Mr. Mervyn Taylor:

I will address an issue that has been raised about the resources available to the National Advocacy Service and in doing so I do not propose to trade wounds. The National Advocacy Service believes it is terribly short of staff, but we have probably half the number of staff it has, yet we still reach people. Recently, we were in Clonmel speaking to hospital staff who wanted to advocate and learn advocacy skills. The question is not so much one of signposting but whether a sufficient number of people will be available at local level. It is very often an issue of working out individual stories, wishes and preferences, sometimes against the wishes of the family and the system.

Deputy Dan Neville raised an issue about mental health. I fully appreciate that mental health services are often the Cinderella service. However, we should be careful not to make mental health a discrete issue because disability, older age and mental health services very often come together.

Issues of clinical governance also arise. If some of the issues raised by the Deputy concern the behaviour of psychiatrists and the attitudes they take, the questions that must be asked - not only in this area but also in others - are what clinical governance system applies, who is supervising the work being done and how does one reach the people in question and make a complaint on the basis that the behaviour is neither responsible nor good enough.

Issues arise about peer advocacy in mental health services. While this approach has been extremely successful for a number of people, there are concerns about how far it can be developed. These concerns must be noted.

On Deputy Sandra McLellan's questions, I have touched on the issue of staff numbers. The fear of making complaints in nursing homes is very real and not limited to them. One of the good things about Irish society is that it is small and people know each other, as Deputy Billy Kelleher noted. This is also a downside, however, in that people are genuinely afraid to make complaints.

It will take a number of years to build a culture where people do not always see a complaint as a personal affront and will look on it as an opportunity to learn how to build a quality service. This is important. A complaint must not always be seen as a personal attack but as a contribution towards the development of a service.

In regard to the point made by Senator Crown, I agree there are limits to advocacy. As outlined in our submission, we believe there must be a rationale stated, as there is a grave danger that advocacy will be seen as a last straw that is clutched at by a bureaucrat who is running out of other excuses. The fact is that advocacy has a role to play, but there are other avenues. There is provision in legislation for complaints, the ombudsman, better services, the decision support service and a range of other options.

Deputy Byrne, who kindly stood in for the Chairman at our conference on 16 October, spoke about Think Ahead. I agree, but we must not just see Think Ahead as a resource but think about the public campaign that is needed to get the public to think ahead. With Think Ahead as a resource, with enduring powers of attorney and with the advance health care directives, people should be advocating for themselves now for a period in the future when somebody else will have to advocate for them and will need to know what they want. This type of approach is as important as legislation or any of the other issues we have mentioned.

The final issue concerns how to get into private homes. It is correct that the greatest abuses happen in the home rather than in congregated settings, although these are the ones that are best known. Home help services can help in this regard, provided they are aware of the advocacy services available. They can tip off the services and can link up with other services. Day care centres and any places where people are in touch with services can also be a touch point for linking up with advocacy services. I agree, getting awareness of our services into private homes is one of the most difficult areas, but it is an area we must apply our minds to.