution stage will be within the remit
of the revised IRB. Training for IRB members will be required and could cover the duty of candour procedure.
The Ombudsman requirements in 33/06 require an opportunity for an appeal to be made following an IRB review that would be
heard by an independent person outside of the Complaints Panel System. This does not align with the best practice standards
endorsed by the Ombudsman Association. The best practice position is that there should be one independent adjudicator. The
ability of the Ombudsman (in this case the Tynwald Commissioner for Administration) to reopen and reconsider the complaint
after the IRB review would result in the ability to overturn the independent adjudicator's decision. This would have a number of
quite serious implications for the process and undermines the principle that the independent adjudicator is the final neutral port
of call in such a dispute.
However, the ability for the Ombudsman to review complaints about maladministration by the IRB could be included as part of a
review of the legislation and will be consulted upon.
An independent
adjudicator or
ombudsman to
replace the IRB
“IRB annual reports should be every year… Any independent adjudicator should report annually and publicly. The independent adjudicator
should be appointed by Tynwald… Any independent adjudicator should have similar powers of enforcement to that of the CQC.”
Annual reports from the IRB to Tynwald are proposed within the Regulations.
The comments made in relation to the appointment of the independent adjudicator and its powers will be considered for the
longer term independent adjudication solution. However, it should be noted that there is a fundamental difference between
ombudsmen/independent adjudicators and regulators (such as CQC). CQC's powers have mandatory force and non-compliance
can result in legally enforced sanctions. Ombudsmen however can only make 'discretionary recommendations', and this is an
established principle accepted by the Ombudsman Association. Nonetheless, in instances where an organisation resists such a
recommendation, the matters can reported to a responsible body (such as Tynwald) for consideration, or alternatively pursued
through the judicial system. Giving an independent adjudicator or ombudsman a mandatory power of enforcement could result in
legal challenges (e.g. private contractors operating commercially on an independent basis under a commissioned arrangement to
Manx Care).
An independent
adjudicator or
ombudsman to
replace the IRB
In relation to the IRB; “[redacted] cannot recall the appointment process, but again there should be input from the appointments
commission rather than appointment by the Department.”
It will be suggested that the appointments commission appoints the joint IRB.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
An independent
adjudicator or
ombudsman to
replace the IRB
“The jurisdiction of the [Tynwald Commissioner for Administration] over the adequacy of the process can be dealt with expeditiously.”
It is agreed that the Tynwald Commissioner for Administration could have jurisdiction over complaints about the IRB, as otherwise
patients and service users would have no recourse to remedy & redress where the IRB is responsible for maladministration
causing injustice. This will be discussed with the Tynwald Commissioner for Administration and consulted upon.
An independent
adjudicator or
ombudsman to
replace the IRB
The IRB system is truly independent and its retention is a serious option which should be included in the long term policy options. The
Island has a track record of producing highly cost effective solutions - The Financial Services Ombudsman Scheme is a good example. It is
remarkably similar to the IRB system
Agreed that this should be included as an option within the longer term policy options for independent adjudication.
An independent
adjudicator or
ombudsman to
replace the IRB
“Combining the IRBs is the way forward but there has to be a change in their title and how they are set up and appointed to”
Agreed this will be covered in the Regulations.
An independent
adjudicator or
ombudsman to
replace the IRB
The inclusion of all health care providers including private would be welcomed.
Noted and will be considered alongside the responses to public consultation.
An independent
adjudicator or
ombudsman to
replace the IRB
"[Redacted] strongly supports the option of having a stand-alone ombudsman as a separate legal entity. Whether recruitment should be
on Island or via the UK Ombudsman’s Association is a matter for debate when weighing accessibility and cost against independence. We
would not support the options of extending the remit of the Tynwald Commissioner or of the DHSC assuming responsibility for this role in a
regulatory capacity."
Noted and will be considered alongside the responses to public consultation.
An independent
adjudicator or
ombudsman to
replace the IRB
"[redacted] is in favour, in the longer term, of an Independent Ombudsman, independent from the DHSC, that reports direct to Tynwald
and that such a body should cover both Departmental services and Private services."
Noted
An independent
adjudicator or
ombudsman to
replace the IRB
"the IRB is unfit for purpose. Complainants are unhappy as:
they perceive it as biased because the convenors are government paid.
it's slow
it can only make recommendations
there is no feedback loop to check these are adopted
there is no ongoing audit of prior recommendations
there is no appeal
For defendants the process is akin to a 'kangaroo court' where staff are summoned to appear with no 'friend' or union rep allowed to
accompany them for support."
This feedback will be considered for the review of the IRB's process in Regulation. The joint IRB will continue to be paid by the
Government in this interim stage. Timescales will be included within the Regulations to address slow responses.
Recommendations and a feedback loop with the DHSC ensuring that changes are implemented was brought in under the April
2021 Regulations and will be retained and strengthened by also being included within annual reporting to Tynwald. It is
considered correct that there is no appeal against the IRB as the independent adjudicator; however, there should be a mechanism
to raise complaints about the IRB's process in reviewing complaints, which is planned to be via an internal complaints procedure in
relation to the IRB with escalation to the Tynwald Commissioner for Administration. The suggestion for staff members to be
accompanied will be considered for inclusion within the Regulations.
An independent
adjudicator or
ombudsman to
replace the IRB
"As [redacted] Have indicated, [redacted] should like to discuss with you the question of the possible involvement of the Ombudsman’s
Association."
Agreed
An independent
adjudicator or
ombudsman to
replace the IRB
In relation to the Department reviewing complaints as an option instead;
"for “lack of perceived independence” [redacted] should be grateful if you would substitute “perceived lack of independence”."
Agreed
An independent
adjudicator or
ombudsman to
replace the IRB
"If the long term policy is to move to an Ombudsman scheme, will the combined IRB be seen as an interim measure, and if so for how
long?"
Until the NHSCS Bill is completed, current estimation is approximately 3 years. However, the Transformation Programme is
seeking additional resource with the aim to reduce this timescale.
An independent
adjudicator or
ombudsman to
replace the IRB
"The Ombudsman scheme will presumably require ‘full time employees’? Including Contracts of Employment which are outside the remit
of the [redacted]. However, there may be some advantage in employing the [redacted] experience to identify and recommend."
Agree for longer term policy on independent adjudicator.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Complaint made to
the service provider
“The IOM should align their process to the UK, i.e. if a concern is not dealt with in 1 day, it is logged as a complaint.”
The approach adopted in the UK has merit. In instances where a concern is raised by a patient/service user and action is taken
within one day to resolve the matter, it is not regarded as a 'complaint'. This may act as an incentive to deliver an immediate
remedy. It is proposed to include this within the Regulations.
Complaint made to
service provider
“What details?” In relation to when the acknowledgement is sent to the complainant.
The detail will be set out within the Regulations. It is proposed to include:
(i) a summary of the complaint;
(ii) where a complaint was made orally, be accompanied by the written record of the complaint with an invitation to the
complainant to sign and return it;
(iii) details of the service provider’s complaints handling procedures;
(iii) inform the complainant how long they can expect to wait to receive a further response; and
(iv) give the complainant contact details for an individual member of staff acting on behalf of the service provider;
(v) if appropriate, request clarification or further details in writing.
Complaint made to
service provider
About Manx Care being required to set up a PALS and an advocacy service and to consult with the public; “Timescales need to be inserted
for these actions”
Timescales will be set as part of transitional arrangements within the Regulations.
Complaint made to
service provider
The 2 working day timescale for acknowledging a complaint is a laudable aim but is it really practical in a 24/7/365 organisation?
It is proposed to change the timescale for acknowledging a complaint to 5 days to be aligned to the process in England.
Complaint made to
service provider
“Can a Mental Health Tribunal Chair raise a complaint?... Can a coroner raise a complaint?”
Only a person affected by a issue, or a person acting on that person's behalf, can raise a complaint. This is in line with best practice
guidance for complaints handling.
Complaint made to
service provider
“The process of nominating someone to assist or deal with a complaint on someone’s behalf needs consideration… What happens to
someone who has a complaint and retains powers of attorney?... Roles of MHKs in the complaints process. Manx Care approach of ensuing
all political contact goes through the CEO seems a poor use of a CEOs time. The public should not be deterred from approaching MHK’s.”
A complaint can be made by a person affected or their representative if the person has died, is a child, does not have capacity or
has requested the representative to act on their behalf. There is also the proposal to include an independent advocacy service
which would allow people to use an independent person to assist complainants.
How this principle of advocacy is administered in practical terms is an operational matter.
Complaints
regulation for
commissioned
service providers of
health and social
care
“Complaints procedure should be in contracts with overseas service providers/organisations, it is understood some are delaying the
process”
It is intended that the Regulations being consulted upon will require all service providers that provide services under the mandate
to have complaints procedures and arrangements for handling complaints in place that are compliant with the provisions of the
Regulations, unless there is equivalent legislation in place (for example, in England).
There will also be a requirement in the mandate for Manx Care to ensure that there is a complaints procedure for all
commissioned providers. This should then flow through to the contracts with those providers. This would apply to any new
contract that Manx Care puts in place with providers from the date that the Regulations come into operation.
Complaints
regulation for
commissioned
service providers of
health and social
care
"On point (e) in page 5,[redacted] thinkthat the matters youmention canbe dealt with either by specific terms inthe contract under
which the external provider is engaged or a looser arrangement such as a service level agreement. No doubt the civil team in the AG’s
Chambers will have a view on the best way to address it."
Agreed
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Consequences for
breach
“The consequences for breach must come in by November 2021. There is no point in drafting regulations which have no consequences.”
The Department will be held to account through its annual reporting to Tynwald, parliamentary committees and the Tynwald
Auditor General (once appointed).
Inspections of service providers will be carried out by the external inspectors appointed under the Manx Care Act 2021, which may
highlight failings in the area of complaints handling. Such reports will be made public along with Manx Care’s action plan for
addressing the short comings. The Department will hold Manx Care to account in implementing the action plan.
Manx Care will also be held to account via its annual reporting to the Department in relation to complaints. The draft Regulations
require Manx Care to provide such an annual report within 3 months after the end of the financial year.
Ombudsmen (in this case the IRB) can only make 'discretionary recommendations', and this is an established principle accepted by
the Ombudsman Association. Nonetheless, in instances where an organisation resists such a recommendation, the matters can be
reported to a responsible body (such as Tynwald) for consideration, or alternatively pursued through the judicial system. Giving an
independent adjudicator or ombudsman a mandatory power of enforcement could result in legal challenges (e.g. private
contractors operating commercially on an independent basis under a commissioned arrangement to Manx Care). The annual
reporting requirement for Manx Care will include that any complaints where recommendations of the IRB were not acted upon
must be identified within the report and the reasons must be given as to why they were not acted upon. It is also suggested that
the IRB should report to Tynwald on an annual basis and that that report should detail progress against all accepted
recommendations that remain outstanding.
The Department has the power under the Manx Care Act 2021 to direct Manx Care and ultimately to remove Board members.
Formal response to
the complainant
In relation to any remedial action required by the service provider; ““Prompt” is not sufficient, there should be a timescale”.
The actions required under this section could be so variable that it is not considered useful to include a timescale for this action to
be taken. However, it is proposed that the response to the complainant will be required to set out the actions to be taken and a
reasonable timescale for completion of those actions.
Formal response to
the complainant
“Patients should be made to feel their complaint has been valued and not a tick box exercise. Feedback should be provided on how their
input has ensured similar events do not happen again. In addition, at the end of the process standardised feedback forms should be sent to
the complainant asking how useful they felt the complaint process had been. These feedback forms should be included in the annual
report and will highlight if the system is working”
Broader wording will be included which requires service providers to ensure that appropriate mechanisms are in place for
complainants to share feedback about their experience of the complaint handling process.
Formal response to
the complainant
“A commitment to jargon free language would also be a really useful commitment at this early stage. It would also be helpful if response
letters contained balanced information, i.e. the facts that support the complaint as well as the contrary evidence. This is an
acknowledgement that their points have been considered and listened to. Response letters must deal with all of the issues raised by the
complainant.”
It is agreed that this is all important in relation to complaints handling. It will be part of the behaviour and systemic change in
culture that will be encouraged through advocacy for the adoption of best practice standards.
General
In relation to the NHSCS Bill; “timescales need to be accelerated”
The Transformation Programme is looking to recruit additional resource to be able to accelerate the timescales.
General
In relation to inspections; “it only identifies CQC as carrying out inspections – [redacted] understanding is that there will be a number of
regulators working across Manx care services and other providers should the wording not reflect this.”
Agreed - wording changed in policy proposals document and will be reflected similarly in the consultation paper.
General
“some of the statutory responsibilities could be laid out in the regulations and not primary legislation.”
Acts of Parliament and Regulations are all statutory in nature. The former are primary legislation, and the latter are secondary
legislation. Regulations flow from a preceding Act, and are given force by the relevant Act. The responsibilities for complaints
handling in relation to services and the IRB's responsibilities can be set out in Regulations and so will be statutory responsibilities.
The DHSC's responsibilities in relation to complaints can not be set out in statute as the current Acts only refer to functions in
relation to services.
General
“Complainants may be timed out of complaints to GMC etc. because of the length of time it has taken Manx Care/DHSC and the IRB to deal
with the complaint.”
Referrals to professional regulatory bodies by the public is a separate matter not directly related to the operation of the NHS
complaints process. However, this could be covered by guidance issued by the DHSC to make the public aware of all avenues in
relation to pursuing a complaint. In relation to the specific example given it is noted that the GMC website states that "There is no
time limit for raising a concern."
General
“Access to Health Records and Reports Act 1993.
At the moment the Information Commissioner is unable to assist with complaints regarding the aforementioned. This Act is used by the
bereaved to obtain medical records for the deceased. This leaves the bereaved in a position of seeking legal advice which is not acceptable.
This situation needs to be addressed by November 2021.”
Changes to the Access to Health Records and Reports Act 1993 is not within the scope of the review of Complaints Regulations but
will be looked at in a future review of primary legislation. Consideration has been given to the joint IRB having the correct data
sharing permission to be able to access the records necessary to complete a review of the complaint.
General
“as a KPI of the process is the length of time it takes for the hospital to release records. Complainant should not be required to make their
complaint without being able to consider the medical evidence.“
"How does technology development comes into it? Especially direct access to medical records."
"Records of complaints. Amendments to patient records. Destruction of complaint records."
There are processes through which complainants can access medical records; however, these may not always been fully
understood. The additional advice function suggested for the DHSC and the introduction of a PALS service should help the
complainant to navigate the processes more easily. The extended time frame for making a complaint should also ensure that the
length of time it takes for the hospital to release records does not prohibit complainants from making a complaint. Consideration
has also been given to ensuring that the joint IRB will have the necessary access to records to be able to conduct a review of the
complaint and it is the intention to include a standard response time for records to be released.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
General
“Funding for legal assistance where required, including legal aid.”
“When can Manx Care / DHSC appoint legal advice and how then can / does the complainant respond.”
This is not a matter for procedural reform.
General
Tacit acceptance that complaints are not being appropriately handled and learning not taking place is implied by the suggested actions to
address this. [Redacted] are concerned that, although progress has already been made, the required changes are still urgent and must
continue to be made alongside this consultation process, regulation changes and ultimately new legislation.
[Redacted] suggest that the Introduction could reference Duty of Candour within the Manx Care Act, since this process and its
consequences are a good example of the outworking of these principles (be seen to deliver).
Agreed that current complaints handling will continued to be looked at through the assurance process and through advocacy for
the adoption of recognised best practice standards.
General
Comment that recommendation 4c is unclear which states "c) include a role for the Department's in offering advice and guidance on how
to progress complaints for health and social care services complaints across the whole national health and social care system in the
arrangements set out within the revised complaints Regulations";
Noted and will be clarified for the consultation paper.
General
"[Redacted] strongly agree with Rec 6 but request clarity on who would decide what is adequate, and how; and ditto for appropriately
trained. Perhaps the application of these requirements would be picked up through the work of CQC’s audits?"
Recommendation 6 states; "The Department should include the following requirements within the Regulations for public consultation:
a) for the complaints function of a service provider to have adequate and appropriate expertise, resources and authority to carry out its
activities effectively; and
b) that all staff of service providers are appropriately trained and supported to deal with complaints (similar to a provision within the Duty
of Candour Regulations)."
It would be for the service provider to document what is adequate and appropriate for its business. It would also be picked up
through the assurance process and external inspections that are required under the Manx Care Act 2021.
General
"Rec 7 is important. Whilst the extent to which offloading from DHSC to Manx Care will almost certainly be questioned in the consultation,
this section makes accountability lines crystal clear. Such a clause would hopefully be worded tightly enough to avoid some of the past
difficulties with nailing down names and departments for accountability."
Recommendation 7 states; "The Department will be held to account through its annual reporting every year to Tynwald and the Tynwald
Auditor General (once appointed). Inspections of service providers will be carried out by the CQC and may highlight failings in the area of
complaints handling. Such reports will be made public along with Manx Care's action plan for addressing the short comings for correction.
The Department will hold Manx Care to account in implementing the action plan. The Department will also hold Manx Care to account in
implementing the recommendations of the IRB(s). The Department has the power under the Manx Care Act 2021 to direct Manx Care and
ultimately to remove Board members. The Department should outline its policy in relation to accountability and breach of the
requirements as part of the public consultation, as outlined above, and invite feedback on the adequacy of the current approach. It is not
recommended that additional consequences for breach are contained within the Regulations being prepared for November. However, it is
expected that feedback will be received as part of the consultation process that could be considered as part of the policy for the NHSCS
Bill."
Noted
General
what are the accepted inadequacies and who says so?
The accepted inadequacies are those that were referred to in the Tynwald debate on the motion in April 2021. If this wording is to
be retained as part of the consultation paper, this will be explained and consideration will be given to ensure that the wording is
such that it is sensitive towards staff members that currently handle complaints well.
General
"[Redacted] believe that this document presents a framework which has the potential to inspire confidence in service users. The
consultation will provide further reassurance of the DHSC’s commitment to cultural change and accountability. Whilst [redacted] agree
with the proposed time frame for the urgent delivery of Stage 1 [redacted] believe that success will require a united ‘push’ and sufficient
resource for this to happen (see also [redacted] comments under Policy above."
Noted
General
"[Redacted] has a legal obligation under [redacted] to investigate any complaint made to it by a patient detained under [redacted]. Unless
this is amended by statute, the new complaints policy will need to accommodate this statutory requirement and, at present, [redacted]
can see no reference to this."
Agreed
General
"in the long term legislation the “Duty of Candour” should be enshrined in the legislation as it is in the U.K."
A duty of Candour for the Department of Health and Social Care and Manx Care was brought in by the Manx Care Act 2021. The
Manx Care (Duty of Candour Procedure) Regulations 2021 sets out the procedure to be followed if an incident occurs that causes
harm to a service user.
General
"The Local Resolution process works very well and the timescales are flexed when common sense dictates."
Noted
Topic
Issue/Feedback/Query from consultation
DHSC officer response
General
[Redacted] provide governance, however the appointments commission have decided that no one with a clinical qualification or NHS
employment can provide this governance. It's akin to you saying no one with a banking or economics training can be on the Financial
Services Authority regulating the finance service. [Redacted] do well, but cannot scrutinise deeply because of this lack of knowledge.
Perhaps [redacted] should have non island medical practice so there is no conflict."
The membership of the HSCC is not within the scope of this review.
General
In relation to the recommendation that the Department have an assurance function over complaints about Manx Care;
"Intermsofthe first paragraphonpage 3, [redacted] wonderedwhether the Department willbe seenassufficientlyindependentfrom
ManxCaretohandlethecomplaintsprocess.although[redacted]realiseitmustbeinvolvedinaddressinganyseriousfailingonthepartof
Manx Care if that gives rise to a need to amend or amplify the latter’s mandate."
General
"At the foot of page 3 the reference to the Select Committee has become mangled. [Redacted] think that the reference to “the 2006
Petition of Doleance/Redress” should actually be a reference to the 2006 Select Committee of Tynwald on Petition of Redress."
Agreed
General
In relation to the recommendation that the Department has an advice role;
"[Redacted] wonder what you envisage as the Departmental role in advising on complaints to be. Do you have in mind imposing a duty on
the Department to draw the attention of service users to the procedures by which they can pursue complaints. If so, might [redacted]
suggest you say exactly that?"
Agreed
General
"on page 9, should the reference to the NHSCS Bill actually be to the Reform Bill as you have defined that earlier on?"
Agreed
General
"The first concern [redacted] have isto ensure independence for the unit conducting investigationsfollowing the initial internalreview.
YouwillnotethatinTynwaldCommissioner’scaseTCA1904,theDepartmentconsideredthat [redacted],ratherthantheSocialCareIRB
should investigate the complaint because the IRB was not perceived to be sufficiently independent of the Department."
That report states that the "DHSC thought that the “preferable route” would be for me to review the complaints rather than a
reference to the IRB because Mr G was unlikely to perceive the IRB to be “impartial” or “unbiased”. The complainants perception
of the situation does not necessarily mean that the IRB is not independent. Care is being taken to make the joint IRB as
independent as possible within the current vires - it is proposed to be a stand alone body, appointed by Appointments
Commission. It will be funded by the DHSC; however, it will no longer be reviewing complaints about the DHSC as the DHSC is not
anticipated to be a provider of services. A more independent adjudicator is being considered as part of the longer term review of
primary legislation.
General
"The very exercise you are undertaking may not inspire confidence in those aggrieved about their treatment if it is perceived to be a DHSC
Departmental Review."
Noted
General
"Althoughyoudonotsaysoexplicitly,[redacted]inferthatyouenvisagetheRegulationscontainingsomethingakintotheGDPRprovisions
on the functions of data supervisors giving those responsible for handling complaints direct access to the highest levels in the relevant
organisation and the right to act with fearless independence in dealing with problems. Have [redacted] understood correctly?"
There appear to be two issues discussed here. The first concerns compliance with GDPR obligations in the context of complaint
handling, which is a matter that is being considered within the Regulations. The second is the matter of complaint handlers and
investigators having the appropriate level of authority to pursue their inquiries without obstruction. It is intended that there will
be a requirement within the Regulations that the complaints function of a service provider should have appropriate authority to
be able to act independently in considering a complaint.
Handling of the
complaint by the
IRB
Indicated a preference for “statute” in relation to whether to put in statute or to alternatively make it subject to approval of the
Department, COMIN or Tynwald for the standard considerations for IRB to decide whether the complaint should be considered further.
Suggested standard considerations to be within Regulations:
(a) the complainant is not directly affected by the subject matter of the complaint;
(b) the service provider has reached a resolution with the complainant which is fair and reasonable in the circumstances;
(c) the complaint has been the subject of a decision on the merits in proceedings in any court;
(d) the complainant has or had a right of appeal, reference or review to or before a tribunal constituted by or under any
enactment;
(e) the complaint has been properly considered under any enactment or arrangement providing for the resolution of disputes or
the investigation of complaints;
(f) the complaint would more suitably be dealt with by a court or under an enactment or arrangement referred to in sub-
paragraph (e); or
(g) the complainant has not exhausted the service provider’s internal complaints procedure.
Handling of the
complaint by the
IRB
Suggested that the IRB should be required to explain the reasons "why" when a decision is made not to consider the complaint any further.
This is already a statutory requirement and will be retained.
Handling of the
complaint by the
IRB
“There should be no discretionary power for the IRB… the requirements for considering complaint should be laid out in regulations and not
up to the current Governors personal opinion of the complainant.”
Agreed that the requirements for considering a complaint will be included within Regulations, although the use of discretion on a
justified basis could be included for in instances where the IRB takes a decision that is not consistent with the established
approach, but reasons are set out in writing for the departure from precedent. This would most commonly occur in situations
where an adverse impact might arise for a complainant as a consequence of a rigid application of 'rules'.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Handling of the
complaint by the
IRB
Whilst there is no problem with setting timescales they do need to be realistic. A case can involve a Convenor studying hundreds of pages
of sometimes disorganised and sometime illegible documents. Speeding up the process of review can only be achieved if Manx Care
resolves it keeping. At the start of addressing a complaint the Convenor should expect to receive an ordered file containing all of the
relevant data.
It is intended to include a requirement that the service provider must provide the information in good order and by the time
requested as part of the Regulations.
Handling of the
complaint by the
IRB
Complaints to the IRB can often be made in parallel with other procedures; notably (but not limited to) Inquests. Whilst the current
Regulations deal with the issue of a complainant who takes legal action against DHSC (and now Manx Care), they are silent on other legal
processes. The current provisions should be retain ed but should be strengthened to provide primacy for the Courts. The Financial Services
Act 2008 deals with the primacy of the High Court in Schedule 4. It is suggested that the new Regulations should provide a similar power to
any Court. This power is particularly relevant to the Coroner of Inquests who should have clear primacy.
We agree that the primacy of the judicial system is an accepted principle which should be reflected in the Regulations.
Handling of the
complaint by the
IRB
If fixing deadlines it is suggested that there should be an "in exceptional circumstances" extension clause at the discretion of the IRB
This is planned to be contained within the Regulations
Handling of the
complaint by the
IRB
the discretionary power for the Health IRB to decide whether a complaint should be considered further or rejected should be based on
standard considerations in the Regulations and it is suggested that any decision to reject should subject to an appeal process to the
Department.
This is planned to be contained within the Regulations
Handling of the
complaint by the
IRB
In relation to a timescale for a convenor to consider a complaint;
"Inparagraph6onthatpage,[redacted]wouldsuggestthatyoumakesomeprovisionforexceptionalcases.Havingasingletimelimitfor
everythingisfineandsimple,butitoftendoesnotworkinpractice.Youneedtoprovidesomeformofescapevalveforthecomplexcases,
some of which will certainly arise."
Agreed
Handling of the
complaint by the
IRB
"In point 5 on that same page, you suggest a formal response be required within 20 working days. [Redacted] experience [redacted]
suggeststhatthisisanunrealisticexpectationintheManxcontext.Similarlyinpoint7youmakethepointyourproposedextensionto12
months for complaints is in line with UK provision, which is true but overlooks the Manx context referred to above."
The Local Authority and National Health Service Complaints (England) Regulations 2009 that apply in England make provision for
complaints to be responded to within 6 Months. This was a response to the same 20 day target embedded in previous regulations
that were never met by NHS bodies. The principle is that NHS bodies respond as quickly as possible within that 6 Month
timeframe, and indeed many set corporate targets for different kinds of complaints dependent upon their complexity. However, it
is not considered that a move to such a long timeframe would be acceptable in the Manx context. Tynwald has asked that the
complaints process and timescales are set within the Regulations, and have commented that there is a lack of statutory timescales
for review of complaints and where they are current timescales are overly long and appear insensitive to patients needs.
Therefore, it is intended to keep the 20 day timeframe for a service provider to respond to a complaint. Many straightforward
complaints can be dealt with within this timeframe. For any that are more complex and require additional investigation the
response after 20 days will allow the service provider to explain to the complainant why this complaint will take longer to
investigate and manage their expectations by giving a revised timescale within which a response will be received.
Investigation by the
service provider
“Timescales need to be outlined and adhered to” in relation to requirement to keep complainant informed about investigation.
Where the question of keeping complainants informed is concerned, it is not considered that a commitment to set in stone a
requirement for people to be kept informed would be the best option. This is because no two complaints are the same and the
investigative process can move quicker or slower in each case (e.g. the need to interview a key witness who is not available
through leave or sickness for a period of a month or more). People should be kept informed about the investigation on a regular
basis relevant to the facts of the case and the need for a proper consideration of the matter subject to complaint. The proposal is
that the complaint response must be issued within 20 working days. If the response is not issued within 20 working days then the
service provider must notify the complainant of the reason for this and advise what the revised timescale for when a response can
be expected to be received. In addition, it is proposed that there will be a requirement for the complainant to be kept informed
about the progress of the investigation on a regular basis.
Investigation by the
service provider
“It is noted that a firmer requirement to keep the complaint informed will be required but this should include a requirement for
meaningful updates and strict timescales, say every 14 days after the 20 day timescale has been breached.”
The current proposal is that the complaints manager must take steps to keep the complainant informed about the progress of the
complaint. The response must be issued within 20 working days. If the response is not issued within 20 working days then the
service provider must notify the complainant of the reason for this and advise what the revised timescale for when a response can
be expected to be received.
The requirement for meaningful updates will need to be part of the behaviour and systemic change in culture that will be
encouraged through advocacy for the adoption of best practice standards.
Investigation by the
service provider
“Participation in complaints investigations and reviews by those involved has to be mandatory, even by consultants… Roles of Consultants
and Medical Director(s) should be considered in the context of the process and follow up learning.”
Agreed, this will be part of the behavioural and systemic change in culture that will be encouraged through advocacy for the
adoption of best practice standards.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
IRB report of their
findings
In relation to reporting by the IRB, suggested they should include details of; “No of complaints, timescale for resolution, actions taken,
feedback”
Agreed
Learning and
improvement
In the proposed new section about learning from complaints, suggested adding requirements for the service provider to;
- Provide feedback to the complainant on changes to ensure they feel their complaint was valued, and
- Provide feedback forms provided to complainant at end of every process (Manx care and IRB) to ensure quality. Include feedback in
reporting process.
A change has been suggested to the response section of the Regulations to require that the response to the complainant includes
a description of the action taken as a result of the complaint, which maps to the 'you said we did' model of customer relations.
Where feedback forms are concerned, broader wording will be included which requires service providers to ensure that
appropriate mechanisms are in place for complainants to share feedback about their experience of the complaint handling
process. The mechanism for receiving feedback should be for left to the service provider to decide as it is operational.
Learning and
improvement
In relation to Manx Care’s action plan for addressing failings in complaints handling identified in inspections; “timescales for correction” of
the failings should be included in the inspection reports.
Timescales for correction are included in the proposals.
Learning and
improvement
In relation to regular reviews to establish any links between complaints and duty of candour incidents; ““Regular” review is not sufficient,
fixed timescale of reviews.”
The intention is for the Regulations to require this on a quarterly basis, for the service provider to take any action identified by the
review and for the service provider to report on that action in its annual report.
Manx Care's
assurance of
complaints about
commissioned
service providers
This Role needs to be substantial - at present small contractors such as GP practices do not presently investigate complaints properly.
There is a lack of independence of investigators. It is vital that the person undertaking an investigation was not party to delivering the
service complained about. The challenge with small contractors such as GP practices and dental practices is to achieve any real
independence for the investigatory role. As a result initial decisions are "rubber stamped" and the complaint ends up at the IRB
It is suggested that this is dealt with through both the DHSC's and Manx Care's assurance framework i.e. that Manx Care are taking
appropriate steps to address this concern. Embedding the detail of such a role in Regulations is fraught with anomalies due to the
quite differing size and scale of providers.
Meeting the
complainant or
representative
“Recommendation 1 of 33/06 was fairly descriptive in its description of the process.
(c)A meeting with Hospital Complaints Manager to discuss the complaint;
(d)A further meeting if required with clinician(s) to provide an opportunity for questioning, accompanied by someone chosen by
complainant;
DHSC are currently suggesting that the complainant have the opportunity to meet a “relevant health care or social professional”. This is a
generic term and can include any number of people who are not “clinicians”.”
Details [redacted] personal experience that the meeting was ineffective because information was unavailable and it was complaints and
management staff without any of the staff who were involved in the care of the deceased.
“Meetings should be attended by a clinician familiar with the case and able to answer questions. It is appreciated that nurses in attendance
may be excellent nurses but they are not qualified to give opinions on technical cancer care, that is the role of a Doctor.”
The meeting required by (c) will be included within the Regulations. The wording suggested for inclusion to address (d) is "offer
the complainant an opportunity to meet with a relevant health or social care professional that is familiar with the nature of the
complaint and is qualified to answer questions about the service user's care that has resulted in the complaint". Clinician is a very
health focussed term. The term health or social care professional is broader and more inclusive of social care practitioners.
Meeting the
complainant or
representative
Meetings with complainants must be minuted (or recorded)
Agreed but this is operational detail to be contained with service provider standard operating procedures.
Meeting the
complainant or
representative
“It would be useful to have some clarity as to what the policy is intended to be about meeting staff to discuss the outcomes of a
complaint. To do this at the start of the process may avert protracted process if people feel listened to and get a good explanation early
on, and possibly also an action plan for improvement… [redacted] think there should be two meetings offered, one at the outset to hear
the complainants story, and one, the resolution meeting after a full investigation to answer the complaint… with the intention of meeting
the complainants reasonable expectations and giving a satisfactory explanation of those that cannot be met... Complainants should be
given more information about remedial plans, progress and where necessary any staffing implications.”
The Regulations are intended to contain provision that the need to meet with complainants must form part of the complaint
handling process. Exactly when, and how often this should occur, is principally an operational matter (i.e. in more serious
complaints it would be advisable to meet with the complainant at the outset in order to define their complaint and agree the
investigative scope, then as part of the investigation, and again at the end to discuss the outcome and action plan).
Overall 2 step
complaints process
"Recommendation 2 procedures are to be welcomed and will no doubt be subject to much debate on timescales. [Redacted] is pleased to
see that there will be a process (9) that seeks to establish links with duty of candour incidents (please also refer to our Duty of Candour
consultation response dated 15th January 2021)."
Noted
PALS/advocacy
"PALS - excellent."
"[Redacted] still see a place for [redacted] to provide independence. [Redacted] help complainants to generate a complaint, construct it in
writing ( [redacted] do not write anything - must be in their own words). It must be written by complainant or someone with written
authority to act on their behalf. Usually a simple timeline is best structure highlighting areas of concern and most important , the outcome
that is sought."
Agreed - no change required
Public consultation
“The public consultation has to be free of leading questions.”
Agreed
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Public consultation
In relation to a wide question to ascertain what the public currently thinks is and isn't working;
"Asking what the public thinks is and isn’t working is indeed a wide question. How will this be done? Will a consultation question give some
background information or examples? Patient/Service User Reps are consulted but do they exist yet and will their networks have the
capacity to provide useful answers?"
It is agreed that this question may be too wide for a consultation on revised Regulations as the responses elicited will likely be
personal accounts of issues faced in relation to complaints handling that will not be able to be addressed directly through
legislation and so not be an effective engagement exercise. It is intended that the consultation paper will ask specific questions
about the accessibility of the information provided to complainants and the best way to disseminate this information to help
inform the future arrangements.
The Department intends to recruit independent patient and service user representatives in quarter two but in the meantime
service users that have recent experience of the complaints process have been consulted as part of this process.
Public consultation
Consider referring to either DHSC or The Department consistently so long as it is clear what is meant.
Agreed that this needs to be consistent in the consultation paper.
Public consultation
"For the purposes of public consultation [redacted] recommend that more clarity is provided about definitions of support and advocacy to
limit possible confusion between the two when considering Patient Advice and Advocacy."
Agreed
Public consultation
In regards to options for independent adjudicator or ombudsman; "The options will need explaining clearly to a public readership for the
consultation. The whole document needs reviewing with this in mind so that no difficult words, acronyms or jargon remain unexplained."
Agreed
Public consultation
"In the third paragraph on [page 2] you say that “It has been stated during the motion’s debate in Tynwald that complaints are not being
appropriately handled to support those who seek redress and learning is not taking place as a result of complaints.” [[redacted] emphasis].
This is an unfortunate choice of word given that the review of a complaint is supposed to be an impartial and dispassionate exercise.
Complaints certainly need to be handled sensitively, but the process needs to be fair both to the complainant and the professionals
involved. “Support” suggests a bias in favour of the complainant. [Redacted] would suggest talking instead about meeting the legitimate
concerns of complainants."
Agreed
Public consultation
"Thesecondfullparagraphonpage2ofthepaperisdistinctlyconfusinginreferringtotwodifferentthingsas“Stage2”(albeitthatinone
case the word appears and in the other Arabic numeral). Readers will be puzzled as to what is going on.It might be clearer to refer to
“point 2” in respect of the resolution and “stage 2” in relation to the legislative changes you envisage making."
Agreed
Public consultation
“Extend the remit (and resources)ofthe existing TynwaldCommissioner for Administration, whose functionistoinvestigatecomplaints
from members of the public who claim to have sustained injustice or hardship as a result of service failures by, or the administrative
actionsofGovernmentDepartments,StatutoryBoardsandlocalauthorities(includingactiontakenontheirbehalf),tocoverinvestigation
of health and social care service complaints.”
(as opposed to; "of Government Departments (including action taken on their behalf) and Statutory Boards")
Wording change suggested for the consultation paper.
Public consultation
"“PALS” needs unpacking. Although it may be obvious to Departmental insiders, it will be lost on the public."
Agreed to explain more within consultation paper.
Public consultation
"Reference to IRB/Independent Adjudicator/Convenor and other terminology/names throughout the document could be confusing for the
public and may be better either standardising or explaining the difference."
Agreed
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
In relation to annual reporting to Tynwald by DHSC and also regular reporting by Manx Care to DHSC; “Fixed statutory timescale, say 3
months after financial year end”. On reporting by an independent adjudicator, suggested “Annually to Tynwald and also publish on DHSC
website” and “Tynwald, the issue with DHSC appointing is the perceived lack of independence”
The intention is for Regulations to require (a) DHSC reporting to Tynwald within 6 months of the financial year end to be in line
with the annual report required under the Manx Care Act and to publish the reports on their website and (b) IRB report annually
(within 3 months of end of financial year) also to Tynwald via DHSC.
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
“An annual report for Tynwald is required but it must be set timescales, i.e. 3 months after financial year end… the timescale for Candour
reports was not included in the new legislation passed in April 2021 despite promises to the public. This was very disappointing and should
be corrected in November 2021.”
Timescales for the reports under the Manx Care (Duty of Candour Procedure) Regulations 2021 are for Manx Care to prepare a
report within 3 months and then to publish it without undue delay. The vires within the Manx Care Act 2021, under which the
Regulations are made, means that the reports could not be required to be published within a set timescale. Further changes to the
Manx Care (Duty of Candour Procedure) Regulations 2021 are not included within this review of complaints legislation.
The timescales for the complaints reports are suggested to be set at 6 months after the financial year end in order to be in line
with the annual report required under the Manx Care Act 2021.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
“The time taken to respond substantively to complainants should be monitored and reported on to assess whether the 20 day target is
actually being met.“
Agreed
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
IRB Reports should be subject to statutory confidentiality. Inevitably they contain highly sensitive personal data about the complainant and
health professionals. The Regulations should allow for publication of summarised reports (at the discretion of the DHSC after consultation
with the IRB) which do not identify individuals.
Agreed - it is intended that the Regulations will allow the information gained by the Review Body for the purposes of the
investigation and reporting to be subject to statutory confidentiality. There is already a requirement that "The Review Body must
redact the report to ensure that any confidential information from which the identity of a living individual can be ascertained is
not disclosed without the express consent of the individual to whom it relates". This confidentiality provision will be retained.
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
The IRB should report to Tynwald to include an anonymised summary of complaints finalised and rolling RAG report on all outstanding
recommendations to Manx Care and DHSC
It is agreed that the IRB should report to Tynwald and it is proposed that this will be required within the Regulations
(independently if possible or more likely through the DHSC).
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
“[redacted] presume the system will also take into account the severity of impact of the complaint. Service standards and reporting should
reflect this.”
Agreed
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
“How redress can be expressed. Publicly?”
Redress will be expressed directly to complainants within response letters and the annual reports will contain information about
the actions taken as a result of complaints.
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
"Manx Care should develop and publish their processes for dissemination of information on complaints throughout the whole
organisation."
Agreed this should be part of the operational policy, which should be published.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
"Does the role of the media / communication team have any part to play in relaying information to the public?"
There will be a statutory obligation for DHSC to report annually and publish the report on its website. Members of the DHSC's
communication team will be able to signpost comments on social media to published reports.
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
"Reporting framework to be agreed between Manx Care, DHSC and Tynwald to evolve over time, like Chief Constable’s Report."
The DHSC's Quality and Safety Committee and Mandate Assurance Committee will be both requesting quarterly KPI's on
complaints. Annual reports to Tynwald will be made. It is agreed that this is likely to evolve over time.
Reporting
requirements for
the DHSC, Manx
Care, commissioned
service providers
and any
independent
adjudicator
In regards to regular reporting from Manx Care;
"Action (g) by The Department could be a recipe for drift if ‘regular’ is not defined."
The timescale will be defined within the Regulations
Requesting a review
by the IRB
“current regulations state if DHSC/Manx Care have not completed the complaint in 6 months then the complainant can escalate to IRB.
Can this be retained?”
Yes this will be retained
Requesting a review
by the IRB
"The changes in time scales for making complaints and requesting IRB involvement are reassuring and are strongly supported."
Noted
Requesting a review
by the IRB
"there is some concern that some conditions, particularly serious depressive illness or psychosis can take many months to recover and
that, for a few patients, capacity to make a complaint about something that took place earlier in their treatment may not be regained until
well into or even after the 12 month period. Although the numbers may be small these may be very vulnerable individuals and it would be
helpful if there were some provision for the 12 month period to be extended under certain circumstances ( e.g. 12 months from when
documented capacity was regained)"
Agreed, it is suggested to retain flexibility at the discretion of the Chair of the joint IRB
Requesting a review
by the IRB
In relation to discretionary powers of IRB and standard considerations;
"[Redacted] would counsel against the standard considerations being fixed by the Department. [Redacted] think they would be better
being settled by COMIN and approved by Tynwald, thereby securing some further independence."
This would fit with the standard considerations being set within legislation and approved by Tynwald, which appears to be the
majority view.
Requesting a review
by the IRB
"At the head of page 4 you assert that “the timescale [should be] 12 months in line with internationally accepted best practice”. [Redacted]
accept that both the Parliamentary Commissioner in England and the Scottish Public Services Ombudsman (“the SPSO”) apply a 12 month
time limit, but their processes are somewhat different, even though the Tynwald Commissioner for Administration Act 2011 was broadly
based on the legislation which established the SPSO. Your predecessors in the Chief Secretary’s Office (as it then was) made a conscious
decision in 2010 to apply a shorter time limit for complaints under what became TCAA 2011 because of the potential difficulties in
recovering accurate data and documents after 12 months: memories also fade with remarkable speed."
The timescales within the Tynwald Commissioner for Administration Act 2011 (TCAA) and for the Financial Services Ombudsman
Scheme within the Financial Service Act 2008 (FSA2008) have been further considered.
TCAA - "The Commissioner must not consider a complaint made more than 6 months after a final decision of the listed authority
has been notified to the complainant."
Schedule 4 of the FSA2008 - "You must bring a complaint to the Scheme within six years of the act or omission which led to your
complaint and within two years of when it should have come to your notice if you weren't aware of it immediately".
After consideration, it is not felt that the '"accurate data" and "fading memories" argument is sufficiently persuasive. The 12
month timescale adopted by all ombudsmen and advocated by the Ombudsman Association reflects a view that the timescale
needs to accommodate a range of variables where the needs of the public are concerned, e.g. some people are not initially aware
that an event has occurred for which the making of a complaint is a legitimate response, and some (particularly in health and
social care) will have impediments or events that reasonably delay their ability to make a complaint to an ombudsman. Therefore,
the 12 month timescale will be set within the Regulations for consultation.
Structure and
makeup of IRB
“[redacted] have heard that there are question marks over the legal status of the SS IRB. [redacted] do not know if this information is
correct however it needs to be resolved if true.”
The establishment provisions provisions for the SS IRB are set out in Social Services Act 2011 and Regulations made under that Act.
This will be amended in order to form a joint IRB as part of the changes being proposed.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Structure and
makeup of IRB
"A single IRB must be the way forward as it takes away complexity and saves time as well as simplifying training and expectations.
[Redacted] are concerned that this has not been addressed much earlier than now."
"In regards training for IRB; "Of the options for addressing training [redacted] all agree that the second option of IRB members having CPD
hours would provide more flexibility and better training pathways, with consequential likelihood of improved compliance. Members of IRB
must be competent as a result of relevant training."
Noted
Structure and
makeup of IRB
"[Redacted] agrees a single Independent Review Board dealing with both Health and Social Care at a single point of access is desirable.
Concerns have been expressed that the volume of complaints from both sources together may exceed what a single IRB could cope with."
It is agreed that streamlining below the current provision would be unwise given the current dissatisfaction with timescales
expressed by many complainants. It is therefore intended that the joint Independent Review Body will consist of 9 members,
which is equivalent to the total number of members currently appointed to the Health IRB and the Social Services IRB.
Structure and
makeup of IRB
InrelationtoremovingtheDepartment'sroleinreviewingcomplaintsandextendingtheremitoftheIRBtocovercare,safety,qualityand
clinical matters etc.;
"Inparagraph7onthatpage,ratherthanseekingtoamalgamatetheprocesses,[Redacted]wouldsuggestthatacomprehensiveoverhaul
is required. Once again, the role of the Department as the arbiter of complaints may justifiably be criticised for a lack of independence."
Agreed that this requires a full review. Anything that cannot be addressed through the Complaints Regulations review in the
shorter term will be picked up as part of the National Heath and Social Care Services Bill.
Structure and
makeup of IRB
"[Redacted] suggest that the funding of the IRB should not be in the Department’s hands but with the Cabinet Office in order to insulate it
from any suggestion of political pressure from a body which it might be criticising."
Since 1 April 2021 the Department's role has changed so that it is no longer a provider of health or social care services; therefore,
the IRB will not have any remit over complaints about the Department. As a result, it is considered that the Department funding
the IRB would not cause any conflict of interest.
Structure and
makeup of IRB
"There is a reference to the new ombudsman should be a separate legal entity: is it accepted that the IRBs do not currently have the status
of legal entities?"
To be considered in setting up any new Review Body
Structure and
makeup of IRB
"[Redacted] is primarily concerned about how the constitution of the two independent review bodies will be combined given the vast
difference in the two, and believes that it will be vital that this is set out prior to public consultation. Specifically, the Commission notes
that the constitution of the Social Services IRB is set out in primary legislation rather than regulations."
Noted - changes can be made by Regulation.
Structure and
makeup of IRB
"If the independent review bodies are combined what impact will this have on workloads and the number of members required for the
IRB?"
"It will be important to understand the potential level of workload and therefore the size of the body should be reflect this"
It is agreed that streamlining below the current provision would be unwise given the current dissatisfaction with timescales
expressed by many complainants. It is therefore intended that the joint Independent Review Body will consist of 9 members,
which is equivalent to the total number of members currently appointed to the Health IRB and the Social Services IRB.
Structure and
makeup of IRB
"[Redacted] notes the use of the term “convenor” in relation to the Health Services IRB. Such a role does not exist in the Social Services
IRB."
"What will the role of the Convenor be and how will a ‘Convenor’ be selected?"
It is not proposed to continue with the term convenor as it adds an additional layer of complexity that could cause confusion for
members of the public. Currently, all members of the Health Services IRB are convenors and consider complaints.
Structure and
makeup of IRB
"The document makes reference to drafting regulations for consultation on page 7, including inter alia membership requirements.
[Redacted] would suggest, based on [redacted] experience, that details relating to what might be described as the “person specification”
should not be set out in statute or regulations."
Agreed
Structure and
makeup of IRB
"If the process is extended to cover all providers, what services are covered by the term ‘private entities’? (private healthcare, nursing
homes, etc. . . .)"
Any provider of a health or social care service on the Island.
Structure and
makeup of IRB
"Experience leads [redacted] to say that initial and ongoing training is essential and should be planned and funded for those appointed to
this role."
"A remuneration model will need to be considered to tie in with the commitment to this role"
Noted
Structure and
makeup of IRB
"[Redacted] feels it would be beneficial to have flow charts for the existing operation of both bodies to be able to consider the most
effective parts of the process"
Noted - this will be requested from the IRBs.
Structure and
makeup of IRB
"Will executive/administrative resources be made available to enable the body to function? E.g. composing ‘Standard considerations’ for
acceptance of a complaint, Annual Report, undertaking investigations, preparation of reports, minutes of meetings?"
Yes, consideration is being given to how this will be made available and the necessary independence of persons providing such a
function.
Structure and
makeup of IRB
"The Ombudsman scheme would change the nature of the complaints process so if it does become a ‘long term’ policy, should the
operation of the IRB be tailored towards this?"
Changes are being suggested to the operation of the IRB as part of a journey towards a independent adjudicator.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Structure and
makeup of IRB
"The document seems to indicate that the Appointments Commission would have a role in making appointments to the combined IRB and
it would offer the following benefits should this be the case:
- It is an acknowledged independent body set up in law to make appointments in accordance with relevant legislation
- It is experienced in independent recruitment to statutory bodies
- It has a systematic and consistent approach to appointing to independent bodies across all sectors across government
- It is broadly familiar with candidates who typically put themselves forward for such appointments
- It is a cost effective independent body
- It has a diverse membership
- It already has the responsibility of appointing to the Social Services Independent Review Body"
Noted
Technical points for
Regulations
It is suggested that the new Regulations should deal “head-on” with (a) frivolous or vexatious complaints. Manx Care (including its
contractors) and the IRB should be specifically empowered to reject a complaint or terminate the handling of a complaint on the basis that
it is:-
(a) frivolous or trivial; or
(b) vexatious; or
(c) it has been pursued in a manner that has been vexatious, oppressive or threatening; and, after written warning to desist, it continues to
be pursued in such a manner.
This is contentious as some people could perceive it as an attempt to further gate access to the complaints processes. We accept
that some complainants can present challenging behaviours, but caution is needed as many patients and service users are
'damaged' by their experiences and this can manifest in the way they present their concerns and grievances. These considerations
would be better addressed outside of the Regulations through a protocol between Manx Care/the IRB and the complainants that
sets out respective rights, responsibilities and expectations between the parties. This is something done successfully by the SPSO
and PHSO.
Technical points for
Regulations
The new Regulations which, inter alia, merge the two IRB’s will require transitional measures which should include:-
(a) cases under investigation transferred seamlessly into the new IRB with the same Convenor;
(b) Convenors duly appointed to the existing IRB’s to continue on the new IRB for the duration of their term.
It is agreed that the Regulations will need to contain transitional provisions to ensure that complaints that straddle both bodies
are dealt with seamlessly. However, it is intended that the membership requirements for the joint IRB will be different to that of
the current IRBs and therefore, the current members may need to reapply for reappointment.
Technical points for
Regulations
"Please define complaint somewhere as there has been gaming in the past as to whether a complaint is a 'concern' or a complaint - so not
lodged appropriately. e.g. verbal = concern, written = complaint only if the word 'formal' appears etc.!!"
It is not intended that the Regulations will contain a definition of complaint. The usual dictionary definition should apply here
given that there is no definition of complaint in the primary legislation. However, clarification in relation to oral complaints being
considered under the Regulations will be added. The operational application of the Regulations should contain a definition to
ensure consistency.
Igoea, Nicola (CO)
26 May 2021 10:36
Hooson-Owen, Kate (Courts)
Malone, Karen (DHSC)
RE: Contact for the appointments commission
DHSC Complaints Regulations Summary of Recomendations for Amendments and Pre-
Consultation.pdf
Minister for Policy and Reform
Cabinet Office
Government Office
DOUGLAS
Isle of Man
IM1 3PN
Tel: (01624) 685705
Fax: (01624) 685710
Email: chris.thomas@gov.im
Our ref: CT/VC
11 October 2019
Our ref: CT/VC
Mrs Kate Hoosen-Owen
Secretary to the Appointments Commission
11 October 2019
Isle of Man Courts of Justice
Deemsters Walk
Bucks Road
Douglas
IM1 3AR
Hardman, Madeline
14 July 2021 12:56
Hooson-Owen, Kate (Courts)
Malone, Karen (DHSC)
Health and Social Care Complaints Regulations - pre- consultation
07.14.Pre-consultation feedback review final.xlsx
Igoea, Nicola (CO)
20 August 2021 08:19
Hooson-Owen, Kate (Courts)
RE: DHSC consultation on complaints and the Independent Review Body
Hooson-Owen, Kate (Courts)
18 August 2021 13:54
Igoea, Nicola (CO)
RE: DHSC consultation on complaints and the Independent Review Body
Igoea, Nicola (CO)
09 December 2021 14:56
Update on the Health and Social Care Complaints Regulations
Additional
correspondence:
Contact
for
the
Appointments
Commission
Full Response Text
Topic
Issue/Feedback/Query from consultation
DHSC officer response
Alternative
suggestions for
investigating/review
ing complaints
“an expert external review may be offered… In [redacted] view, a reliable, off Island professional group of investigators specializing in DHSC
complaints (such as [redacted]) could be commissioned to look at all unresolved serious complaints. [redacted] would have access to
reliable experts and be truly independent. [redacted] would be familiar with the complex nature of some complaints and, although
probably expensive, would make sensible recommendations for improvement at an early stage.”
This will be considered as a longer term policy options for an independent adjudicator.
Alternative
suggestions for
investigating/review
ing complaints
“The complaints procedures should align with and connect into professional standards and [professional] bodies. The role of these bodies
and references to them should be understood by staff and patients alike.”
Professional bodies' standards are generally set out in Codes of Conduct, which derive their authority from the statutory basis of
most professional regulatory bodies. There is an argument for the Regulations to include provision that referral to a professional
regulatory body must be considered and acted upon where a complaint indicates non-compliance with a Code of Conduct or other
professional requirement or expectation.
Alternative
suggestions for
investigating/review
ing complaints
“The role of whistle-blowers is not considered anywhere apart from in the motion.”
There is a new Government wide whistleblowing policy being created and due to be consulted upon which will apply consistent
standards across Government. Clarity needs to be given to staff on what should be treated a whistleblowing and what should be
treated as a complaint as they are 2 separate processes.
Whistleblowing is when anyone who provides a health or social care service raises a concern after witnessing an event. They may
have no direct personal involvement in the issue they are raising but want to speak up in the public interest where an act or
omission creates a risk of harm or wrongdoing. These issues are classed as protected disclosures under the Employment Act 2006
and, when reported, should follow the whistleblowing policy and process.
It is important to identify where a non-whistleblowing issue is raised by someone who provides services but the issue is raised in
the capacity of a service user (i.e. where a staff member is receiving services and has cause to compliant about their experience).
This should be handled as a complaint under the complaints policy and procedures.
Where an issue raised in a complaint overlaps with issues raised under the whistleblowing process, the complaint should still be
responded to as a complaint.
Alternative
suggestions for
investigating/review
ing complaints
"Should be 3 stage, local resolution, IRB, Ombudsman."
This suggestion does not align with best practice standards endorsed by the Ombudsman Association. A simple two stage process
will be implemented for handling complaints.
The Tynwald Commissioner for Administration could have a role in reviewing complaints about maladministration by the IRB as
this is a current gap. This will be discussed with the Tynwald Commissioner for Administration and consulted upon.
Alternative
suggestions for
investigating/review
ing complaints
"Actually there are 4 options not 3 - Ombudsman should be contracted from UK ombudsman assn so entirely independent.
Private included-Yes
Review whether processes correctly followed and verdict correct.
Should be ombudsman trained with legal and medical experience.
Reports to holder of complaint -DHSC or Manx care who share it with Minister/Tynwald
Gov contract to external provider for a binding decision on process and verdict."
This suggestion will be considered as part of longer term policy options for an independent adjudicator.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
An independent
adjudicator or
ombudsman to
replace the IRB
“[redacted] see no reason why the IRBs and other issues cannot be restructured in time for November 2021… If the complaint regulations
and the IRB situation is not resolved by November 2021 then [redacted] advice to future complainants would be to bypass the DHSC/Manx
Care complaints system and refer the complaint directly to the professional body… there should be no delay in appointing an Ombudsman
and this should be done by November 2021 even if using the Tynwald Ombudsman for this service is an interim measure. A check on
maladministration will improve the system immediately.”
“[DHSC] have inserted themselves into the complaints procedure issued in April 2021 which is a conflict of interest”
The current vires will allow a joint ombudsman to be formed with statutory timescales for responses and a process for reviewing
complaints set out in legislation. It is also the intention to amend the legislation to allow the Tynwald Commissioner to have a role
in reviewing complaints in relation to maladministration of the IRB's handling of complaints. This would provide a mechanism by
which complainants who experience maladministration causing injustice on the part of the IRB can refer their concerns to a truly
independent arbiter. This would focus principally on the way the IRB has conducted itself in procedural terms, not the substance
of the complaint referred to the IRB (e.g. a care and treatment matter etc.). Limited jurisdiction by the Tynwald Commissioner
would retain the IRB's integrity where its core function is concerned (the 'independent' consideration of health and care
complaints) but provide for administrative justice on the more narrow point of whether the IRB has conducted itself in line with its
statutory remit and responsibilities. This will be an interim measure on the journey towards a process that more closely reflects
statutory arrangements and best practice across the UK nations and internationally.
It is agreed that not all issues may be for service providers to resolve. In cases where an individual is unsatisfied with standards of
conduct, ethics or performance by an individual health professional, it may be for the respective professional body to investigate.
These include, for example the Nursing and Midwifery Council, the General Medical Council, the General Dental Council, the Royal
Pharmaceutical Society, and the General Optical Society. Where serious concerns about a registered healthcare worker are
identified, a referral to the appropriate professional regulator could be made by the complainant and should be made by the
service provider to whom the issue was reported.
The DHSC's role in the complaints will be reset as part of this review of legislation. The Department should not be an active player
in the complaints process in relation to services (as with the DHSC's role in England). It is not a provider of services and the
complaints procedure should only apply Manx Care and its commissioned agents.
An independent
adjudicator or
ombudsman to
replace the IRB
“The Governor [of the IRB] had not read or considered the complaint file properly. Offers to meet repeatedly were denied, the Governor
quoting process. Access issues were not considered by the IRB, their demands quoting internal procedure were impossible to navigate.
Demands that a bereaved complainant review a [redacted] medical records for a third time (which include colour scans of [redacted]
internal organs) is not acceptable on any level but forms the basis as to why my particular complaint was refused… complainants do not
have a right to attend staff panel hearings. In [redacted] case it didn’t get that far but complainants should have that right, perhaps with
the options of submitting questions to staff via the Governor/Panel…
The IRB procedure will be given more transparency by being set out in the Regulations and a statutory requirement for effective
publicity to be given to its procedures will also be included.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
An independent
adjudicator or
ombudsman to
replace the IRB
Please see below list of things that the [Parliamentary and Health Services Ombudsman] provide which the IRB do not.
Public website
Public telephone number
Public helpline
Willingness to discuss queries over the phone
Social media presence (twitter, Facebook, newsfeed etc.)
Annual public reports (currently only to DHSC)
Annual public Accounts (currently only to DHSC)
Annual public open meeting
Public consultations on their service
Internal complaints procedure on their service (IRB have none)
Public statement on their principles
Freedom of information requests (IRB currently claim exemption)
Data protection statements
Ability to investigate public hardship or injustice (IRB do not. They are silent on maladministration)
Leaflet provided at end of service provider process (DHSC advise contact IRB but provide no address etc.)
Internal medical advice (IRB use the director of public health).”
Feedback welcomed on their service (IRB ignore any critical feedback)
User friendly and modern documentation setting our your rights (IRB format has been the same for years and omits certain rights)
Disability /Equality statement
Control over who is employed by them (Comin appoint the IRB, the IRB have no control )
Staff holding relevant qualifications
Internal legal advice (IRB use AG office)
There will be a requirement for the joint IRB to give effective publicity to complaints arrangements within the Regulations, which
would cover having a webpage and telephone number. Other requirements in the regulations will cover a public reports to
Tynwald, contact details for the IRB to be provided by the service provider at the end of the local resolution process, more
professionals and qualified members of the IRB to cover the requirement for medical advice.
Whilst we agree in principle with this comment, some of the information is best practice operational suggestions. The joint IRB will
be encouraged to apply best practice advocated by the UK's Ombudsman Association to its operation. In the longer term, the aim
is to move towards a set up that is more similar to the PHSO but on a smaller scale and appropriate for the Isle of Man context.
An independent
adjudicator or
ombudsman to
replace the IRB
“The IRB are not qualified and do not deal with maladministration, public injustice etc. This is the role of the Tynwald Ombudsman. The IRB
are also not qualified to deal with issues on Candour. The ability of the Ombudsman to review was clearly stated in 33/06… An
Ombudsman should be appropriately qualified with ombudsman qualifications”
It is agreed that the IRB are not currently qualified as they are lay members. It is intended that the revised, joint IRB will be set up
differently with more qualified professionals as members.
There is a duty of candour procedure set out in Regulations for service providers to follow. Any duty of candour incidents that
result in complaints would be reviewed as complaints. Any that are not resolved at local resolution stage will be within the remit
of the revised IRB. Training for IRB members will be required and could cover the duty of candour procedure.
The Ombudsman requirements in 33/06 require an opportunity for an appeal to be made following an IRB review that would be
heard by an independent person outside of the Complaints Panel System. This does not align with the best practice standards
endorsed by the Ombudsman Association. The best practice position is that there should be one independent adjudicator. The
ability of the Ombudsman (in this case the Tynwald Commissioner for Administration) to reopen and reconsider the complaint
after the IRB review would result in the ability to overturn the independent adjudicator's decision. This would have a number of
quite serious implications for the process and undermines the principle that the independent adjudicator is the final neutral port
of call in such a dispute.
However, the ability for the Ombudsman to review complaints about maladministration by the IRB could be included as part of a
review of the legislation and will be consulted upon.
An independent
adjudicator or
ombudsman to
replace the IRB
“IRB annual reports should be every year… Any independent adjudicator should report annually and publicly. The independent adjudicator
should be appointed by Tynwald… Any independent adjudicator should have similar powers of enforcement to that of the CQC.”
Annual reports from the IRB to Tynwald are proposed within the Regulations.
The comments made in relation to the appointment of the independent adjudicator and its powers will be considered for the
longer term independent adjudication solution. However, it should be noted that there is a fundamental difference between
ombudsmen/independent adjudicators and regulators (such as CQC). CQC's powers have mandatory force and non-compliance
can result in legally enforced sanctions. Ombudsmen however can only make 'discretionary recommendations', and this is an
established principle accepted by the Ombudsman Association. Nonetheless, in instances where an organisation resists such a
recommendation, the matters can reported to a responsible body (such as Tynwald) for consideration, or alternatively pursued
through the judicial system. Giving an independent adjudicator or ombudsman a mandatory power of enforcement could result in
legal challenges (e.g. private contractors operating commercially on an independent basis under a commissioned arrangement to
Manx Care).
An independent
adjudicator or
ombudsman to
replace the IRB
In relation to the IRB; “[redacted] cannot recall the appointment process, but again there should be input from the appointments
commission rather than appointment by the Department.”
It will be suggested that the appointments commission appoints the joint IRB.
Topic
Issue/Feedback/Query from consultation
DHSC officer response
An independent
adjudicator or
ombudsman to
replace the IRB
“The jurisdiction of the [Tynwald Commissioner for Administration] over the adequacy of the process can be dealt with expeditiously.”
It is agreed that the Tynwald Commissioner for Administration could have jurisdiction over complaints about the IRB, as otherwise
patients and service users would have no recourse to remedy & redress where the IRB is responsible for maladministration
causing injustice. This will be discussed with the Tynwald Commissioner for Administration and consulted upon.
An independent
adjudicator or
ombudsman to
replace the IRB
The IRB system is truly independent and its retention is a serious option which should be included in the long term policy options. The
Island has a track record of producing highly cost effective s
[Response truncated — full text is 181,781 characters]