A third of complaints made to the Mid-Western Health Board's appeals office were upheld, the latest figures reveal. Most of the 935 complaints made last year were about supplementary welfare allowance payments and medical cards.
Mr Seamus Woods, chief appeals officer, said although there was surprise initially at what appeared to be a high number of successful appeals, the rate was comparable with similar services overseas. "It is in line with international research that we would have in the order of 30 per cent of complaints upheld."
The office recently became the first in the State to be awarded an ISO 9002 quality award, two years after it was established. The four appeals service staff report directly to the board's chief executive, Mr Stiofan de Burca.
Mr de Burca said the health service, with the biggest customer base in the State, made decisions which often had a wide-ranging effect on people's lives.
"The lack of a carefully developed, independent appeals structure inevitably leads people, who feel they have been denied their entitlements, to channel their grievances through other processes, and encourages the perception that a lack of transparency exists within an organisation, and that the decision-making process is flawed."
At the presentation of the ISO certificate, the Ombudsman, Mr Kevin Murphy, said he hoped it would be a precursor of similar achievements throughout the health service. Meaningful appeals procedures are the principal mechanism for the citizens, as "captive customers", to engage with the board and should be a form of quality control.
One person who successfully appealed a decision, Mr Tony Forde, from Co Tipperary, said he had been disappointed originally with the outcome of an application for a nursing home subvention for his elderly mother. Appeals on the amount of subventions being awarded, which continually come under inflationary pressure, accounted for 20 per cent of all complaints last year.
"Me being an only child, I was unable to provide adequately for my mother's care and attention needs. This was putting an increasing strain on me," Mr Forde said.
"I consider the right of appeal to be an essential entitlement for any citizen who may feel aggrieved by what may be sometimes perceived as an inefficient or bureaucratic decision by a public body."
Last year, 58 of the 180 nursing home subvention cases were allowed. Ninety of the 358 medical card complaints and 93 of the 387 complaints on supplementary welfare allowance were also successful.
Mr Woods was critical of the fact that people in full-time employment for more than 30 hours a week, who may be on low wages, are precluded from applying for supplementary welfare allowance. Often they lose allowances when they change from a back-to-work scheme to full-time employment.
Apart from that, the health board has a lot of discretion in awarding payments. "Some people would say there is a lot of negatives with it. They do not have a sense of entitlement but it can also be very proactive in meeting individual needs."
There is no particular pattern in complaints being upheld but Mr Woods said the service now had a role in training health board staff involved in original decision-making. The training focuses on giving clients a role in the issues being raised and informing them on why they are being refused.
"A lot of people have not been given full information when they are being refused. When we set up initially, clients did raise that issue with us."
The success rate of complaints did "not necessarily mean that 30 per cent of original decisions were wrong", he said. Complainants often opened up more when dealing with the appeals service.
A right to appeal when medical cards were refused should be enshrined in legislation. Medical card guidelines were inadequate, he said, although they are currently being reviewed by the Department.