Maura Mc Court died in hospital in February 2014. Six months after her death, her partner, Laurence Collins, complained to the Health Service Executive (HSE) about her treatment. He received an apology at her inquest, held a fortnight ago.
A report into her care made several general recommendations, including “following up diagnostic tests” and “performing observations on patients as clinically needed”. Surely these are the least any patient could expect. Also, they sound remarkably like recommendations made in several other reports over the past 10 years.
Are lessons ever learnt and improvements actually made in services on foot of complaints? If so, the health system ought to function a whole lot better than it does.
The Health Act 2004 (Complaints) Regulations 2006 provided for the establishment of a statutory complaints process. In 2014, the latest year for which statistics are available, service users made almost 20,000 complaints, up 43 per cent on 2013. Thousands of complaints must have been investigated in the past decade. If even one lesson was learnt and one recommendation implemented as a result of dealing with each complaint, huge improvements in service delivery would have been made by now.
Why are reports still recommending the same changes years later? A 2015 report by the Health Information and Quality Authority (Hiqa) on its investigation into the safety, quality and standard of services provided by the HSE to patients in the Midland Regional Hospital, Portlaoise, said it was "clear there had been a failure to recognise the importance of addressing and learning from complaints".
Following other highly critical reports, the HSE developed a new complaints policy, which has operated since May 2015. Among its commitments is “using information from complaints to make improvements” and publicising outcomes of complaints more widely.
Flawed system
Although these are welcome changes, many complainants will be unable to get redress because the complaints system is fundamentally flawed. This is not the HSE’s fault, but is down to legislation. The Ombudsman and Information Commissioner,
Peter Tyndall
, to whom complainants can appeal if they are dissatisfied with the HSE’s response, is legally precluded from examining complaints involving clinical matters, which can only be dealt with by the Irish
Medical Council
.
In the UK, Northern Ireland, and most EU countries, ombudsmen have unfettered jurisdiction in the area of clinical judgment. According to Mr Tyndall, "many complaints my office receives in the health area include both clinical and non-clinical issues. People are extremely frustrated and angry that we cannot examine all aspects of their complaint."
My own experience showed that making a complaint can indeed be pointless. In March 2014 I complained on behalf of a relative who waited almost four years for a urology outpatient appointment. The delay was due to a consultant downgrading a testicular lump from “urgent” to “routine” based solely on the information given in the GP’s referral letter. The complaints process created a file several inches thick and included an appeal to the ombudsman.
Lack of resources
Last month, almost two years later, I heard that my complaint had not been upheld. The ombudsman concluded that, “having regard to the circumstances, eg clinical judgment and lack of resources, there was no substantive evidence of maladministration”. He also noted that the ombudsman could not “influence how consultants prioritise patients or manage waiting lists”. So my relative has been left with no redress.
Not only is the complaints system unfit for purpose but Hiqa and the ombudsman’s office do not seem to be working together, although, theoretically, they operate a memorandum of understanding to ensure that the public is treated fairly.
Soon after I received the ombudsman's letter, Hiqa published a leaflet called My Choices, My Autonomy and an accompanying guide for health professionals, which both state that "not having enough resources is not an acceptable excuse for providing poor care". Surely this initiative is something both offices should have co-operated on? Why does one agency believe a lack of resources is an acceptable excuse while the other does not?
It is not good enough. We deserve a better complaints system. This will involve legislation and must be prioritised by the new government.
Your Service, Your Say is available at hse.ie. You can also talk to any member of HSE staff or ring 1850-241850
drjackyjones@gmail.com
Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.