The legal changes needed to allow the creation of the new-look health body took a step forward in the House of Keys last week.

Manx Care is set to become the new organisation to take charge of operational health matters, keeping it at arm’s length from the policy and strategic issues in the Department of Health and Social Care.

It is due to operate in ’shadow’ form from January and then go live in April. Teresa Cope was last month announced as the new body’s first chief executive, moving from her role as chief operating officer at Hull University Teaching Hospitals NHS Trust

Last week the Manx Care Bill, which puts the changes into law, passed through the clauses stage in the House of Keys, the most detailed point of legislative scrutiny.

But there were some concerns raised.

The Bill sets out how Manx Care should be set up and how it, and its service providers, will undergo inspections and accountability. It also outlines what actions the DHSC or Council of Ministers can take if Manx Care fails to discharge any of its functions.

Lawrie Hooper (LibVannin, Ramsey) called it a ’gentlemen’s agreement’ under which the DHSC would be the body deciding whether to take action on problems raised and also questioned what would happen if Manx Care refused to enact a direction.

He added: ’My concern is there are currently serious problems in the health service. We know there are going to continue be problems in the health service and I am not convinced this inspection and regulatory regime the bill sets out is actually robust enough to help tackle some of those problems.’

But Health Minister David Ashford said if DHSC ever decided against taking any further action when a problem was highlighted, the department would have to publish an explanation why.

’There is no incentive in DHSC, if something is discovered, to try and say we will not investigate,’ he argued. ’If anything the incentive is the other way around to actually say this is a serious matter and it should be investigated.’

He said the ’ultimate sanction’ if Manx Care refused to comply with a direction was that services could be removed, while the Council of Ministers would have the power to dismiss the Manx Care board.

But he added: ’This whole thing has been set up deliberately to give Manx Care as much autonomy as possible within the system and what we do not want to do is change that so that we end up with it just being an offshoot of DHSC, because that would completely unravel the entire thing of what we are trying to achieve here.’

Mr Hooper also suggested there was an ’inherent conflict’ between different parts of the bill, as the autonomy of Manx Care is underscored, while elsewhere the bill says the department could require Manx Care to use things such as government shared services.

Mr Ashford said while using shared government services was ’sensible’, if Manx Care made a case for a more efficient use of money, then it was unlikely the department would force it to do so.

Following the conclusion of the clauses stage of the Manx Care Bill last week it will be placed for its third and final reading in the House of Keys today (Tuesday). If passed, the bill will then move on to the Legislative Council for further scrutiny.