Mr. Tony O'Brien:

I will cover that issue as I go along, if that is all right. I would like to respond jointly to the points made by Deputies Kelleher and Neville. In any commercial enterprise, a complaint would be regarded as a gift from a customer and considerable investment would be made to reap the benefits of it. I agree absolutely that complaints should be perceived in that way. I also agree that this is not how they are universally perceived at present. We are on the same page there. Equally, I agree that we have a system which is capable of too quickly turning a request or a concern into a complaint, thereby putting it into a highly formalised process set down by legislation. This is equally unhelpful. I will use a particular example to illustrate this. It was put to me recently when I was visiting a service. A service user who was visiting an outpatient service had a particular need to sit down, but there was a shortage of seats. Her physical circumstances meant that she needed a seat. When she approached the desk to express her requirement for a seat, rather than someone getting her a chair it was suggested that she might be given a complaint form. Hopefully that is an extreme example, but it speaks to what I am saying about simple requests or concerns being too quickly turned into complaints and channelled down from there. It is important that as we address this issue at large, we do not institutionalise the process of dealing with feedback, concerns or requests. Complaints should become complaints when it is appropriate that they are dealt with as complaints, rather than because that is the easiest way to deal with any representation in the broadest sense of the word from an individual using a service.

Deputy Kelleher is right when he says that the HSE is a monopoly provider in the sense that it is the provider of last resort. I agree that this creates a sense of dependence on the part of those who use the HSE's services, particularly when there are areas in which demand for services exceeds current supply, as we all know. This results in waiting lists, which, in turn, results in a sense that there are discretionary decisions to be made. Regardless of whether this concern is actually founded or likely to be the case, it is not unreasonable that an individual would be concerned that discretionary decisions might not go his or her way in the future if he or she is perceived to be a complainant. That is one reason it is critically important that there is access to advocates, in the sense of the word as we are using it today.

The current formal complaints process is, in effect, laid down by the Health Act 2004. It is, by definition, extraordinarily complex. It provides for a necessity to go off in all sorts of different directions, depending on what the complaint is about. In the past fortnight, the Minister announced his intention to make the necessary legislative change to simplify that process. That will be followed through on with the simplification of the ability go on to the second tier - the Ombudsman - regardless of what the complaint is about. This will bring an end to the approach which means, in effect, that the standard complaints procedure cannot deal with a matter that is in any way clinical. Such cases had to be dealt with on an ad hocbasis, and whatever we did or did not do was not then subsequently appealable to the Ombudsman. If we make a single doorway or pathway for complaints, it will inevitably make the whole process much easier. We strongly welcomed and indeed advocated for the simplification that was announced recently. A single portal for complaints, healthcomplaints.ie, will be given additional investment under the supervision of the Ombudsman to make it a more realistic pathway to get in.

That 800 different complaints persons were identified in the Ombudsman's report is to some extent a legacy issue. As we create more fully the hospital groups and the community health organisations, it is intended that there will be a single identified co-ordinator for all complaints in each of those health delivery entities, just as there will be in the ambulance service and one or two other specialist national services. Mr. Lynch will say a little more about this approach, which will bring absolute standardisation across the system but not in a way that makes it harder to navigate. It is designed to make it easier.

To be honest, I had not been aware of the perceived changes that have increased the barriers to public representatives raising complaints. Now that I am aware of this factor, I will seek to do something about it. Questions can come back at times if it is not clear that the representation is being made on behalf of the person who is the service user. As someone who deals with many representations, I know it is not always entirely clear from the information provided who the individual is or what the service is. Sometimes there will be a requirement to come back looking for more information. There should be no objections in principle to making progress with concerns raised by public representatives. If such objections exist, I ask public representatives to let my office know and we will seek to ensure they are unblocked.

With regard to funding, we agree that advocacy services should be funded in a way that is independent of the service provider. In other words, they should be funded independently of the HSE and entities funded by it. At present, we fund many advocacy services for the simple reason that if we were not doing so, it is probable that nobody would be doing it and that would be worse. Under the initiative announced by the Minister two weeks ago, this will be brought under the national patient safety office. That office will be part of the Department of Health, which is not a service provider. Obviously, the Minister is directly accountable to the Oireachtas in a way that we are not. Advocacy services will be publicly funded through the mechanism in question. It is likely that some of the funding we currently provide will be lifted out of our budget. It will go back into the Department's budget so that no one loses out as a result. We will do some work on this in the period of preparation. We fund advocacy of all sorts of clients. Not all of it is the type of advocacy we are talking about here. Many of the thousands of entities we fund are engaged in different types of advocacy. We would not that to be disrupted.

We are fully committed to the implementation of the recommendations on complaints contained in the Ombudsman's report. Mr. Tyndall was kind enough to invite me to speak at the launch of that report and we committed ourselves very firmly to it. Mr. Lynch, our national director for quality assurance and verification, is leading out on that.

I will seek to get information from Senator Colm Burke on the individual review he mentioned in order that we might address the matter. We are changing the way we resource reviews because with the traditional methods, there will inevitably be delays because a small number of people are being asked to do a great many external reviews. We have established a new process and Mr. Lynch will speak about it.

The coronial process of inquests is, of course, fully independent and quasi-judicial. We fully respect the independence of coroners but agree, as a general principle, that it is desirable that inquests should be held and brought to conclusion as soon as is practically possible following the event that is being inquired into so that the lessons learned and the recommendations can be obtained by the service providers. I am very conscious that the period leading up to or waiting for an inquest is a particularly stressful period for the surviving relatives in those situations. It is, therefore, generally desirable that it should be brought forward.

I do not know the overall level of funding that will be provided for advocacy under the national patient safety office as those decisions have yet to be made. I think we can be assured, however, that it will be a greater sum than the current sum in aggregate.