The Ombudsman, Peter Tyndall, wants us to complain more. According to a new report, Learning to Get Better: an investigation by the Ombudsman into how public hospitals handle complaints, we make fewer complaints about healthcare than people in other jurisdictions. The report identified two main barriers: "a fear of repercussions for their own or their relative's treatment" and "a lack of confidence that anything would change as a result of complaining".
The report does not mention the patience, perseverance and sheer doggedness needed to pursue a complaint to the bitter end, although it acknowledges that “the complaints process is not easy to navigate”. Less than 0.1 per cent of service users complain, and many give up in frustration.
It does not have to be this way. The National Healthcare Charter, Your Service, Your Say, specifies that a complainant should receive an acknowledgement within five working days and an outcome report within 30 working days. If not, the complaints officer must update the complainant every 20 days until the report is completed. The outcome report should explain whether the complaint has been upheld and include recommendations about how services will improve.
Only 68 per cent of all HSE complaints are investigated within the 30-day target. My family are still waiting for a resolution to a complaint, made 16 months ago, which is now being investigated by the Ombudsman.
In June 2010, a relative was referred to the urology outpatient clinic at University Hospital Galway for an urgent appointment. In February 2014, nearly four years later, he received an appointment for the following month. Shocked by the long delay, I complained on his behalf as he had neither the confidence nor the energy to do it. In May 2014 we received a letter saying his urgent referral had been recategorised as routine. There was no explanation for the four-year delay, nor of how an urgent referral became routine. At our request the HSE national advocacy unit reviewed the case. In June 2014, a letter arrived saying “unfortunately a review officer has not been assigned to this case yet due to the high volume of reviews”. A month later, another letter explained that as no recommendations were made in the first report, a review could not be carried out and [the review officer] “is referring it back [to UHG] for recommendations to be made”.
A report received in August 2014 explained that consultants make decisions about which cases are urgent and routine based solely on the GP referral letter. No explanation was given for the four-year wait for an appointment other than to say, “At the time [your relative] was referred, waiting lists were not under such intense scrutiny as they are at present.” We complained to the Ombudsman in August 2014. In November a senior investigator wrote saying our case had been screened and sent for examination. Only 10 per cent of all cases received in the Ombudsman’s office are sent for examination. The other 90 per cent are straightforward and dealt with quickly. Unfortunately, at Christmas there were 22 cases before ours and a week ago there were six cases before ours. So, 16 months on, we are still waiting.
Complaints are categorised by the HSE according to the principles of the National Healthcare Charter: access; dignity and respect; safe and effective care; communication and information; participation; privacy, and accountability. In 2013, the latest year for which statistics are available, 6,823 complaints were made about HSE services. A further 5,573 complaints were made about voluntary hospitals and agencies. Most complaints were about safe and effective care (25 per cent), access (24 per cent), and communication and information (21 per cent). Only 1 per cent complained about “improving health”. Does this mean all patients got “information and advice on how to stay as healthy as possible” as described in the charter?
The Ombudsman’s report makes important recommendations which would make the process of making a complaint easier. One is “publicising outcomes” so staff and service users know what changes have been made as a result of a complaint. Another is a “no wrong door” policy so that it is the system and not the complainant that is responsible for ensuring each complaint gets to the appropriate place.
These recommendations may take months or years to be implemented. In the meantime, be prepared for delays and frustrations before you hear whether your complaint has been upheld. It will be worth it in the end.
drjackyjones@gmail.com Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.