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Complaints against the Public Health Service

Chapter 7 - The need for delegation and clear lines of authority

Over the years successive Ombudsmen and Chief Executive Officers of the health boards invested considerable energy in establishing a good working relationship between the Office and their respective boards. This was done primarily to promote the interests of complainants who, having failed to secure redress at health board level, brought their case to the Ombudsman.

This positive working relationship facilitated the regular review of liaison arrangements, the functions of liaison officers and the quality and timeliness of reports being furnished to the Ombudsman. It also facilitated the examination of many procedural issues arising from the Office's experience in examining specific complaints e.g. payment of Disabled Persons Maintenance Allowance from age 16 years, backdating of Domiciliary Care Allowance payments based on prior health professional involvement with the applicants, complaints relating to childcare issues and the raising and recovery of non-statutory charges. Over time, there were joint discussions aimed at ensuring greater consistency across all health boards e.g. the development of internal complaint handling/appeal procedures and, generally, agreeing to implement, or take account of, requests/recommendations of the Ombudsman in relation to one board without the need to replicate the investigation process in other boards.

The decision to disband the various boards, and to rationalise the operation and administration of the health service will obviously lead to major change in the manner in which such healthcare is planned and delivered. Certainly, insofar as the Office of the Ombudsman is concerned, the departure of the Chief Executive Officers who were a valuable contact point for this Office, and who were quite visibly accountable for the delivery of health services within defined geographical boundaries, will require a new focus on accountability within the newly restructured service.

While there are clearly many advantages to the new structure - and principal among these are the benefits accruing in time from a single unified and consistent approach to health service delivery - it must be recognised that the new structure will pose many problems too.

Some of these problems will be short-term in nature arising from the departure of personnel with long years of experience in the health service and the arrival of new staff who are in the process of becoming familiar with their new responsibilities.

However, looking to the longer term challenges, it is important that the new staffing structures and reporting arrangements are sufficiently simple so as to ensure that the Health Service Executive (HSE) is responsive to client needs at local level.

One of the fundamental principles of good complaint handling is that complaints should be resolved quickly and as closely as possible to the point of service delivery. This underlines the need for managers with clear lines of responsibility and delegated powers and, in turn, clearly defined lines of accountability. When complaints are made to the Ombudsman it would lead to greater efficiency if local managers have the authority, within certain parameters determined by the HSE, to decide the outcome of these cases with this Office. This "subsidiarity" will undoubtedly pose challenges for the HSE as it endeavours to bring about a single unified health service. However, if the HSE is to embrace a client-centred approach to delivery of services, it is vital that complaints are resolved locally and, in the main, complaints referred by this Office are also resolved locally. The experience of this Office throughout 2005 would indicate that this is an area that requires urgent attention by the HSE. Beyond that, this Office would also welcome the establishment of a forum, similar to that which existed with the health boards, to discuss issues arising from the examination of individual complaints.

Following the presentation of this Report to the HSE, the Ombudsman is hopeful that it will be possible to meet with senior management of the HSE to discuss the development of new liaison arrangements with her Office and indeed, to elaborate on the other issues covered in this Report.

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