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

I welcome the delegates. Having listened to the points made by Deputy Caoimhghín Ó Caoláin about the presentations, I want to focus on the issue of patient confidentiality.

The protection of information is obviously very necessary, particularly when one is dealing with medically sensitive files, etc. Like Deputy Caoimhghín Ó Caoláin, I sometimes find that it is used as a guise to obstruct public representatives making representations on behalf of citizens. While we do not parade around the country looking for problems, they come to us, for example, via family members or concerned neighbours. The idea that I cannot act on such representations in any way has to be revisited very quickly. This attitude is becoming more prevalent in the health sector and across many other areas of public administration.

It is simply to close down representation and accountability and to sideline advocacy by a public representative. This is regrettable and in some areas people are becoming more obstructive in this regard. As I stated, it still is limited within the system but is becoming more prevalent. I perceive it almost to be getting to the point where representations of public representatives are no longer being entertained unless they have written consent signed by somebody who witnessed it, etc., which I do not consider to be good. To be clear, I would be much happier were I not obliged to make any representation, as it would make my life a lot easier. Clearly, however, there is a fundamental role for a public representative and it should be considered by all advocacy groups as being complementary to advocacy, as opposed to being in the way of professional advocacy. Equally, the system should be cognisant that public representatives are aware of what is happening. This trend is limited but is growing.

The hint in all the presentations is the term "public service". It is a service to the public and therefore efforts should be made to provide as good a service as is possible with the resources made available to it by the executive or by the health service provider itself. There is an obligation on people who work in public service to provide it. This is merely an observation but they often are in a monopoly in that there is only one hospital in one's area and one cannot walk down the road to go to another hospital. Similarly, there may be only one school, one bus service and so on and consequently, they often operate as a monopoly. One could then argue that because of this less notice is taken of a customer's complaint; it is just a natural instinct. I am in favour of retention of the public services as they are by and large in respect of health care for example, but there is an underlying view that if people complain, they cannot go anywhere else and consequently, one simply listens to them but does not act. The opposite should be the case and there should be a full embracing of complaints. It should be part and parcel of any modern system, as it is the cheapest form of research one ever will be obliged to do to find out what one's service is or is not doing. Most private companies or companies that deal with the public on a continual basis in a private capacity embrace complaint. They actively seek to find complaints because it is the best form of research into how they can improve their services and often it is free because people will make that complaint. It will be necessary to change this mindset and as I stated, this goes back to the original idea of public service.

To be clear, these are observations, rather than casting aspersions widely on people who work in the public service. However, and this may be because of underresourcing, understaffing or simply pressure on people trying to deliver a service, I find there is some harshness in the system in respect of palliative and end-of-life care that perhaps should be revisited. In particular, this is because people are highly vulnerable at that time when a loved one is at the end of life. I acknowledge we have some wonderful facilities, some wonderful hospices and so on, but for people who are not in those good facilities but are in hospitals, for example, it can be a harsh environment for families. I believe much work must be done in this regard. The staff are so busy in trying to maintain life and in trying to keep people healthy and are working with people under huge pressure that it is questionable whether enough support is being put in place. The system is a little harsh in the area of end-of-life and palliative care.

Overall, a big difficulty is that there should be a single citizens' point for many things. Members have discussed this for a long time. We have the Ombudsman, the Ombudsman for Children and some other ombudsmen, as well as advocacy groups and citizens' information services. I am sometimes concerned that an individual does not know where to go or how to start a complaint. I will stick with the health services for the moment and the first thing we should have is open disclosure. Open disclosure would help the entire system in making people feel confident they can complain, either in administrative areas or in clinical areas. Again, the system will try to resist this because once one starts admitting open disclosure, one also starts to admit liabilities and that clearly is an issue that also must be addressed. If a system is expected to be open, it cannot be allowed to be perceived as being easy in respect of liability. These are observations.

Finally, I had written down a point I wished to raise. It goes back to what I was going to say on the issue of fear and people being afraid to make a complaint. I will tell the witnesses why this is. They are not only afraid for themselves but often are afraid for the staff as well, that is, the people who actually provided the service. This may be because the complaint involved one person only or because people simply do not wish to create difficulty. For most Irish people, we are a live-and-let-live type of nation, we all know one another and are fairly interconnected in smaller communities in particular. However, I find there is fear both for people themselves and often for the staff as well. One must be conscious that people will go to the ends of the earth to avoid making a comment. While the system does not encourage it, equally as a nation we are not great. It goes back to the old example of restaurants whereby people will spend all day bad-mouthing a restaurant but will never tell the chef it was a bad meal. One must be conscious of this.