Mr. Ger Deering:

I thank the Deputy for his kind comments. They are very much appreciated. It is true that my colleagues and I enjoy the job. Ms Hanrahan would say the same. We get huge satisfaction when we resolve an issue, which is a business in which members are likewise engaged. One such issue that comes to mind is a recent and current one that touches on a lot of areas to which the Deputy referred. The case involved a person in a nursing home who was allocated a house by a local authority. This was a good news story and the person was ready to move. The difficulty was that he needed a wheelchair to access the house. The person was in a private nursing home temporarily. We have a situation whereby assessments are not done on people in private nursing homes by occupational therapists and people like that. He could not move to the house until the assessment was done. The Deputy referred to common sense and empathy. I am glad this was the approach that prevailed in this instance but it took a little work on the part of our office. The assessment was done, the wheelchair was provided and the person moved into his new home. We need more joined-up thinking generally to make those things happen. It is good that we can intervene to make them happen but they should happen organically.

The Deputy mentioned the bureaucracy associated with the cross-border initiative. I was surprised to see some of the reasons listed in the complaints that came to us as to why people were refused reimbursement. Some related, for example, to the referral from a GP. As we know, GP offices are busier than ever. A doctor might dictate the referral and have the secretary sign it on his or her behalf. A person will go off and pay for treatment abroad on the basis of that referral. Upon return and having made an application for reimbursement, the person is told the letter should have been signed by the doctor or it was not dated by the doctor. There are other reasons for refusal, such as issues regarding proof of travel. There is a whole range of things on which people are falling down. I am not saying the complainants are falling down but, rather, that the bureaucracy is making life difficult for them. For that reason, we have gone into an in-depth investigation on this matter. I expect the Deputy will be interested in the report we provide, which we hope will be in a few weeks. Even more importantly, I am hopeful the HSE will take on board our recommendations, in the same way it has taken on board recommendations from other reports we have done, and find a way to make these schemes more accessible. The schemes are more necessary than ever now. People of senior age who need a cataract procedure, for instance, cannot wait. They need it done without delay and where it can be done in another jurisdiction, they should be able to avail of that.

Interestingly, there is no cost to the Exchequer under these schemes because people can only be refunded either the amount they paid for the procedure or what it would have cost the HSE to do it here. If they pay more, they will get back only what the HSE would have paid for the procedure to be done in Ireland. There is no additional cost. It really is about facilitating people and taking what the Deputy described as a common-sense and empathetic approach to these matters. Nobody is asking for people to get a refund they should not get. What is being asked is that they not be penalised because somebody else made a mistake. Another problem we found was that a doctor might refer a patient to the ear, nose and throat, ENT, department of a hospital, for example, and somebody might decide in processing the claim that the patient should have been referred to a named consultant. In fact, as far as I know, the scheme does not require that. We have dealt with all of these kinds of issues. I am hopeful that the recommendations we make in the report will be accepted by the HSE and the schemes will be made more accessible to people.

The Deputy referred to the risk of somebody becoming homeless. In the particular case referenced, the person had applied for the HAP scheme. Local authorities are able to give a discretionary top-up in such instances. In a number of cases, we have gone back to local authorities and asked whether they can use that discretion. What was interesting about the specific case the Deputy mentioned is that the rent was approximately €650 a month, if I recall correctly, which means the person was getting exceptional value. I would like to be shown where accommodation can be had for €650 a month at this stage. It is not as though the person was seeking funding for expensive, elaborate accommodation. Thankfully, empathy and common sense prevailed in that instance.

These are important examples. We do not do full investigations. What Ms Hanrahan, her team and all of the people in the office are trying to do is get this resolved for the person as quickly as possible. HAP is a good example. If we have to go to a full investigation, there is a risk the person will have lost a property in the meantime. We prioritise certain complaints. If a person is at risk of becoming homeless, our people pick up the phone immediately and contact the local authority. We prioritise cases in that regard.

The Deputy mentioned cross-Border homelessness and resistance. No particular body comes to mind which is particularly resistant, but we encounter pockets of resistance within an organisation. This sometimes comes down to individuals who may be very rigid in their interpretation and see their job very much as dotting the i's and crossing the t's, and they leave out the common sense and empathy. I meet the Secretaries General of Departments and will shortly meet local authority chief executives. We are constantly trying to meet organisations and point out to them that they have a problem within them which they need to look at. I am happy to say that I cannot think of one organisation that I would say to the Deputy is resistant to us. However, I can certainly think of little pockets of it in organisations and we work on those and try to get them around to our way of thinking and to co-operating and working with us. I hope I have covered all of the areas the Deputy mentioned.