Mr. Peter Tyndall:

On the issue of what the independent advocacy service would be like, linking that to some of the issues around the service in Wales, I echo the comments about the need to have well trained, professional advocates as part of any service. It is not for me to determine how an advocacy service across Ireland would work, as there are people better placed than I to do that. However, access to such a service is important In that context, I believe advocates should be located prominently at each of our general hospitals. They should be easily found and their phone numbers should be well advertised on posters so that issues can be taken up on the spot. The concern would be that this happens rather than a concern about who provides the advocacy.

In Wales, advocates come from a variety of backgrounds but it was the quality of training, induction and the national standards that applied that were significant in raising the quality of the service. Those advocates were significant initiators of complaints to my office there. The volume of complaints that came through involving an advocate made up a significant proportion of the work. This shows that people who might not put their case forward, do so when they have help. I also had experience of seeing peer advocacy operating well within the mental health context and I used some of those advocates to train staff in my office in the past because I found their perspective, from the service user point of view, was very good at helping staff to think about how they approached people with mental health problems who wanted to make a complaint.

I want to deal now with the issue of nursing homes and of people being afraid to complain because they will be identified. My office has the power to investigate complaints on the basis of its own initiative, rather than on the basis of identifying a complainant. A member of staff of a health facility cannot make a complaint to my office. The system is designed for patients, carers, their advocates and so on. However, if a member of staff brings matters to my attention, we can choose to investigate those without a complaint. Therefore, there are possibilities in that regard and my staff has been alerted to the fact that if issues of that nature arise, we should consider making an own-initiative investigation.

Ombudsman investigations are about what has happened and are not about blaming an individual for getting something wrong. They are about investigating whether what happened was right and, if not, what needs to be done to ensure it does not happen again and about making things right for the individual. It is possible within an investigation to identify where things went wrong, without having to place a public spotlight on an individual.

This can be very damaging because people become very defensive, and it is not necessarily the best way of seeking improvements. It is sometimes better to work with services to achieve an improvement rather than name and shame, which can have the opposite effect to that intended. Ombudsmen also look at recurring patterns. If we see several cases along a similar line or that kind of systemic issue, this is picked up as a potential role for advocacy services, and I would certainly endorse that. If one has a broad picture as a result of running a national service, for instance, one will see patterns and will be able to contribute to improving services generally and not just in the particular setting. I hope that answers some of the issues that were raised.