Mr. Peter Tyndall:

It is wonderful. One of my recommendations is that an advocacy service should be put in place. We are pleased that such a service has been announced. What we have in mind is something that is accessible to patients and is not a national advocacy service. We want something that individual patients can access. Within the general hospitals, we want such a service it to have a relatively high profile so that it is easy for a person to see where to go. We are anxious to see what is delivered in the context of the commitment to provide an advocacy service.

In terms of our report, our recommendations were agreed by the HSE. We had very good co-operation from the HSE once we identified what the issues were. We are also working with the HSE as it produces action plans to implement the report. We have made it very clear, in this instance, that we will reassess in 18 months' time to see what has happened on the ground because sometimes recommendations can get lost in a welter of recommendations. Although there is a commitment to implement them, a central commitment to implement them does not always lead to changes in practice for individual patients throughout Ireland. We will go back to make sure the changes happen not just at a national level and on paper. We will send people to see what is happening on the ground to make sure the change has been put in place, as agreed.

I refer to a simplified health complaints system. The system, as it currently stands, has two stages - one of which is sometimes observed and one is not. The issue of whether there is a review stage before complaints come to my office is an important one. If complaints are looked at locally and there is a delay and if they are then looked at by the HSE centrally and there is a delay, by the time they reach my office, the detail in the complaint has been lost in the minds of many of the people engaged in it. For the person who is making the complaint, the issue is most important and he or she is very clear in their mind about what happened. The staff who may have been involved in the complaint - doctors and nurses - may well have long forgotten the particular incident. Therefore, it is very difficult for us to understand what may or may not have happened at the time.

We want to see a streamlined complaints system introduced and to see the same system used across the health service. In order to move this forward, when we took on jurisdiction for private nursing homes, we introduced a simplified streamlined model complaints policy which we rolled out to the proprietors at that time. We held workshops and seminars across Ireland for the proprietors of private nursing homes and we issued them with a standard complaints policy that we expect them to use. The advantage of that is that we will see whether they have complied with best practice when dealing with complaints. In addition, everyone will see that the same standards are applied across the sector rather than have the huge variety of standards that exist at the moment. We have removed the second stage because we think people should attempt to resolve a matter informally at the point the incident happens and have one investigation. If the issue is a serious one, then there should be an investigation by an independent person or persons. Some of the complaints will be about food or whatever, so one does not need an independent person. For more serious complaints, it is best that one engages an independent person to investigate.

We say investigate once and investigate well and if the issue cannot be resolved at that point, the complaints should come to the Office of the Ombudsman and not to another third party. It is a simple, streamlined, effective complaints service, which applies across the health sector. We have taken the first steps to putting that in place.

One of the complexities people face when complaining is that they can only complain about part of their care to the HSE and to my office. Technically the issues around clinical judgment often are only part of a complaint. Let us say that somebody is complaining about the care of their loved one - they may have issues around care and compassion, or issues around whether a treatment regime that was put in place was followed but they may also have issues around diagnosis. Currently some of the clinical judgment issues cannot be dealt with within the existing complaints system. That is clearly wrong. If a person is unhappy about the care, it should be possible to make one complaint to one body. Because of a recent Supreme Court judgment, the person must complain to the professional body of the individuals concerned which has to apply a very high threshold before it can look at complaints. There is a large number of complaints that nobody can look at. Clearly that must be fixed. I was delighted when the Minister for Health, Deputy Varadkar indicated that he intends fixing that. I hope that can be done. I do not think it will be a speedy process, but at least we seem to have embarked on the correct path at this point.

I hope that has been helpful. There is more in the statement, but I am happy to take questions.