• You are here:
• Home /
• Speeches

Speeches

Advocacy and Complaints (09.11.2006)

Address by Michael Brophy, Senior Investigator, Office of the Ombudsman at National Federation of Voluntary Bodies/Brothers of Charity. National Advocacy Conference held at the Radisson Hotel, Limerick, 8th and 9th November 2006.

Introduction

May I begin by saying that I admire the mission of the National Federation, the promotion of the equalisation of opportunities for persons with intellectual disability through the provision and development of high quality, person centred services. In addition I am very much taken with the focus placed on a rights based approach, adopted by the Brothers of Charity in its Charter of Rights 2005, based on rights identified by self advocates using the services of the Order. My aim in this presentation is to provide you with a fuller picture of the role of the Ombudsman in relation to people with intellectual disabilities, and how her Office can be instrumental in the enhancement and protection of such rights.

The core function of the Ombudsman is to protect the individuals who avail of the public services from unfair, unsound and unjust actions on the part of those who are entrusted to deliver those same services. The Ombudsman seeks to ensure that individuals availing of those services are treated with dignity, respect and sensitivity, and that complaints from individuals or their families are handled in a proper, fair and understanding manner.

Consequently, insofar as you are concerned, the Ombudsman is primarily concerned with things that go wrong in the area of health and personal social services. It is not surprising, therefore, that she is often critical of aspects of those services, highlighting shortcomings on a regular basis, and she will continue to do so in the future. Events over the past twelve months, ranging from Leas Cross to the Lourdes Hospital in Drogheda, demonstrate that such protection, and the element of accountability afforded by the Ombudsman is still a vital requirement.

If there is one insight that I have gained from my experience of working for the Ombudsman, it is that each individual person who presents a complaint to the Ombudsman is a unique individual person, just like each one of you listening to me here today.

You are the most complete unique individual person that has ever been created.

There has never been an exact replica of you before, nor will there ever be again. It is a truism; all individuals differ. We all make sense of any given situation in our own unique, individual ways. Each of us feels pain and pleasure, sadness and delight in our own unique, individual ways. We think, ruminate, reflect, reason, dream and hope for the future in our own unique, individual ways. We remember, anticipate events and experience sensations of all sorts in our own unique, individual ways. We have our own secret thoughts and ideas, playing out in our own unique minds. We all differ in our construction of events and the meaning that we attribute to them, which will be unique. An individual person will come before the Ombudsman as a complainant, with a unique system of beliefs and values based on his/her own personal history. These beliefs and values act as internal filters which provide motivation for action, determine how decisions are made and, as I experience, give a reference point for evaluating events and circumstances after the fact. When a person feels unfulfilled or unsuccessful in an exchange with another individual it is likely that his/her beliefs or values for that event have not been met. This is the case whether the exchange is between persons as spouses, parents and children, employer and employee, Ombudsman and complainants or Brothers of Charity and the recipients of their services.

My experience is that the key to dealing with individuals is to acknowledge them as unique persons and act accordingly. It is my belief that this also applies in whatever capacity you represent. One consequence of adopting this process is that one is required to differentiate between the person and the category to which he/ she belongs. For most of you the category generally may be that of " client " or " service user ". However, it is vital that you do not confuse the category " client/service user " and the entity "person" . They are two different logical levels. In fact it can be argued that you cannot even discuss them in the same sentence. A client is a member of a category, he/she is not the category. He/she is first and foremost an individual person. Health and Personal Social Services are delivered to a person, not to a category.

I have often thought that the logic of such a differentiation leads, not to the development of customer charters, but rather to the development of a charter of a person's rights, as a recipient of a service. It was with this concept in mind that the Ombudsman developed a code of good practice for the health service in dealing with patients which, together with the Ombudsman Act, she intends to use as a framework in her examination of complaints relating to public healthcare. A copy of this Code is associated in the appendix to this paper.

The Ombudsman

So who is the Ombudsman? Well the first thing to say is that she is a woman, Ms Emily O'Reilly a former journalist, and a mother of five children. Some of you will be aware of her role as Ombudsman but, for those of you who are not, I will explain the background briefly.

The Office of the Ombudsman opened in January 1984. The Office is based on a model which is recognised across the world and, in very many respects, what the Office does is replicated in the work of other national Ombudsman Offices across Europe, in Australia, New Zealand and in Canada.

As I said earlier the core function of the Ombudsman is to protect the individuals who avail of the public services from unfair, unsound and unjust actions on the part of those who are entrusted to deliver those same services which, it is claimed, lead to adverse effects for the complainant; where this is found to have been the case, the Ombudsman will recommend suitable redress.

The Ombudsman does not have the power to nullify the impugned action or decision. Neither does she have the power to impose a legally binding solution. That is the role of the courts. These might seem to be significant obstacles to an effective Ombudsman operation but, in fact, they are strengths. For one thing no Ombudsman recommendation, made following an investigation, has ever been rejected by the public body concerned.

Public Bodies

The following are the public bodies subject to investigation by the Ombudsman at present:

• Government Departments and Offices (e.g. Department of Social, Community & Family Affairs, Department of Education & Science);
• Local Authorities (all county, city, borough and town councils);
• The Health Service Executive; and
• An Post

There are some specific exclusions from the Ombudsman's jurisdiction, the principal ones at present being:

• decisions in relation to asylum seekers, work visas and citizenship;
• actions taken in the administration of prisons; and
• issues which have already been adjudicated upon by a court or where court action has been initiated;

The enactment of the Health Act 2004, is an important landmark in the development of the Office of the Ombudsman. Since 1985 the jurisdiction of the Office was limited to the administrative actions of the HSE and those hospitals which came under its direct control. The new legislation makes provision for the establishment of a statutory complaints procedure in the health service, not only for those services delivered by the Executive but also for those agencies providing services on behalf of the Executive. The net outcome of this development will be that the major hospitals in the Dublin area, the so called Public Voluntary Hospitals, will come within her jurisdiction, as will other similar hospitals in the rest of the country, together with ( so important for you ) institutions, nation-wide, providing services on behalf of the HSE to the intellectually disabled, including the Brothers of Charity.

The remit is also being extended by provisions contained in Part 3 of the Disability Act 2005. The Ombudsman will have jurisdiction to deal with complaints about actions relating to access to public buildings and services, and also in relation to sectoral plans drawn up by a number of key government departments, including the Department of Health and Children. This legislation also has specific implications for health service providers in the area of the assessment of need, service statements and redress, and this is vitally important for you. However, the Government did not provide any role for the Ombudsman in dealing with complaints in this area.

Issues

The Office receives several thousand complaints each year. Roughly 50% of the valid complaints involve civil service bodies, about 25% relate to local authorities and about 17% involve the health boards. A typical complainant has been refused a payment or a grant or believes he/she has been paid less than his/her entitlement. However, not all complaints have to do with payments; issues to do with service delivery e.g. delays, failure to explain decisions, patient care in the hospital system, improper discrimination, unfair treatment etc. also feature quite prominently. A particular important issue for you going forward will be how your applications for a refund of the illegal charges will be dealt with. Many people think that this refers only to nursing home residents. But you are keenly aware that this is not so, and residents of various other institutions are also affected. I can guarantee you that the Ombudsman will seek to ensure that any such applications are treated in accordance with the law, and also in a proper, fair and transparent manner.

Dealing with Complaints

Procedures for taking and dealing with complaints are designed to be as user-friendly as possible. Complaints may be made in writing, by telephone, on-line or by calling to the office in Dublin. Staff are available to the public on a monthly basis at Citizen Information Centres in Cork, Limerick, Galway as well as in Coolock, Dublin. In addition a series of visits to other provincial centres is arranged on an annual basis, today for example our staff are in Carlow. Staff also pay visits to the homes of complainants where appropriate.

Details of a complaint will always be put to the public body concerned. Depending on the response, staff may examine the body's files on the issue and will often also discuss the case with the relevant officials. Having heard from the body, and considered the matter, we will then generally discuss the case further with the complainant. To some extent, this procedure functions as a form of mediation and it can often result in a settlement acceptable all round. Only in a small percentage of cases does it become necessary to resort to a written investigation report with formal findings and recommendations. Such formal reports are necessary where the adverse effect to the complainant appears, on the face of it, to be significant and where the body is unwilling to take action to mitigate the claimed adverse effect. Formal reports are also resorted to where the issues raised are of general significance and where principles or interpretations of wider application may be developed.

Promoting Good Practice

An Ombudsman serves the public not just by dealing with individual complaints but also by promoting good practice within the public service. The Ombudsman's Annual Report has always served to highlight practices or laws which are unfair in their consequences. In more recent years the Ombudsman has taken the initiative to highlight and actively promote good administrative practice, including getting public bodies to set up their own complaints systems. The Ombudsman has also set out a list of rights which people should be able to invoke in their dealings with public bodies. These include; the right to be heard, the right to receive sufficient information, the right to be given reasons for decisions that affect one and the right to assistance and representation. You will see shades of your own advocacy policy in these rights.

Particular Groups

I mentioned earlier that I admired the focus which your organisation place on a rights based approach for people with disabilities. Whilst the Ombudsman institution relies on both law and broader concepts of justice and equity in the fulfillment of its mission, because the treatment of persons by the administrative branch of government is under scrutiny, human rights issues may be implicated in a complaint. The language of the human rights arena is not, generally, been invoked by complainants, but human rights principles have certainly helped shape the response of the Ombudsman to complaints. Very many of the issues which the Ombudsman has dealt with, and commented upon, over the years are human rights issues, though this parlance has not generally been used. The rights of travellers, of people in long-stay residential care, of children with special educational needs, the equal right of women to social security payments, issues of unfair discrimination - these are amongst the human rights issues with which the Office has dealt. More generally, to the extent that the Ombudsman is there to ensure fairness and equity by the public service in its dealings with the public, this is fundamentally an exercise in the promotion of human rights and in part a domestic human rights defensive mechanism. In this context I know that the Ombudsman will be paying particular attention to the provisions of the European Convention on Human Rights Act, 2003 as an element in her consideration of complaints under her new jurisdiction.

How then can the Office be of particular relevance to people with intellectual disabilities? Let me say here that we never differentiate between those complainants who have a disability and those who have not. In this context I think it is important to emphasise that the Ombudsman does not make representations on behalf of individuals. In the process of effecting a fair and independent examination of an issue presented to her as a complaint, she seeks to ensure that public service activities and, in particular, the exercise of decision-making powers, whether discretionary or otherwise, are carried out not only in a proper legal manner but in a manner consistent with fairness and good administrative practice, irrespective of any characteristics of the complainant. Notwithstanding this stance people with intellectual disabilities can benefit in a more generalised manner from the work of the Office and examination of individual complaints often leads to the identification of systemic defects in procedures, approach or even attitudes and at this level valuable feedback can be given to the bodies within remit. Procedures and systems can then be improved in order to ensure that particular complaints do no recur. In addition, without usurping the role of the Oireachtas the Ombudsman can, and does, draw attention in her reports to anomalies, inadequacies or inequalities in the law or the application of same. It is in these areas that she is able, to some degree, to level the playing field for disadvantaged groups in our society. Let me outline a particular example of a complaint which demonstrates the systemic affect arising from a specific act of advocacy.

Domiciliary Care Allowance

The Ombudsman received a complaint from a representative of a support group for parents with autistic children in relation to Domiciliary Care Allowance (DCA) entitlement. In effect she came to us as an advocate for those individuals, around an issue of improper discrimination. When we examined the complaint The Ombudsman found that there were different practices operating within the same health board ( as it was then ) in relation to the payment of DCA.

Seventeen members of the support group who had applied to Community Services in Laois/Offaly for DCA in respect of their autistic children, were awarded the allowance from the date of the application for the Allowance. However, members of the group living in the Longford/Westmeath area were awarded the allowance from the date their child became eligible for the Allowance ( which was earlier than the date of application ). The advocate considered that the parents living in the Laois/Offaly area were being treated in a discriminatory manner, and that arrears should be paid to them from the time that their children became eligible for the allowance. In all seventeen cases the children had an involvement with the Board and its staff in relation to their condition prior to being awarded DCA. However, the parents had not been advised of their possible entitlement to the allowance. This was the reason why they had not submitted their claims at an earlier date.

The Ombudsman contacted the Board about the complaint and pointed out that there was an onus on health board staff to inform their clients of the existence of various welfare entitlements. The Ombudsman considered it reasonable to expect in cases of this nature, where there had been contact between the Board's staff and the children, that the staff would have brought the possible entitlement to DCA to the parents’ attention.

The Board reviewed the applications involved and agreed to pay arrears in each of the seventeen cases. The arrears were backdated in each case and the total arrears amounted to over €76,000. Of equal importance was the fact that all of the other health boards also accepted the Ombudsman's position, so you can see how an individual case can have a knock on effect for other people in similar situations.

Intellectual disability and the right to complain

In the past, providers of services to the intellectually disabled may have considered complaints as irritants interfering with their normal work and/or as criticisms of their decisions against which they had to defend themselves. While there is greater emphasis nowadays on improving the quality of service, the standards of service are, generally, set by the providers themselves and they also devise the systems and procedures for achieving these standards. The effectiveness of these procedures and the relevance of the standards set can, however, be judged or assessed properly only by reference to the very people, the individuals for whom the service is provided. A good internal complaints system is essential in maintaining the confidence of such individuals. In this context a good system should be:

• Accessible
• Simple
• Speedy
• Fair and Independent
• Confidential and Impartial
• Effective and Flexible

Hurdles to making a complaint

As advocates I am sure that you can tell me of the many hurdles that face individuals with intellectual disabilities who wish to lodge a complaint. It is very important that these hurdles are taken into account by the individuals dealing with such complaints. Difficulties may arise when individuals have problems articulating their views or are themselves incapable of making decisions. Complaints are often difficult and complex, consequently they require an extra degree of sensitivity and usually a greater input of staff time.

Complainants may not be believed for a number of reasons; their thought processes may be seen to be, or may actually be, disordered or otherwise impaired. Accounts of events provided by a complainant may be perceived as the product of an impairment rather than having a basis in reality. Complaints may often not be recognised, or may be disregarded or dismissed as a symptom of the disability. In addition, they may be perceived as less credible than the service providers, leading to premature conclusions; their perceived motives for lodging a complaint may undermine appropriate complaint handling processes. In my opinion there is no place in complaints management for premature and uninformed judgments on the credibility of complainants or the validity of the complaints.

Service users may often not complain because doing so may strain the relationship with their service provider or they may fear adverse responses. This perceived barrier to lodging a complaint may be very much greater because of a number of factors; long term relationships with services providers increases the development of dependencies; there is little or no choice of service providers involved in the person's care in the public sector; the control service providers exercise in certain environments e.g. supported community accommodation; the reliance on service providers to provide support and access to community services; the difficulty of some individuals in expressing themselves assertively.

Finally, users may not know what standard of service to expect, or have an understanding of their rights. In the absence of such information they may not know when they have grounds for making a complaint. They may not be aware of options for raising complaints, for example, how complaints are made, who to speak to about a concern or complaint and what options exist if they do not want to complain at the local level.

Strategies for overcoming such hurdles

Providers should consider the following strategies when dealing with complaints:

• A greater use of advocates to assist service users to formulate and voice their complaints would be of tremendous assistance to those users. It is important that staff are aware of the particular difficulties facing those individuals when they wish to complain. The use of an advocate, either from within the organisation or from an independent body, should not be seen as an escalation of the complaint but rather as a means of facilitating local resolution. The availability of a trained advocate early in the complaints process can often ensure that the issues are clarified both for the individual and the service provider. It may also allay the individual's potential fears about making a complaint and assist them to understand and contribute to the complaints process. However, advocacy services are not a substitute for a complaints procedure and should not be utilised to deflect potential complaints. Ideally, the Ombudsman would like to see the development of the role of an independent advocacy service, facilitating the individuals' movement through the process, matters concerning treatment, therapies, medications, social welfare benefits, family relationships and domestic concerns. In this context we have commenced discussion with Comhailre in relation to their role in this process and how our Office can facilitate engagement in this development.
• specialist training of staff to foster a positive complaints management culture;
• appropriate supervision and support for staff and managers in implementing complaint management guidelines;
• guidelines, which should include provision for monitoring the implementation of complaint management guidelines;
• management support and leadership for the development of suitable policies, the provision of staff education and the monitoring of complaint management system;
• provide the users with accessible information on the complaints system, how to lodge a complaint, how to access advocates and service standards. This information may need to be provided periodically depending on the nature of their illness or mental status.

Everyone in an organisation providing services to the intellectually disabled, at all levels of staff, needs to be firmly committed to the right of users to complain, either directly or through a family member, guardian or other representative. Complaints should be approached as an opportunity rather than as a problem. The process by which complaints are investigated and resolved should be transparent and accessible to the public.

Culture

I am firmly of the belief that the foregoing strategies can flourish in organistion with a strong client centred culture. Culture manifests what is important, valued and accepted in an organisation. It is not easily changed when it is deeply held, and not susceptible to change by a pronouncement, command or an emotionally laden description of a new vision. Most of us instinctively regard complaints as unpleasant and not something to be welcomed, because they are a very personal comment on performance. Once the word complaint is used there is always the danger of a personal and usually negative reaction. There may be a sense of fear and hurt, concern about reputation, distress at the lack of understanding of action and motives, and vulnerability. Worry, surprise, annoyance, anger, disappointment, anxiety and distress are amongst the most common reactions. Clearly, there may be a fear that complaints will have a significant and lasting impact on those to whom blame is attributed. Responses can, and do, exacerbate a complainant's sense of grievance by appearing defensive, using technical language, casting doubt on the complainants' account, or arguing that dissatisfaction is a symptom of the disability being treated.

The other end of the cultural spectrum is one where the satisfactory resolution of complaints is seen as a very important objective and information generated by the complete process is valued. In this culture staff are adequately trained, and supported, with complaints investigated promptly and with authority.

The culture of any organisation is set by the chief executive and senior management. It is essential that they view the handling of complaints and patient safety as an integral part of good governance. The culture must reflect the fact that they are accountable for their performance and that their management processes are increasingly open to scrutiny by the users of the service, Government, the general public and, indeed, the media. This accountability and openness extends to how it handles complaints, and this, in turn, requires that staff are adequately trained to deal with complaints and supported in the event of a complaint being made against them. Ideally training in handling complaints should be a compulsory part of induction and continuing education. The acceptance of regular reporting on the complaint handling process would also feature prominently in this culture, not merely as a record of the number of complaints received without any adequate analysis or comment, but rather with a view to monitoring arrangements for complaint handling, considering trends in complaints and lessons which can be learned.

Finally, can I return to the issue of your uniqueness as a person which I outlined at the start of this address. Each one of us is a unique human being. Your humanity is not defined by what it does or what it can do. It is defined by what it is. Your humanity is not a performance judged on its successes. It is a given, which can be recognised even in its failures. Whether or not a person speaks, thinks, creates, works or is capable of socialisation, every human being has the same rights ( even if he or she cannot exercise those rights ) or rather we have the same duties towards them. A human being is still a human being even when he/she has ceased to function normally. Someone who is profoundly mentally handicapped may not talk, reason, laugh, judge or take part in politics, but he or she is no less human for all of that. Humanity becomes a value or a virtue in the sense in which humanity is the opposite of inhumanity. There is a certain value accorded to humanity, imposing on oneself a certain number of duties and proscriptions as regards our behaviours to others, the philosophical foundation of human rights. One's own duty is to be human, to act compassionately and this is something that nobody can do on your behalf. It is by doing good to men and women that one helps humanity to exist.

Organisational values can only be right if they are underpinned by personal values. Each day you come to work and try to give your own unique form of life to those values. However, such systemic organisational values are difficult to transfer generically into the daily routine of so many unique individuals. Mere exhortation or encouragement is not enough. It is not a question of managers pushing the right buttons. Indeed, managers cannot, technically, motivate staff, as it is an internal state that directs people towards certain goals and objectives. The place to develop these values, and improve the quality of the service to the intellectually disabled is in the hearts of the individuals working within the system, and working out from there.

One way of achieving movement towards this development and improvement is by way of living out of your own individual, unique, value of personal excellence. In grammatical terms excellence is defined as being exceptionally good at an activity or performing exceptionally well. Robert Pirsig in his seminal work on quality " Zen and the Art of Motor Cycle Maintenance " suggests that such quality or excellence is exemplified in peace of mind, with right values, right thoughts, and right actions that produce work which will be a material reflection for others to see. An individual displaying such quality or excellence is at the front of the train of their own awareness, watching to see what is up the track and meeting it when it comes. In Pirsig’s view that is gumption, that is quality, that is excellence.

Q What is up the track for persons working for the intellectually disabled?

A The provision and development of high quality, person centred services, each day, every day.

I will bring away two concepts with me from this conference; the first is the concept of advocacy as " another head on my shoulders " and the second is the concept of " nothing about me, without me " I wish you well in both concepts, and the Ombudsman wholeheartedly acknowledges and commends your work and efforts in promoting them for individuals with intellectual disabilities, and looks forward to working with you along this journey in the future.

Can I leave you with the following extract from the inauguration speech by Nelson Mandela as a form of encouragement to you on this journey.

Our deepest fear is not that we are inadequate

Our deepest fear is that we are powerful beyond measure

It is our light, not our darkness that frightens us

Our playing small does not serve the world

We were born to manifest the glory of God that is within us

It is not just in some of us

It is in everyone

And as we let our light shine we unconsciously give other people permission to do the same

Thank you for your kind attention

Appendix

The Ombudsman's Statement of Good Practice For The Public Health Service In 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.

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.

Back to contents