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"We're Listening to You" (16.04.2004)

Address by Ms Emily O'Reilly (Ombudsman and Information Commissioner) at South Eastern Health Board

At the outset I would like to express my appreciation to Pat McLoughlin and Greg Price for the invitation to address the launch of this publication "We're listening to You" which is the culmination of a highly commendable initiative to improve the relationship with those members of the public who avail of the services provided by the Board.

I hope to bring to my position as Ombudsman - and particularly in the area of healthcare - not just my own professional experience of reporting the social, cultural and political life of this country for almost twenty years, but also my own life experience as a woman, as a mother of five young children, as the daughter of two now elderly parents and therefore as someone with regular, personal contact with the health services right though from maternity provision, paediatric care, the dental services, cancer care, the care of the elderly and also, on rare occasions thankfully, acute emergency care.

So I come to this role with my own views, shaped largely by personal experience, as to what the Irish people want from their health and personal social services. They want a service which is accessible, and in which above all they can have confidence. They want to feel that the service is responsive to them and inclusive of them.

This confidence can be secured only if the system is open, transparent and accountable and if there are effective mechanisms in place to ensure this. Your complaints and appeals system is one such mechanism. You should never forget that the individuals who avail of your services have, in the main, no alternative choice of supplier. They are captive clients. However, they are also individuals who have rights in their dealings with the Board. These rights derive, not from a contract, but from the very fact of their membership of a civic, democratic, society. In this regard your appeals and complaint procedures are very important mechanisms which give the citizen the chance to engage with the Board and receive a meaningful response.

Many people see my role of Ombudsman as one-dimensional, limited to examining complaints. But I also have a role in promoting good practice within the public service. There are certain principles of good administration which I believe should guide public bodies in their dealings with the public. I also believe that individuals have certain rights which they should be able to invoke in their dealings with public bodies. These include the right to be heard, the right to receive sufficient information, and the right to be given reasons for decisions that affect them. These are developed further in "The Ombudsman's Guide to Standards of Best Practice for Public Servants". This Guide sets out a set of standards under the separate headings of dealing with people "properly", "fairly", " openly" and "impartially"

As an element of dealing fairly with people. I consider that people should be informed as to how they can appeal a decision when a benefit or an entitlement has been refused. In this context I have actively encouraged all of the Health Boards to engage in the establishment of meaningful appeals and complaints procedures. I am particularly pleased at the obvious effort which you have put into this aspect, and which is evident here today.

I also commend you on the emphasis placed on the principles of equal access and treatment, staff commitment to dealing with appeals in a timely fashion, the need to recognise the different needs and expectation of your clients, and fair procedures, all of which are at the very heart of those standards which I have just mentioned. In addition, I also commend you for the emphasis which you place on dealing with complainants, as individuals who are worthy of dignity and respect. This is particularly important as you deal with some of the most vulnerable of our citizens who rely on Medical Cards, Nursing Home Subventions, Domiciliary Care Allowance and Supplementary Welfare Allowance. Your complaints and appeals process in these areas are classic examples of your service being judged and assessed by the very people for whom the service is provided.

I think a good rule of thumb for dealing with these vulnerable people is to imagine that the elderly woman could be your mother, the disabled child your child, or the middle aged couple struggling to care for an infirm parent, members of your own family. I am particularly conscious of the manner in which all of us, my office and boards such as yours communicate with those who seek our help. A kind, considered, thoughtful few lines takes no more physical effort than the cold, clinical official communication that is sadly, still all too common. Very often, neither you, nor I can offer anything that meets their needs, but let us not overlook the role of ordinary human kindness when it comes to the simple act of communication.

I see the effective working relationship which exists between my Office and the South Eastern Health Board as crucial in furthering the broad aspects of my work as Ombudsman; the examination of complaints, helping to raise of standards in public administration, the development of safety as an issue in healthcare delivery, the rights of patients and systems of redress. In this context I particularly welcome your proposals to publish guidelines on decision making in those areas which affect the most vulnerable in our society.

This is a two way process. At present, some of the more recently recruited members of my own staff, are preparing to undergo training in many of those areas of decision making covered by your proposed guidelines; fair procedure, lawful authority, reasonableness, the exercise of discretion etc. These elements are at the heart of fair decision making, and I know that Greg Price and Michael Brophy are in the process of developing a joint initiative, in which staff from my Office will meet your key decision makers in the area of entitlements, to share experience and best practice with the aim of developing an enhanced quality of decision making in those key areas.

I would like to return briefly to the issue of public confidence in the health service. It is a time of great change in the health services. The focus on quality is increasing and the public, generally, is becoming more demanding in all areas of the service. Given recent developments in other Board areas, one of which resulted in the closure of hospice services, and the other in which women were subjected to operations after giving birth which prevented them from having any more children, I am firmly of the opinion that this issue of confidence is vital. If it is ever lost, it will be almost impossible to restore.

Things can and do go wrong in every organisation. There is nobody here today, including myself, who can say that nothing ever went wrong in their office, surgery, clinic, ward or operating theatre. We all make mistakes. The critical question is how we react when we make such mistakes and things go wrong. In this context it is essential that senior medical staff view the handling of complaints as an integral part of clinical governance and risk management. In a recent case my Office found it necessary to recommend that a health board review its complaint handling procedures and address the role of senior medical staff in dealing with complaints and the importance of good communications procedures in responding to the concerns of complainants. In this context I would draw your attention to the Statement of Principle enunciated by the National Patient Safety Foundation, an organisation established by the American Medical Association;

" When a health care injury occurs, the patient and the family or representative are entitled to a prompt explanation of how the injury occurred, together with its anticipated short and long-term effects. When an error contributes to the injury, the patient and the family or representative should receive a truthful and compassionate explanation about the error and the remedies available to the patient. They should be informed that the factors involved in the injury will be investigated so that steps can be taken to reduce the likelihood of similar injury to other patients. "

The inculcation of such a principle in Irish healthcare would require a dramatic change of culture in the system, and this is a point that I will be addressing in the near future at a conference on patient safety which is being co-sponsored by the Medical Council.

The acceptance of regular reporting on the complaint handling process would also feature prominently in this new culture, not merely as a record of the number of complaints received without any adequate analysis or comment, but rather with a view to monitoring arrangements for complaint handling, considering trends in complaints and lessons which can be learned particularly for service improvement and patient safety. I am confident that the system which you are launching here today has the capacity to deliver on those aspects, and I congratulate you again on the development of this initiative and wish you every success in the future with it. I sincerely hope that it is a model that others will follow.

Thank you

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