Ombudsman Emily O'Reilly tells Fiona Tyrrell patients deserve greater focus.
Undignified deaths, a failure by medical professionals to engage with patient complaints and poor record-keeping are some of the recurring themes in the first report from the Ombudsman on the experience of dealing with complaints against the public health service.
At times the Irish health service is more focused on warding off litigation than dealing with patients' complaints properly, according to Ombudsman Emily O'Reilly who has also called for greater emphasis on dignity in the provision of patient care.
Speaking to The Irish Times on the publication of a review of her office's experience of dealing with complaints in the public health service, the Ombudsman expresses concern about complaints procedures in Irish hospitals.
There is at times a suspicion that people complaining may have litigation on their minds, which is usually not the case, and the reaction is to "man the barricades", she says.
She cites one case where a family queried the medical care their father received prior to his death. The family, according to the Ombudsman, were not viewed as human beings but rather as possible adversaries in future legal proceedings and their complaints were passed from the complaints office to the relevant consultant and back again to the complaints office. On foot of this case, the Ombudsman has called for medical staff and consultants to be brought into the complaints structure.
O'Reilly has found that complaint handling in hospitals has been dependent on the goodwill and co-operation of medical staff. With certain exceptions, the Ombudsman "has rarely found that health professionals, particularly doctors and consultants, engage wholeheartedly with patients' complaints".
This, when combined with a reluctance by patients to complain because they are very dependent on the system, makes for a very "unsatisfactory situation", she says.
Medical staff invariably see complaint handling as a matter for the administrators, even though the kernel of the complaint might well involve particular doctors or consultants, she says.
This may be because it is felt that the examination of complaints interferes with other more important work, can reflect badly on the individual performance of colleagues or is made solely for the purpose of seeking compensation.
Most of the time people want an apology and an assurance that a similar event won't happen to other patients or their families, she says.
With an estimated 937 deaths possibly occurring as a result of preventable clinical error annually, a blame-free, non-punitive culture must be encouraged so that individuals report errors and the sector truly learns from its mistakes, the report states.
Doctors have traditionally been "terrified" of being blamed and have "no tradition of telling on each other", according to O'Reilly. The Neary case is just one particular incident, but the likelihood is that other incidents, maybe not as extreme, have happened elsewhere, she says.
"Colleagues don't squeal on other colleagues. I think that senior doctors see themselves as almost independent republics. I don't blame them - that is the culture in which they were educated and in which they have worked. It is very, very difficult to change culture. You don't just do it by writing down a protocol."
Lack of dignity for patients in the delivery of care is also a major theme of the report. Dignity is missing from a lot of places in the health sector, according to O'Reilly.
This, she says, is partly because healthcare workers are "over stretched" and because so much has become routine that healthcare workers have lost the capacity to empathise. However, there is also a lack of leadership on the issue, she says.
"Dying is such a routine part of hospital life and yet for the person dying and the family, it is the most monumental event. Of course you can't expect staff at a busy hospital to completely empathise, but they should have sufficient regard and respect for the dying and for the bereaved to make sure they are dealt with sensitively and as humanely as possible."
Impressed with the "extraordinary" level of care her own father received at Our Lady's Hospice in Harold's Cross before he died a year and a half ago, Ms O'Reilly has called on hospitals to incorporate hospice care as much as possible.
Conceding that it would be very difficult to replicate a total hospice philosophy in a hospital setting, some aspects could be incorporated, she says, such as making sure that people who are with someone who is dying can get refreshments 24 hours a day and providing a room for the bereaved to go after someone has died.
With more than half of all deaths in Ireland occurring in hospitals, it is vital that the experience of an estimated 15,000 people and their relatives should be a matter taken seriously.
"We need to make sure, in as far as possible, that public patients die in some degree of privacy and dignity."
Failures in communications between healthcare professionals and their colleagues, and between professionals and carers, are also the source of many complaints to the Ombudsman. Common problems include the provision of conflicting information, poor record-keeping and a lack of involvement in care plans.
There were only 20 complaints to the Ombudsman regarding Irish hospitals last year. This, according to Ms O'Reilly, is because the major hospitals are not yet in the office's remit and because people are unclear and unsure about the complaints procedure within hospitals.
The majority of these complaints concerned confusion over treatment of a patient prior to death and the treatment of a family after that death.
The remit of the Ombudsman's office has been extended to cover all bodies and service providers to the Health Service Executive, bringing in for the first time the big voluntary hospitals, such as St Vincent's and the Mater, which care for the majority of people in the State.
This, in addition to the forthcoming establishment of a statutory complaints procedure in the health service, has prompted O'Reilly to recruit staff to deal with the expected increase in complaints to her office from the hospitals once the Minister for Health draws up the regulations to put a framework on this complaints system.
O'Reilly describes the report her "calling card" to the recently established HSE "to let them know what I do and what I intend doing in relation to the extended remit in the health area".