Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I thank Mr. O'Brien for his presentation. This morning we heard from advocacy groups who outlined their views and concerns on what is required to be done to ensure we have proper accountability in how complaints are followed through in our health services. There are certain cohorts with specific vulnerabilities and areas of disability, where people may be in a congregated setting without family supports. We have seen major problems manifest themselves, such as in Áras Attracta.

The HSE has a monopoly in what it offers to the public, who have no choice but to use this service, be it the local hospital or services for elderly people or people with disabilities. There is an obligation on the HSE to ensure complaints are followed up. One could argue that to improve one's service one should embrace complaints, and most companies dealing with the public in the private sector make the complaints procedure very easy because it is probably the best form of research they can garner on their product or service. The same should be the case with the HSE. It should be very easy for people to make a complaint. This is something we really need to embrace. While we have moved towards the establishment of advocacy services and patient safety services, we need to accept that it should be easy for an individual to complain and for it to be followed up in a meaningful way to get to the bottom of the complaint one way or the other. The measure of success is that we would not need those advocacy services if the system was working and functioning properly.

This morning, an issue was raised about public representatives following up on behalf of a constituent or somebody who approaches them with a complaint. Often people contact us because they are not happy with a service or they have experienced a delay in a service, difficulty accessing a service or an issue with regard to the treatment or support they were given or not given. By and large, the HSE is very forthcoming in dealing with public representatives' queries. However, I am beginning to detect a slow but incremental creep of the use of patient confidentiality and the protection of patients' details, and it is becoming more difficult for public representatives to make representations on behalf of people who approach us. We are asked for specific details of the person on whose behalf we are making the complaint, but very often it is a third party, such as a family member, who comes to us. Is the HSE using client confidentiality, patient confidentiality and data protection concerns as a means to slow down or obstruct the process? I am not saying this is specific to the HSE, but I am beginning to detect this as an issue across the public service in general. I appreciate that there is an obligation with regard to data protection and client confidentiality, but sometimes we are requested to furnish details we simply cannot get. Earlier, Deputy Ó Caoláin gave photographic evidence of an example of this. We should be conscious of ensuring that when people come to us we can pursue the complaint. If a person or family member comes to me and makes a serious complaint I have two ways of looking at it. I can either do nothing or do something. If I do nothing and at some stage down the road something is shown to have happened, then I did not act in the way I should have. We should not put barriers in this specific area. I accept that public representatives make numerous representations to the HSE but, particularly with regard to complaints, we do not put pen to paper lightly because very often there are implications.

With regard to services, there is no doubt there is an element of fear in a person making a complaint, as it is the only service available. Even if the service is not good or the supports being given are not great, they are the only supports that can be accessed. If people make a complaint, they may feel there may be a vindictiveness in the organisation at some stage that could jeopardise treatment in future. It is a genuine concern I have heard people raise on numerous occasions. They come to us to make a complaint but when we look to pursue it, they say they may have to return to the service next month or next year and they do not want to cause any difficulty for themselves or their families.

Let us be honest in that another area where people can have concerns is that they do not want to get people in trouble. They want a concern to be aired but we are quite a close-knit community, we know each other and we are interdependent. Although one person may cause difficulties, people in general do not want to cause problems for staff providing a service. People very often appreciate the staff providing a service may be under pressure because of resourcing issues. It is a delicate balance of holding people to account while, at the same time, of ensuring that when people have a complaint, they can bring it to the attention of authorities without jeopardising an individual's career or bringing about a disciplinary process over and above what they may have expected. They just want the concern dealt with. This is a tricky balance as there is an element of accountability and obligation as well.

With regard to the comments on independence, the national patient advocacy service, recently announced by the Minister for Health, is meant to be independent. Very often, many of these organisations depend on funding directly from the organisation to which they advocate for a patient. Have we not finally accepted that we need complete independence, including resourcing and finances, in such cases? Let us be honest in that somebody makes a decision about how much an organisation gets. If it does not get enough, the organisation cannot do its job correctly. How independent can a body be if it is fundamentally dependent on getting resources from an organisation it must hold to account?