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Annual Report of the Ombudsman 2007

Chapter 2 : Resolving Complaints and Improving Public Administration

While my Office’s fundamental role is to examine individual complaints against certain public bodies, I often refer to the “added value” that my Office brings to bear arising from the complaint examination process. By this I mean the wider improvements in public administration which my Office brings about through the unearthing of systemic issues which come to light through individual complaints. The positive spin-off that this yields manifests itself in many diverse ways.

While the primary purpose of my Annual Report is to report to the Oireachtas on the carrying out of my functions it also serves the wider role of alerting the public and public bodies to cases of interest which I have dealt with over the previous year. Many of the public bodies which I deal with carry our similar functions or administer similar schemes. For instance, all hospitals face similar challenges in seeking to provide first class patient care, all local authorities have to apply complex planning legislation and deal with a large number of planning applications, while the various regions of the Health Service Executive administer a variety of benefit schemes.

Thus, an individual case where I find fault with a particular public body and suggest improvements in practices and procedures, can provide a valuable learning experience for other public bodies which carry out similar work. For example, in my 2006 Annual Report (page 34) I outlined the very positive developments which took place in Sligo General Hospital in order to rectify past failings in patient care which I had identified arising from an individual complaint. These developments included the establishment of a Steering Committee in the hospital to drive new initiatives in relation to patient autonomy, integrated care, communication skills and dignity and design. The Committee also ensured that these initiatives are acted upon, and are continuously evaluated within the hospital itself. A communications protocol was also developed which highlighted best practice in relation to the provision of information to patients and their families, and an onus was put on the line manager in each speciality to ensure that all staff working in their area read and understood the policy and guidelines in operation.

I would encourage public bodies to actively study and learn from cases set out in my Annual Reports so that their own customer services can be improved as a result. I suspect that public bodies which take a progressive approach to raising their own standards already do this.

A further wider benefit which the work of my Office provides is to correct a wrong which I have identified in one case involving a public body which, in turn, leads to a retrospective review of similar cases which had arisen previously and where appropriate redress may be warranted arising from the decision reached in the individual complaint. This can yield benefits for a class of people who had never complained to my Office. A good example of this featured in my 2006 Annual Report (page 14) where I found that the Health Service Executive had overcharged a man for in-patient services in a nursing home. I found that the process by which the fees had been calculated was not in accordance with 10 the relevant statutory provisions. Not only did this lead to a refund of €1,126 being made to the complainant but, in addition, refunds totaling €131,000 were made to fifty-one other families who had never complained to my Office.

Of course, general improvements put in place arising from individual cases can prevent similar problems arising in future which not only improves public administration, but enhances relations between public bodies and their clients by decreasing instances of conflict and complaint. This, in turn, has positive resource implications for public bodies. Furthermore, most of the public bodies I deal with have to interpret and apply complex legislation, schemes and regulations and individual complaints which I report on can help to clarify how best to apply certain rules and regulations and result in a greater consistency of approach, not only by the public body complained of, but by other public bodies carrying out similar work.

Based on lessons learned from individual complaints, over the years my Office has produced a series of guidelines for the public service which serve as templates to improve the quality of specific aspects of customer service. These include:

§  The Ombudsman’s Principles of Good Administration;

§  The Ombudsman’s Standards of Best Practice for Public Servants;

§  The Ombudsman’s Guide to Internal Complaints Systems;

§  Redress - Getting it Wrong and Putting it Right.

On a broader front, the Department of Finance developed the Civil Service Code of Standards and Behaviour which not only sets out the general standards of customer service, but also the rules relating to participation in political activity and the avoidance of conflicts of interest. The code forms part of civil servants’ conditions of service. There is an acknowledgement in the Code that it builds on the principles set out in The Ombudsman’s Guide to Standards of Best Practice for Public Servants.

It is also important to emphasise that in tackling individual complaints my Office will quite often cite aspects of the foregoing guidelines to illustrate where a public body has fallen down in some aspect of its customer service. This ensures that the guidelines continue to have a relevance in upholding and improving standards of public administration as well as providing concrete guidance to individual public servants on how to minimise causes for complaint and how to respond to them when they arise.

The first case, involving the Department of Social and Family Affairs, related to a dispute about entitlement to Child Benefit in respect of a child who was being home-schooled and centred on the interpretation of the relevant legislation. I also had regard to the Irish Constitution and the European Convention on Human Rights in resolving the complaint. The case led to an amendment to the relevant legislation.

A woman contacted my Office about a decision of the Department of Social and Family Affairs to refuse her request for a continuation of payment of Child Benefit in respect of her daughter, who had reached 16 years of age. The difficulty arose because her daughter was not attending an “institute of education” as defined by legislation governing the payment of Child Benefit, but was, rather, being home-schooled. Home schooling was not recognized as an “institute of education” for the purposes of Child Benefit. The woman had appealed the decision to the Social Welfare Appeals Office, but her appeal was disallowed.

On receiving her complaint, I examined the relevant legislation which the Department relied upon in making its decision. It also appeared to me that a number of Articles of the Irish Constitution were of relevance to this case.

Article 42.1 gives primacy to the family as educator of a child and states as follows:

“The State acknowledges that the primary and natural educator of the child is the Family and guarantees to respect the inalienable right and duty of parents to provide, according to their means, for the religious and moral, intellectual, physical and social education of their children.”

Article 42.2 provides that parents should be free to educate their children, inter alia, in the home, as follows:

“Parents shall be free to provide this education in their homes or in private schools or in schools recognized or established by the State”.

I felt that Article 42.3.1 was of particular relevance to this case. It states as follows:

“The State shall not oblige parents in violation of their conscience and lawful preference to send their children to schools established by the State, or to any particular type of school designated by the State”.

It seemed to me that the definition of an “institute of education” in the Social Welfare legislation could have been construed as the State forcing parents to send children to a school, rather that having the right to educate them at home and this was not in harmony with the provisions of the Constitution.

Furthermore, Article 2 of the First Protocol to the European Convention on Human Rights also provides that;

“No person shall be denied the right to education. In the exercise of any of the functions which it assumes in relation to education and to teaching, the state shall respect the right of parents to ensure such education and teaching in conformity with their own religious and philosophical convictions”.

I further examined case law in this field and found In Re: Article 26 of the Constitution and the School Attendance Bill, 1942 [1943] I.R. 334, where the parameters of the power and duty of the State to intervene as guardian of the common good in matters relating to minimum levels of education, moral , intellectual and social were considered. In this particular case, the Supreme Court found as follows;

“We are of the opinion that the section is open to objection from a constitutional point of view in one other respect. Under subsection 1, not only the education, but also the manner in which such child is receiving it must be certified by the Minister (for Education). We do not consider that this is warranted by the Constitution. The State is entitled to require that children shall receive a certain minimum education. So long as parents supply this general standard of education we are of the opinion that the manner in which it is being given and received is entirely a matter for the parents and is not a matter in respect of which the State under the Constitution is entitled to interfere”. (my emphasis)

On this basis, I wrote to the Department on the woman’s behalf, and I asked it to consider, in the first instance, Section 2 of the Age of Majority Act, 1985 which provides that the age at which a person ceases to be a “minor” is at 18 years of age. The woman’s daughter was under 16 years of age and still classified as a minor under legislation and, as a result, it could be argued that the relevant provisions of the Constitution were still applicable to her until such time as she reached 18 years of age. I pointed out that there were constitutional issues of relevance to the complaint, which had implications for Articles 3, 92 and 93 of S.I. 417 of 1994, Social Welfare (Consolidated Payments Provisions) Regulations, 1994. Essentially, as a child does not attain the age of majority until it reaches the age of 18, the definitions of an “institute for education” as set out in Article 3 and underlined in Articles 92 and 93 could be open to constitutional challenge, as they do not make provision for education in the home by a parent as would appear to be guaranteed by the Constitution. I added that there was a possible construction that the State, through the Department of Social and Family Affairs, was acting ultra vires in that the implications of the legislation governing the right of a person to an extension of Child Benefit between the ages of 16 and 18 years, would be a breach of the duty imposed on the State not to interfere with the right of parents to educate their child in the home. I put it to the Department that the legislation, through its wording, could be construed as compelling a parent to educate their child in a place other than the home, in order to remain qualified for Child Benefit. I therefore asked the Department to consider whether a decision could be made, given the reasons which I outlined above, to grant the woman an extension of Child Benefit on an administrative basis from the date of termination of the payment to the date on which her daughter reached eighteen years of age.

One of the key public bodies with responsibilities relating to the provision of homeschooling is the National Educational Welfare Board (NEWB), provided for by the Education (Welfare) Act 2000, and established in 2002. Under this legislation, a home-schooled child, between the ages of six and 16 years, must be registered with the NEWB. The Department examined my submission and decided that it would consider an administrative payment if the woman could provide it with a certificate of registration with the NEWB, in respect of her child. While the woman had contacted the NEWB with a view to registering her child, in accordance with legislation, she was not advised to register her daughter as she was almost 16 years of age, at that time. The Department eventually accepted this position and awarded an extension of Child Benefit to the woman on an administrative basis from the date her daughter reached 16 years of age to the month of her 19th birthday. This resulted in arrears of over €5,100 being paid to the woman. More importantly, this complaint raised a matter of significant concern in relation to the provisions of the legislation which existed at the time. The Department advised me that in recognition of the circumstances of this particular case, it would bring forward proposals to amend the relevant legislation to recognise homeschooling as a form of full-time education which would in future qualify for extension of Child Benefit when a child reaches 16 years of age. This legislative change was subsequently introduced by means of SI 859 of 2007.

This next case, involving the Department of Agriculture, Fisheries and Food, led to improvements nationwide in the administration of the Cattle Monitoring and Movement System (CMMS).

I received a complaint from a farmer concerning the way in which the Cattle Monitoring and Movement System (CMMS) operated by the Department of Agriculture, Fisheries and Food was unfair to him and possibly to other farmers in situations where animals were bought or sold. There is a legal requirement on buyers and sellers of cattle to notify the Department of any movement of the animals. This is a national and EU requirement and one that was introduced to ensure traceability of the food supply. The system for doing so was, in theory, quite straightforward and was supported by the CMMS database which recorded the movement of animals between different locations and owners. A cattle census carried out five times every year also sought to ensure that owners were in a position to check that the sale or purchase of cattle was accurately recorded. Additionally, the Department provided pre-printed forms to ensure notification, by either buyer or seller, to the Department. The forms were printed and postage paid by the Department.

However, as in the case of many of the complaints I examine, things do not always go to plan. Unfortunately, while the postage paid form specified that the Department should be advised of the sale/purchase of cattle, it did not specify who exactly should notify the Department. In this case, the buyer indicated that he would return the form but, for whatever reason, he forgot to do so. However, because of the way the scheme operated in this instance, it was the seller who actually suffered the substantial €3,500 penalty due to the non-notification of the sale by the buyer.

The seller appealed the imposition of the penalty to the Agriculture Appeals Office which although sympathetic to his situation, was constrained to examining the appeal in the context of the terms and conditions of the scheme. In fact, the Appeals Office had gone so far as to highlight the problem in its own Annual Report. After considering the complaint, I sent a detailed letter to the Department asking that it consider the issue. In response, it indicated that it noted my comments but concluded by explaining that it had nothing further to add to what was decided by the Appeals Office.

I was unhappy with this response and further correspondence and meetings took place between my staff and more senior members of the Department. Eventually, the Department agreed that, because of the circumstances of the case, the penalty would be withdrawn. Equally importantly, from my point of view, the Department agreed to review the scheme. Following this review the Department introduced a system whereby both parties to the movement of cattle are offered an opportunity to notify the movement of cattle independently. I consider that the Department’s response was a recognition that the introduction of the necessary administrative changes will help to avoid similar complaints arising in the future.

The following complaint against South Dublin County Council, about planning administration matters, led to the Council giving compensation to the complainant and improving its planning application procedures.

In my Annual Report for 2006, I included a section on “Public bodies... acting correctly in accordance with the law and any other rules and regulations”. I illustrated, with examples, instances where public bodies had failed to comply with the law and how such failures had affected persons in an adverse way. In 2007, I continued to receive complaints about the failure of public bodies to comply fully with the provisions of the law in their dealings with the public.

In this instance, the complaint concerned the failure of South Dublin County Council (SDCC), in the exercise of its functions as a planning authority, to deal properly with a third party objection to a planning application. An application for planning permission was refused by SDCC in April 2006 and the applicant lodged an appeal with An Bord Pleanála (ABP) in May 2006. SDCC was notified of receipt of the appeal by ABP on 29 May 2006 but the Council failed to notify a third party, who had made an objection to SDCC in relation to the planning application, that an appeal had been lodged, as it was obliged to do under Article 69 of the Planning and Development Regulations 2001.

SDCC acknowledged its error to my Office and offered €200 by way of compensation to my complainant. It also gave details of the improvements it had made in its administrative systems to ensure a similar error would not recur. These were as follows:

§  Weekly electronic reminders to ensure that appeals lodged are inputted to the Council’s database;

§  Daily electronic reports of appeals flagging cases where parties must be notified;

§  Twice weekly, the daily electronic reports will be manually checked against the document database to identify cases where a party had not been notified.

In addition, the provision of an email notification system through the Council’s website whereby parties can register to be notified by email of all stages in the progress of an application, was also being examined. The complainant was satisfied with the compensation offer and I was pleased that SDCC had acknowledged its error, offered compensation and had reviewed its procedures without the need for further intervention by my Office. The case highlights the need for all public bodies to be vigilant in relation to their obligations under the law and where they fall down to remedy the matter quickly or offer redress, as appropriate, and take steps, in a proactive way, to ensure a similar problem does not arise again.

In the following case, I found a number of faults about the way Limerick County Council administered a Council loan. This led to redress for the complainant and improvements in procedures.

I received a complaint from a woman against Limerick County Council in relation to a loan which she received under the Improvement Works in Lieu of Local Authority Housing Scheme. Under this scheme, the local authority pays the full cost of the improvements to the house and the applicant repays a reasonable weekly or monthly sum. In this case, after initial difficulties securing a contractor, work to the value of €24,265 was carried out to the complainant’s house. The complainant maintained that she was not properly informed by the local authority of the cost of the works and only found out the correct figure several years after repayments on the loan commenced. According to the complainant, she was not asked to sign any contract which specified the amount of the loan nor did she receive any written notification from the Council regarding the cost of the works. She understood that the amount of the loan was €14,835 and she proceeded with the work on that basis. She pointed to correspondence which she received from the Council’s solicitors which supported her position.

The Council maintained that although there did not appear to be a specific letter on file advising the complainant of the costs of the works, the complainant was in contact with the Council during the time it took to secure a contractor. The Council stated however, that this matter was complicated by the number of tenders received and subsequently withdrawn and that this may have led to incorrect figures being included in correspondence from its solicitors.

It was clear that the complainant was adversely affected by the lack of clarity surrounding the contract price as the cost of the works is a significant factor in the calculation of the weekly repayment due on the loan. In addition, should the complainant seek to redeem the loan, the contract cost would clearly be a highly significant factor in the calculation of the redemption figure.

In examining this case the following were apparent:

§  The Council had been unable to produce documentation to the effect that it had a legal agreement with the complainant to repay a loan of €24,265;

§  The Council had been unable to produce evidence that the complainant was informed of the cost of the loan or that she consented to the works proceeding on the basis of the revised contract price;

§  On three occasions since loan repayments commenced, the Council’s solicitors referred to an incorrect loan value in correspondence with the complainant’s solicitors, and;

§  The Council accepted that confusion arose in relation to the final contract price/loan amount due to the number of tenders which were accepted before the final contractor was appointed.

My Office requested that the Council review the matter, and bearing in mind the significant financial consequences for the complainant, particularly given her limited income, my Office requested that the Council offer appropriate redress. The Council agreed to adjust the complainant’s account to reflect a loan value of €14,835 and to credit her account with repayments which she had made which would have been in excess of those due on the lower loan value. In addition, the Council put in place revised procedures to ensure that a similar situation did not arise in the future.

This complaint against Beaumont Hospital (which is part of the Health Service Executive: Dublin North East Hospitals Group) related to the treatment of an elderly patient in the days before she passed away. It led to procedural changes and additional training for staff. It will also lead to further follow-up action by the hospital’s Integrated Quality and Safety Committee.

I received a complaint from a woman who claimed that there was confusion surrounding the circumstances in which an un-prescribed dosage of medication was given to her mother over a five day period while she was in Beaumont Hospital. The family felt that the additional dosage of the medication had a sedative effect on their elderly mother and this impacted on her ability to communicate with them over the last days of her life.

The hospital’s report to my Office regarding the complaint was comprehensive. It was of a high quality, and its recorded actions were supported by protocols and agreed procedures. In addition, the hospital addressed all the points which my Office had raised.

Several thousand drug prescriptions are dispensed each day in our hospitals. The success of each normally depends on good communication between a doctor who makes a diagnosis and formulates a treatment plan, and a nurse who delivers the medicine to a patient. This critical communication should convey all the necessary information about the dispensing of the patient’s medicine. The main tool used to direct the administration of medicines in a hospital setting is the prescription chart. This chart contains details of the medication and formulation, who it should be given to, how much, which route, how often, and for how long. The chart is updated daily as medication is administered to the patient.

However, for long stay patients, there are regular occasions when the details of the prescribed medication need to be re-written, manually, onto a new prescription chart. This is because, given that the chart is updated daily, the spaces where the nursing staff sign to indicate that medications are administered to patients become full.

From my examination of the complaint and the patient’s prescription chart, it is clear that the she was first prescribed a drug, Mirtazapine, on 11 July 2006. This drug acts as an antidepressant and it has a sedative effect. The original dose was 15 mg. The frequency of administration of the drug was clearly stated as Nocté - at night. It was to be administered orally.

A second prescription chart was commenced, on 24 July 2006, two weeks later. The earlier drug prescription details were re-written, by hand, on the new chart. However, the “frequency” of the dosage was not stipulated. In any event, the “frequency”, as administered, was the same as the earlier chart, namely Nocté - at night. The prescription was recorded as having been administered at 2.00 each night for two weeks, until 3 August 2006. The second chart was full at that stage.

A third chart was commenced on 4 August 2006. The earlier drug prescription details were again re-written on the new chart. Again, the frequency of administration was not noted. However, from 4 August 2006, the 15 mg dose was administered, three times per day, once at 8 am, once at 14.00 and again at 22.00. This was three times the original prescribed dose.

It was clear to me that there were two administrative errors in this process. The first was the failure of the doctor to specify a “frequency” on the prescription charts dated 24 July and 4 August 2006. The second administrative error occurred when a nurse, without apparently consulting with the doctor, recorded the “frequency times” of administration of the prescription as 3 doses per day, on the chart dated 4 August 2006. This entry was inconsistent with the original prescribed “frequency” of one dose per day.

This sequence of Mirtazapine administration continued, namely three doses per day for five days, until 8 August 2006 when the patient was administered the dose twice. It was at that stage the medication error was noted. In summary, the patient was administered three times the intended dose of the medication over a period of four days and twice the intended dose for one day. From my examination of the complaint it is clear that the source of the problem lay in the non-compliance with the hospital’s policy on Medical Management. In particular, by not stipulating the frequency of the dosage on the second prescription chart, which commenced on 24 July 2006, the medical staff were in breach of the hospital’s policy on Medical Management. This policy stipulates that the nurse should ensure, among other issues, that the frequency and time of administration of medicine is stated.

From my point of view, as Ombudsman, I was satisfied that, when the error was identified on 8 August 2006, the hospital had taken appropriate action having immediately:

§  Admitted the mistake;

§  Alerted the family members;

§  Offered an immediate apology to the family;

§  Changed its procedures;

§  Taken corrective action, and;

§  Implemented a course of staff training.

Furthermore, the hospital advised my Office that, as a direct result of the patient’s experience;

§  all nursing staff involved in the error were sent on a medication study day and were individually spoken to by the Clinical Nurse Manager;

§  The Divisional Nurse Manager met with the Clinical Nurse Manager from the ward. Practices in relation to medication errors were discussed and new signage for medication trolleys were developed. These signs were placed on all mediation trolleys throughout the hospital, to be used as a reminder to staff to double check dosages and prescriptions;

§  The Divisional Nurse Manager met with other Divisional Nurse Managers in the hospital and informed them that such an error had occurred and advised that they should be aware of this for their own individual areas. The Divisional Nurse Manger also met with the Director of Nursing on this matter;

§  A Risk Management Occurrence Form was sent to the Insurance Department.

Ordinarily, I would have been happy to let the matter rest on the strength of the hospital’s positive response. However, I am of the view that the practice of manually re-writing prescription charts, once full, was open to the potential for administrative error, with resultant possible adverse effect on patients. In saying this, I accept that, even with a thorough knowledge of medicines, prescribing errors can still be made, especially when attention is diverted. A hectic work environment, busy workload, time pressures, whether a doctor is prescribing for his or her own patient and poor team communication, can contribute to such lapses. Organisational factors can also contribute to such incidents, including inadequate training, low perceived importance of prescribing and a possible absence of self awareness of errors.

I believe that, from every point of view, achieving the highest attainable standard of patient safety is imperative in our hospitals. In this particular case, a medication error occurred when one of the patient’s drugs was being administered to her. My detailed examination identified a possible systemic source of the problem, namely the flawed rewriting of prescription charts. It was clear to me that this case highlighted an issue which needed to be examined in more detail with a view to eliminating, or at least minimizing the possibility of a recurrence of a similar incident. Medical mistakes, which have their roots in administrative error, can be a major source of patient harm.

Accordingly, I pursued the matter further with the hospital. As a result, the hospital placed this issue on the agenda for its Integrated Quality and Safety Committee. I welcome this development and I have asked the hospital to let me know the outcome of its deliberations in due course. I commend the hospital for the action taken and its acknowledgement of the importance of learning from medical errors which is an essential element in the improvement of patient safety in hospitals.

I also wrote to the Health Information Quality Authority (HIQA), informing it of the background to the complaint and advising it of the outcome of my examination, in the context of HIQA’s role in setting quality and safety standards in health service provision and developing guidelines and standards of best practice for health service providers.

Arising from this complaint against Roscommon County Hospital (which is part of the Health Service Executive West/North Western Hospitals Group) the complainant was given compensation and the hospital improved its procedures for the protection of the personal possessions of patients.

A woman contacted me following the sudden death of her mother in Roscommon County Hospital. The complaint centred around the fact that while her late mother had been wearing her wedding rings when she died, which had been taped to her fingers before her remains went for a post mortem, they went missing while the remains were still in the care of the Health Service Executive (HSE). A garda investigation had taken place into the matter but did not shed any light as to when or how the rings went missing. The complainant, along with other family members, met with senior hospital staff to discuss the matter, and the Director of Nursing carried out her own investigation into the incident. The complainant wanted to ascertain what steps were taken to ensure that a similar incident would not happen again.

I sought a report from the HSE regarding the complaint, and was advised that Roscommon County Hospital accepted that comprehensive and robust procedures were not in place at the time, and that nursing documentation did not specify a list of valuables to be recorded on admission. As the complainant’s mother had acute medical needs at the time of admission, these had taken priority and the patient’s valuables had not been fully recorded. I was further advised that a new written process and protocol for all staff admitting patients was being developed in conjunction with nursing staff. A review group was also established to examine the process and to provide clear guidance to all staff with regard to procedures to follow in the event of a death, and to outline the roles and responsibilities of all staff members. The General Manager of the Hospital apologised in writing to the family for the distress and upset caused to them. The complainant and her family had also sought compensatory payment in respect of the missing rings from the HSE, and were requested by the Irish Public Bodies Mutual Insurance Ltd. (Insurance Company acting for the HSE) to forward documentation in relation to their value. The complainant submitted a written valuation in the amount of €3,000 which the Insurance Company agreed to pay. However, the complainant had engaged the services of a solicitor and felt that these fees together with a time and trouble payment should be paid to her, given the efforts she and her family had made to pursue her complaint with the HSE. When I initially approached the HSE with regard to this additional payment, the complainant’s request was refused. However, following contact with the Director of Consumer Affairs within the HSE, this request was acceded to, and a total payment of €5,000 was made to the complainant in addition to her legal costs.

The resolution of this following complaint, which arose through the interpretation of a Department of Health and Children Circular, led to payment arrears for respite care being granted by the Health Service Executive: Dublin Mid-Leinster to some 34 foster-parents.

I received a complaint from a couple in the Laois/Offaly area, who were foster parents, regarding the decision taken by the Health Service Executive (HSE) locally, to withhold respite payments from foster-parents in that area. The couple said that respite payments had been in place for foster-parents who required a short break from their caring duties, and that these payments were continuing to be made in other HSE areas. It appeared that the decision to withhold the payments in the Laois/Offaly area emanated from an interpretation placed on a Circular which had issued from the Department of Health and Children in July 2 001, which ceased the payment of discretionary allowances to foster-parents.

The HSE had written to the Department seeking clarification with regard to the interpretation of the Circular. When I raised this issue with the Department, I was advised that the implementation of the policies governing the payment of respite care to foster-parents, and the standardisation of practices regarding foster care services throughout the country, was, in fact, a matter for the HSE. I took the view that the HSE was not precluded from paying some level of respite to foster-parents under the terms of the Circular, and the reality was that most areas were making the payment. I wrote to the local HSE outlining my own views in the matter. I pointed out that it was unfair to have taken a decision to stop respite payments in that area and to seek verification or clarification afterwards from the Department.

I requested that the issue be reconsidered, with a view to restoring the payments with appropriate arrears. I was pleased to learn that respite payments were subsequently restored to some 34 foster-parents residing in the Laois/Offaly area, and that arrangements were made to pay arrears to them which amounted to €67,000 in total.

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