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Complaints against the Public Health Service

Chapter 8 - The Ombudsman's Statement of Good Practicefor the Public Health Servicein Dealing with Patients

1. HUMAN RIGHTS AND VALUES IN HEALTH CARE

Everyone has the right to be respected as a human being.

Everyone has the right to have his/her physical and mental integrity respected.

Everyone has the right to the security of his or her person.

Everyone has the right to have his/her privacy respected.

Everyone has the right to have his/her moral and cultural values and religious and philosophical convictions respected.

2. INFORMATION

Every patient has the right to information about the available health services.

Every patient has the right to be fully informed about their health status, including the medical facts about their condition; about the proposed medical procedures, together with the potential risks and benefits of each procedure; about alternatives to the proposed procedures, including the effect of non-treatment; and about the diagnosis, prognosis and progress of treatment.

Information should be withheld from patients only exceptionally, when there is good reason to believe that this information would, without any expectation of obvious positive effects, cause them serious harm.

Information must be communicated to the patient in a manner appropriate to the latter's capacity for understanding, minimising the use of unfamiliar technical terminology. If the patient does not speak a common language, some form of interpreting should be available.

Every patient has the right not to be informed about aspects of their condition and prognosis, at their explicit request.

Every patient has the right to choose who, if anyone, should be informed on their behalf.

Every patient has the right to be informed of the identity and professional status of the individuals taking care of them and of any procedures and guidelines which would bear on their stay and care.

Every patient has the right to be able to request and be given a written summary of their diagnosis, treatment and care on discharge from a health care establishment.

3. CONSENT

The informed consent of the patient is a prerequisite for any medical intervention.

Every patient has the right to refuse or to halt a medical intervention. The implications of refusing or halting such an intervention must be carefully explained to the patient.

The consent of the patient is required for the preservation and use of all substances of the human body. Consent may be presumed when the substances are to be used in the current course of diagnosis, treatment and care of that patient.

The informed consent of the patient is needed for participation in clinical teaching.

The informed consent of the patient is a prerequisite for participation in scientific research.

4. CONFIDENTIALITY AND PRIVACY

All information about a patient's health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind must be kept confidential, even after death.

Confidential information can be disclosed only if the patient gives explicit consent or if the law expressly provides for this. Consent may be presumed where disclosure is to other health care providers involved in the patient's treatment.

All identifiable patient data must be protected. The protection of the data must be appropriate to the manner of their storage. Human substances from which identifiable data can be derived must be likewise protected.

Patients have the right of access to their medical files and technical records and to any other files and records pertaining to their diagnosis, treatment and care and to receive a copy of their own files and records or parts thereof, provided access does not put their health at risk

Intervention may be carried out only in the presence of those persons who are necessary for the intervention unless the patient consents or requests otherwise.

Patients admitted to health care establishments have the right to expect physical facilities which ensure privacy, particularly when health care providers are offering them personal care or carrying out examinations and treatment.

5. CARE AND TREATMENT

Patients have the right to a quality of care which is marked both by high professional standards and by a humane relationship between the patient and health care providers.

Patients have the right to be treated with dignity in relation to their diagnosis, treatment and care, which should be rendered with respect for their culture and values.

Patients have the right to enjoy support from family, relatives and friends during the course of care and treatment and to receive spiritual support and guidance at all times.

Patients have the right to humane terminal care and to die with dignity.

6 SAFETY

Each patient has the right to be free from harm caused by failures in service delivery, medical malpractice and errors.

When availing of health services each patient has the right to expect that such services and treatments meet high safety standards.

Each patient has the right to expect that hospitals and health services monitor risk factors on a continuous basis and ensure that systems are in place to ensure optimum quality and safety of the environment of health service delivery to patients and service users.

Each patient has the right to expect that all managers and health professionals accept full responsibility for the safety of all phases and elements of medical treatment within their control.

Each patient has the right to expect that medical professionals minimise the risk of errors by monitoring precedents and receiving continuous training.

Each patient has the right to expect that health care staff who report existing risks to their superiors and/ or peers will be protected from possible adverse consequences.

This last right is of the utmost importance. A blame-free, nonpunitive culture encourages individuals to report errors and truly learn from their mistakes. It also supports organisations in their efforts to better understand those errors and make improvements. A just environment assumes that staff at the sharp end of care are concerned about patient safety but are working within complex systems and in situations that potentially contribute to errors.

Dying with Dignity

Over half of all deaths in Ireland occur in hospitals and it is therefore vital that the experience of an estimated 15,000 people and their relatives should be a matter to be taken into account in consideration of this issue. Such experience could lead the development of the adoption, within the health services, of the concept of a good death; the right of people who are dying in hospitals to a dignified death, pain free as is possible, and in conditions which enhance their dignity and privacy. The concept would also take into account the needs of family members and of other hospital patients; the right of patients and, where appropriate, their families, to be communicated with respect, in facilities which afford full privacy and confidentiality.

Application

If patients cannot avail themselves of the rights outlined above, they should be exercisable by a person designated by the patient for that purpose; where neither a legal representative nor a personal surrogate has been appointed, other measures for representation of those patients should be adopted.

Patients must have access to such information and advice as will enable them to exercise these rights.

Where patients feel that their rights have not been respected they should be enabled to lodge a complaint. The mechanisms at institutional and other levels to facilitate the processes of lodging, mediating and adjudicating complaints should ensure that information relating to complaints procedures is readily available and that, where necessary, assistance and advocacy on behalf of the patient would be made available.

Patients have the right to have their complaints examined and dealt with in a thorough, just, effective and prompt way and to be informed about their outcome.

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