Mr. Peter Tyndall:

The situation in Ireland in terms of health complaints is an interesting one. They are very much lower than they are in comparable jurisdictions. We all know that health complaints are one way of driving improvement in the health service. If one does not know what is going wrong, then one cannot know how to put it right and, therefore, we undertook our first own initiative investigation into health complaints earlier this year. In doing so, we tried to establish why people were not prepared to bring their complaints forward. We did not believe that it was because the quality of health care in Ireland was so much better than elsewhere and that people did not have things to complain about. We felt it was much more likely that there were structural reasons for people not complaining. We found a number of reasons. I will mention a couple of them but more have been documented in the statement I have provided to the committee. One of the reasons people were afraid to complain was that they were concerned about the impact a complaint might have on themselves, as patients, or, more usually, on their family members. They felt, particularly for people in vulnerable long-term care situations, that they would put them at risk by complaining.

The second reason that people often advance is that the complaints system is so complex and arduous to pursue a complaint to its conclusion that people simply lose the will to continue with a complaint even when they start. When one finds situations, as we did, where it is almost impossible to find on the website where one might lodge a complaint, and where it is not obvious on the hospital's premises where one might go to complain, then one starts to wonder why it is that we are not taking complaints more seriously. One might ask what has this got to do with advocacy. In my previous life, I was used to working in a context where hospital patients had access to independent professional advocacy. That meant there was somebody to stand beside patients when it came to making a complaint and very often, he or she could focus a complaint. Sometimes the advocate nipped complaints in the bud because he or she raised the issue of concern on the spot with health professionals and the matter was dealt with there and then. On other occasions, he or she was able to provide explanations to individuals which meant that the patient did not have cause to complain. When a patient did want to complain, an advocate was able to help him or her articulate a complaint in such a way and helped him or her pursue it through what was often a labyrinthine process until a reasonable outcome was reached.

One must ask why is there such a labyrinthine process. The answer is that at the moment, the HSE's Your Service, Your Say guidelines are very high level and it is not spelled out in detail how a person can make a complaint. That means there is a different process in place in virtually every health setting in Ireland.

We have put forward quite a large number of recommendations but I will focus on a couple of them. One of my recommendations is the introduction of an advocacy service that would be available to patients in all health care settings. Given the difficulties people face when trying to lodge a complaint and the fears that they have about complaining-----