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Committee on Public Petitions debate -
Thursday, 16 Feb 2023

Office of the Ombudsman Annual Report 2021: Office of the Ombudsman

Before we start, I wish to explain some limitations to parliamentary privilege and the practice of the Houses as regards references to other persons witnesses may make in their evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected, pursuant to both the Constitution and statute, by absolute privilege. Witnesses are again reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity, by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity.

Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative they comply with any such direction.

Before we hear from our witnesses, I propose we publish the opening statement on the committee's website. Is that agreed? Agreed.

On behalf of the committee I extend a warm welcome to Mr. Ger Deering, Ombudsman and Ms Jennifer Hanrahan, senior investigator at the Office of the Ombudsman. I suggest Mr. Deering make his opening statement for about ten minutes. We will then have questions and comments from members, each of whom will have approximately ten minutes. This will allow members to contribute again in the second round. I invite Mr. Deering to make his opening statement.

Mr. Ger Deering

I thank the Chair and committee for the invitation to come here today to present the Ombudsman annual report 2021 entitled Improving Public Services. I am accompanied by my colleague, Ms Jennifer Hanrahan, and we look forward to engaging with the committee. One of my first tasks on taking up the role as Ombudsman in February 2022 was to publish the annual report for 2021. I would like to acknowledge that the achievements as set out in the annual report were delivered during the term of my predecessor, Mr, Peter Tyndall.

We all interact with public services on a daily basis, for example if we apply for a grant, need to use a public hospital, or receive a payment such as child benefit or income support. I acknowledge the hard work, good intention and motivation of staff working to deliver public services. Thankfully, many public services are delivered efficiently, effectively and to a high standard. I also acknowledge that sometimes interaction with our public services has not met the standard required, resulting in people being negatively impacted. My job as Ombudsman is examine such situations to learn and to drive improvements in the delivery of public services. We chose the title Improving Public Services for the 2021 annual report to reflect the ethos of my office and my commitment as Ombudsman to driving fairness, transparency and accountability in the delivery of public services.

As Ombudsman, I consider complaints from users of our public services who believe they have been treated unfairly or suffered an injustice as a consequence of maladministration by a public service provider. In 2021, my office received 4,004 complaints, which was 17% increase on 2020 and the highest ever in the 38-year history of the Office of the Ombudsman. Almost 80% of these complaints fell into three main categories, namely complaints against local authorities; complaints against Departments and their offices; and health- and social care-related complaints. Local authorities accounted for the largest proportion of the increase in complaints received, with 1,290 complaints which is an increase of 45% on 2020. Complaints mainly concerned issues related to housing applications, along with complaints about planning and road or traffic complaints. Given the current challenges in the housing sector in Ireland, it is not surprising that 61% of the increase in local authority complaints related to housing. Two such case studies were highlighted in the annual report. In one case, Galway City Council unfairly changed the record of a traveller family’s waiting time on the housing list. The second case relates to Cork City Council’s use of discretion to review the rent contribution of an individual in immediate threat of homelessness. I am happy to say that in both cases the councils reviewed their decisions following engagement with my office.

When I took up my role as Ombudsman the upward trend in housing-related cases was apparent. My aim is to listen to and learn from those working on the ground and from the complaints my office receives, to identify key issues and look for practical improvements in the delivery of public services. To improve the administration of the schemes, the Government has established to assist people in need of housing supports, and as part of my commitment to reaching out and engaging on important issues, I held a workshop with NGOs working in the field of housing and homelessness in 2022. This resulted in a number of proactive measures being pursued by my office.

The sector that received the second highest number of complaints in 2021 was Departments and offices. However, this statistic hides the good news story that complaints in this area were down 12% on the 2020 figure to 1,066. The highest number of complaints was about the Department of Social Protection at 579 complaints; followed by the Department of Foreign Affairs at 103; the Office of the Revenue Commissioners at 83; and the Department of Agriculture, Food and the Marine at 77. The significant increase in complaints about the Department of Foreign Affairs to my office was mainly explained by an increase in complaints about passport services. The bulk of these complaints can be attributed to delays in processing an unprecedented level of first-time passport applications due to pent-up demand during the pandemic and the increase in applications caused by Brexit. While we received further complaints of this nature in 2023, I am happy to note that significant improvements have since been achieved by the passport service.

The third highest number of complaints in 2021 related to health and social services, which saw an increase of 26% in the number of complaints on the previous year. This includes complaints against the HSE, public hospitals and Tusla. More than 300 of the complaints received were about HSE services, including 56 related to schemes administered by the HSE to help people get access to treatment abroad or seek reimbursement for treatment they have received abroad under the cross-border directive, CBD, scheme.

My objective as Ombudsman is to resolve individual complaints in a fair and objective manner. In addition, I sometimes come across areas where I feel the learning from one complaint, or several similar complaints, can be harnessed to have a broader impact and drive improvement in a sector or in the delivery of a scheme. In such circumstances, I have the power to initiate a special investigation into areas of systemic concern. In May 2021, a systemic investigation into the appropriateness of the placement of people under 65 in nursing homes entitled Wasted Lives: Time for a better future for younger people in Nursing Homes was published by my predecessor. It focused on the experiences of those under 65 who were given no alternative but to live in a nursing home to meet their care needs. This investigation found that Ireland still has progress to make in advancing from a medical model of disability to a social model and that various changes need to be made to systems to facilitate a person-centred approach to care and an approach which is in keeping with the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD, and Ireland’s strategic approach to disability. The report made a series of findings and 19 recommendations, which cover a range of issues including funding, informed consent, quality of life, access to services, navigating the system, policy, and human rights. These recommendations were accepted by the HSE and my office has been engaging with it on the implementation of the recommendations. I plan to publish a progress report looking at implementation by the HSE as we reach the two-year anniversary of the publication of this report later this year.

In November 2021, Grounded: Unequal access for people with disabilities to personal transport schemes, a report into access to transport for those living with a disability, was published by my predecessor. This report set out the investigations undertaken by my office since 2011 into the administration of the following transport schemes: the motorised transport grant, the mobility allowance and the disabled drivers and disabled passengers scheme. It highlighted the unfairness and inequity of the decisions to discontinue the first two schemes without replacement, or in the case of the disabled drivers and disabled passengers scheme, to reinforce the inequitable eligibility criteria in primary legislation. This report was timely as it coincided with the resignation of the members of the Disabled Divers Medical Board of Appeal, DDMBA, over similar concerns. Twelve years later, I am deeply disappointed with the lack of progress to date to deal with this clear inequity and the manner in which people with disabilities continue to be let down by the State.

When I started as Ombudsman in February 2022, I was deeply concerned by some of the complaints my office received about how the HSE is administering schemes designed to assist patients to access treatment abroad. We all know of the long waiting lists to access care nationally. Stories of delays and distress are a regular feature of national news. When a person cannot access care in Ireland in a timely manner, they have the right to go abroad within the EU to have treatment. Under the CBD scheme, they can pay upfront to have the treatment privately in another member state and then apply to the HSE to be reimbursed. We have received numerous complaints relating to individuals being refused payments by the HSE for treatment that can cost thousands of euro. The toll on these complainants, not just in terms of their physical health, but all also on their mental health, financial circumstances and day-to-day quality of life is immense. With this in mind, I commenced a special investigation into the administration by the HSE of schemes to fund necessary medical treatment in the EU and, following their exit from the EU, the UK. The report of this special investigation is near finalisation and I hope to be in a position to publish it in the coming weeks.

The second special investigation I commenced in 2022 relates to housing. Specifically, looking at ways to optimise the housing assistance payment, HAP scheme as administered by the Department of Housing, Local Government and Heritage, the HAP shared services office and local authorities. I intend to also complete this investigation in 2023.

In 2022, we published our strategy to 2025. This plan sets out the strategic objectives of my office, which includes our commitment to ensuring better administration and delivery of public services nationally. I recognise that in public service, as in all walks of life, things can and will go wrong, but I firmly believe that accepting, acknowledging and learning from mistakes, oversights, unfairness and inequity is intrinsic to driving improvements in our public services.

I want to thank the Cathaoirleach and the members for the opportunity to present the work of our office. We are happy to answer any questions that the committee may have.

With regard to the report, what are the shortcomings of it, especially in the area of disability and transport? This committee has brought it up before and 12 years later, as mentioned in the report, there is still a lack of progress. What is holding things back? Why is solving the issue such a slow process?

Mr. Ger Deering

It is very difficult to say what is holding it back but it has to be in some ways a lack of joined-up thinking and a lack of willingness to actually put a new scheme in place. To briefly give the history, my predecessors carried out a number of investigations and found inadequacies in the schemes that were in place. Unfortunately, the response to that was to discontinue the schemes, which was completely unacceptable because they were not replaced.

It is accepted that the schemes had problems but at least they were there. They were of some benefit to the people who used them. Most recently, there was a High Court challenge to the current scheme. It was found that the criteria that were put in place for the scheme were not in line with the governing legislation. I think everybody had agreed that the criteria in any case were way too restrictive. However, the solution the Government came up with at the time was to put those restrictive criteria into the primary legislation. With those very strict criteria, some people can access the scheme but it is very restricted. There are other people who are equally as immobile but who do not meet those restrictive criteria, perhaps having no limbs, or whatever that criterion is. We believe that at each step of this process, the solution of actually either withdrawing a scheme, or making it more restrictive, is really wrong. We have been told that there are moves afoot, and I welcome the fact that the Minister of State at the Department of Children, Equality, Disability, Integration and Youth, Deputy Anne Rabbitte, is chairing a cross-departmental committee looking at this. We just got an update today which says the committee will be publishing a report and we would like to see that.

Is the cause of the hold up the fact that the issue is across Departments? Should it be the remit of one Department?

Mr. Ger Deering

Yes, I think we would make much more progress if it was the remit of one Department. Strangely enough, this scheme, because it is a rebate of the current scheme and because it is a rebate of tax, is under the responsibility of the Department of Finance. It is not for me to say which Department should deal with these matters. One would think that there are other Departments with an interest here also. Certainly, the Department of Health comes to mind and the Department dealing with disability should have a major input. I welcome that they are now working together. However, I think it would be helpful if one Department took a lead and decided to implement a new scheme.

Up to now it was the Department of Finance that was responsible for the only scheme that is left.

Mr. Ger Deering

Yes, the Department of Finance was responsible. I have written to the Department and engaged with it. It maintains it is only responsible for the policy and not for the implementation of the scheme. This is part of the difficulty. We need a Department that is responsible for the policy and the implementation on the ground. We need an easily accessible, universal scheme that gives people the means to provide themselves with personal transport.

Could Mr. Deering give us a quick outline of proactive measures being taken by his office regarding the issue of homelessness?

Mr. Ger Deering

As I mentioned in my introduction, we had a workshop earlier this year with people working in the areas of housing and homelessness. It is such a big area and there are so many problems. We tried to identify one particular area where we believed we could make an intervention that would help. The area we identified was the housing assistance payment, HAP, because there are so many people now in receipt of this payment.

Whatever happens, it is going to take time to provide people with houses and long-term accommodation, but at least HAP is a measure that allows people to rent properties. People sometimes forget that HAP was originally introduced as a labour activation measure. In the older system of rent subsidy, if people were unemployed and got a job they lost their rent subsidy. This sometimes meant that it was not worth people's while taking a job, or indeed they were worse off if they went to work.

The principle of HAP is a good one. It is based on income, rather than the fact that someone has now become employed. The idea was to help people to source accommodation for themselves, and then to be able to better themselves and continue to work and pay a differential rent, based on their income.

One of the things mentioned in the workshops we did was the delays in processing a HAP application. We all know how difficult it is at present to get accommodation. If one is lucky enough to find accommodation and to come to an agreement with the landlord, one needs a very fast response with the HAP application or otherwise that property will be gone. Other difficulties were mentioned as well. Sometimes people are able to manage to pay a deposit; they might even be able to match the first month's rent, but sometimes they do not get that back, which they should.

We have identified administrative improvements that can be made in the HAP scheme. We are looking at the role of the Department of Housing, Local Government and Heritage in this. We are looking at the shared services organisation in Limerick that implements it and we are also looking at it from a local authority perspective. That is where we believe we can make the best and quickest intervention to bring about improvements in the housing sector.

Why were the records of Traveller families waiting times on the housing list changed?

Mr. Ger Deering

This has happened more than once. Local authorities have to continually assess their housing list. Every year or two they will contact people on the housing list to make sure those people are still in need of housing. The local authority then reviews its list. Many councils are still doing this inquiry by letter. They write to the family, whether it is a Traveller family or a non-Traveller family, asking certain questions and asking them to confirm that they are still on the housing list.

This has happened in more than one area where the local authority will write to a Traveller family who may have moved. There may be other reasons why a letter is not the most suitable way to contact that family. The local authority does not receive a response from the family so it takes the family off the housing list. Then at a later stage, when it becomes evident that this has happened they have to rectify the situation. Let us say that a person has been on the housing list since 2012 and this issue happens in 2020, they will reinstate the family from the date the situation was rectified. That is not fair or reasonable. The family should be reinstated from the time they were originally on the housing list if they are still in need of housing. That is our view and we have talked to local authorities about this topic and we are going to talk further. Local authorities need to find a way of communicating effectively that works for people so they can be sure that people are receiving the information and the request to update the housing list.

Moving away from the letter as the means of communication would be useful, particularly for Traveller families.

Mr. Ger Deering

A letter may be fine for some people but if the local authority does not receive a response it needs to follow up and find out the reason for that.

My apologies for not being able to attend in person. I am dealing with something else in my office. I thank Mr. Deering for his presentation. Because I was dealing with something else here I did not pick up on every point that was made in the presentation. Is it correct that the largest number of complaints were against local authorities?

Mr. Ger Deering

That is correct.

Are those complaints mostly to do with housing? Mr. Deering may have clarified this previously

Mr. Ger Deering

That is correct.

I missed the figure given for complaints against the HSE. What was that figure?

Mr. Ger Deering

The figure for the HSE was 796. Sorry, that is health and social care.

Was Mr. Deering surprised by that figure or did he think it would be higher?

Mr. Ger Deering

Considering that we were in a pandemic and considering all of what the HSE was doing, it is not surprisingly high. We strongly encourage organisations and public bodies to have a good complaints system in place. To be fair to the HSE, for much of the work it carries out, it does have a good complaints system in place.

To be fair to the HSE, for much of the work its staff do, they have a good, dedicated system in place for dealing with complaints. That is not to say they always get it right or that the complainant is always happy with the outcome. However, we believe they have a system in most of their areas for dealing with complaints in a positive way. I have to give them credit because in the main they engage reasonably well with us when we have complaints.

On the breakdown of those complaints to the HSE, did they all relate to the system or were they more to do with delays or waiting lists? Was there any area that Mr. Deering noticed when they got complaints that were more difficult than others? Were a lot of them do with waiting lists?

Mr. Ger Deering

The first thing I should point out - and I know this is not part of the Senator's question - is that we do not deal with clinical judgement. For example, we get complaints sometimes about the treatment somebody received from a particular professional. Complaints about clinical judgement are not complaints that we deal with at the moment. In fact, across the board in our complaints, communication is usually at the heart of them. This often relates to poor communication regarding a procedure that may have been postponed. There are a lot of communication issues and issues with how people are maybe dealt with. However, yes, of course, waiting times are part of the problem as well.

That is something that could be resolved where it is an issue of communications. This could probably reduce a lot of those complaints.

Did Mr. Deering give a figure regarding legal practices? Do they get many complaints about legal practices?

Mr. Ger Deering

We do not. The complaints we receive are against the regulatory body, which deals with the complaint against legal practices. If somebody has a complaint, for example against a solicitor or a barrister, that complaint will go to the Legal Services Regulatory Authority.

Is it the case, therefore, that the Office of the Ombudsman does not get many?

Mr. Ger Deering

We could get complaints against that authority about how it dealt with those complaints, but we do not have a large number of them.

I am not surprised about the Department of Foreign Affairs because of the issues we had with passports. That is fair enough. How many relate to the marine? Did Mr. Deering say there were 77?

Mr. Ger Deering

There are 77 that relate to the Department of Agriculture, Food and the Marine.

That is still pretty low.

Yes. We are pleased with some of the public bodies. In fact, it was unfortunate that complaints about local authorities increased so much because given the pandemic and all that was happening, public bodies and Departments did manage to reduce the number of complaints that came to us, which is a good thing. That is what we want to happen. We want to see these bodies first providing a quality service so that one does not need to complain, but where people do complain, we hope that this is solved as quickly and as informally as possible in the body itself.

I am happy with Mr. Deering's response about disability transport and the concern he has shown in that regard. It is good to hear that the Minister of State, Deputy Rabbitte, and others are working to try to get solutions to that because it is a burning issue for quite a number of people.

I thank Mr. Deering for sticking with me through all those questions. Is he happy with his own powers and procedures, or is there anything he is looking for that we could find to improve the service he gives?

Mr. Ger Deering

No, I am very happy with the powers and resources we have. Everybody can do with more resources, and I know many people coming before a committee such as this will put resources at the top of the list, but I am happy with the structure in our office and the dedicated people we have. The important thing is that we have significant powers of investigation and powers to get information, and that relates to both an individual complaint and where we carry out a systemic investigation. I think the powers are sufficient.

Coming before a committee such as this and being able to report directly to the Oireachtas is important so that when we carry out an investigation, if it were the case that we did not get the co-operation or that we are making recommendations for improvements, we have the support of a committee such as this one in making those recommendations. However, as the office has evolved over the years and when we look at the most recent reports, it is the case that public bodies are accepting the recommendations. I am sure we will talk a little more about this in a few minutes. For example, with regard to the report "Wasted Lives", which is about people under 65 who are in nursing homes, the HSE accepted all the recommendations in that, and it is working to implement them. Maybe we would like to see them being implemented a bit more quickly, but I am not sure there are any powers we could have that would assist us to get them implemented any more quickly. It is a matter of a mix of the powers of investigation, which we have, and the powers of moral suasion, which include coming before committees such as this.

I thank Mr. Deering for his time. Finally, I presume a percentage of the complaints are spurious and the Office of the Ombudsman would probably not give much heed to them.

Mr. Ger Deering

We treat every complaint seriously because the fact that somebody makes a complaint to us means they are unhappy. Sometimes people are happy to get an explanation from an independent third party, if I were to put it that way. It may be the case that the body concerned has tried to explain to the person that he or she could not qualify for a particular scheme or whatever that was, and the person is doubtful of that answer. Sometimes, we investigate it and even if we do not uphold the complaint, we explain to the person:

Look, this is how the scheme operates. The body did what it should have done and did what it could do.

All those complaints have at their heart some dissatisfaction on the part of the complainant. I will not tell the Senator that everybody is happy with the outcome they get from our office. It ranges from people who get significant benefits as a result of our intervention to people who get at least an explanation they accept. Of course, I am sure there are people who will still be unhappy they did not get what they were looking for.

I call Deputy Buckley.

I thank Mr. Deering for attending. I will start at the back of the report and work the opposite way. In his conclusion, he said, "acknowledging and learning from mistakes, from oversights, from unfairness and inequity is intrinsic to driving improvements in our public services". Even though he said in his opening statement that his office received its highest number of complaints in 38 years, it is still a pretty good news story. He also said lots of public bodies are starting to learn from their mistakes and to engage with the Ombudsman's office. Mr. Deering has just said that some people do not like the answer they get, but the most important point is that communication is key, no matter which way it goes. We in public life know this because rules, regulations and certain standards are set out in black and white. I will give an example. I nearly got murdered one time on an estate in east Cork because I brought in a rule book to deal with speed bumps on housing estates. It stipulated that there could not be a bus stop, because there had to be a minimum of 500 m of straight road. Unfortunately, the third stipulation was that two people had to be knocked down, and not one. That was madness, but this was the rule book I had at the time. Does Mr. Deering know what I mean? Sometimes people do not like the answers.

I want to touch on a few issues. I understand that housing is probably the largest because we have not been building enough houses for starters. I understand the HAP came in instead of the other allowances that had been paid previously, but I do feel for local authorities - and we have all worked with local authorities – because it is very hard to shovel snow while it is still snowing. If one does not have something, one cannot move forward. On the Department's side, especially in the area of housing, we do not have enough inspectors for HAP properties, many of which are substandard. People are caught in a rush and there is nowhere and no alternative.

Mr. Deering mentioned the 19 recommendations, which were a follow-on from the Wasted Lives report. I am looking forward to that report. I want to touch on the issue of the CBD. I come across cases where, unfortunately, common sense does not come into it. Somebody has ticked all the boxes and arrived the day before in a certain country, but the consultant will not be there on that day and cannot sign the paperwork. Yet, when the procedure goes ahead, the officials come back and say, "No, they did not sign it on that day". Again, this is about communication and a bit of common sense. I have seen a case where a person who was unfortunately a double amputee was looking for an adaptation grant, but because of Covid-19, the consultants were not working. Yet, that individual came out of a hospital after a double amputation.

Common sense would require that all those adaptation forms be signed, even where there is no consultant available, in order that the process could at least be gone through to a level at which individuals' basic needs are met. It should not take a consultant to cop on that this person, unfortunately, has had a double amputation and needs assistance. Again, communication is key.

I read through some of the summaries in the Ombudsman's report and was interested to see that in one case, a nursing home refused to respond to a family. That is shocking. The excuse was given about not dealing with individual cases. It is more shocking that when the Ombudsman sought the information, the nursing home management said it was not obliged to respond. Mr. Deering spoke in his opening statement about responsibility and accountability. I do not envy his job, which I know is tough. From listening to him, it seems he genuinely enjoys it even though it can sometimes be frustrating. However, it seems as though things are moving forward. I have the utmost respect for the various ombudsman offices and I appreciate all the work they do. It is not easy to change something when people are resistant to change.

Mr. Deering referred to the case of an individual in Cork who was potentially facing homelessness for the sake of an additional €40 or €50. There is a saying that is relevant here but I cannot think of it. We need a common-sense approach. For the sake of €50, we should be able to keep a person housed. There does not have to be the big hullabaloo of potential homelessness and going through the whole process with Departments and the pressure that puts on individuals or families. The work of the Ombudsman's office shows that through engagement and communication, these matters can be resolved with a common-sense approach and a bit of empathy, leading to a good outcome.

If it is appropriate, can Mr. Deering say in which Department or body he meets the most resistance to change? We deal with most of the Departments on a daily basis. I like dealing with local authorities and having one-to-one conversations with the staff there. I do not like Zoom calls. I like to go to a county hall, sit down with people and put forward the concerns of the public I represent. They may not like what I am saying but it is my job to do so and to see whether we can find a middle ground. I am interested to know where Mr. Deering is finding the greatest resistance.

The majority of what is in the report is good news. Things are moving forward. Yes, there is a lot of hardship out there in the areas of housing and disability services. Those issues must be addressed. However, the reports that are coming out, including the one with 19 recommendations, which we are told will be taken on board, mean I am optimistic. I can be pessimistic at times but I am optimistic about this. When we have an Office of the Ombudsman, we have a driving force for change. These committee meetings are important. I am also a member of the Joint Committee on Autism, which involves engagement with the Ombudsman's office, going through its reports and getting its side of the story. It is about working together, as committees do and as the Ombudsman does. As a public representative, I would love to have the kind of back-and-forth engagement there is with his office. We sometimes find it difficult to get answers when we table parliamentary questions and so on. We are bounced off and told it is a matter for another Department. We have a classic story that if one were to put in question about a blue biro, there would be a wait of 15 to 21 days for a response and it would not include any mention of the blue biro. That is the stuff we are dealing with.

I wish the Ombudsman the best of luck. I am looking forward to the reports that will come out shortly. It is vital that we are able to talk about issues, whether it is housing, nursing homes or cross-border schemes. We are listening and we are here to help. We will keep in contact with the Ombudsman's office. I thank the Chairman for facilitating this engagement. I get a bit hot-headed now and again but it is nice to give credit today when we have a good news story.

We are lucky the Deputy started at the back of the report. It might have been a different story if he had started at the front.

Mr. Ger Deering

I thank the Deputy for his kind comments. They are very much appreciated. It is true that my colleagues and I enjoy the job. Ms Hanrahan would say the same. We get huge satisfaction when we resolve an issue, which is a business in which members are likewise engaged. One such issue that comes to mind is a recent and current one that touches on a lot of areas to which the Deputy referred. The case involved a person in a nursing home who was allocated a house by a local authority. This was a good news story and the person was ready to move. The difficulty was that he needed a wheelchair to access the house. The person was in a private nursing home temporarily. We have a situation whereby assessments are not done on people in private nursing homes by occupational therapists and people like that. He could not move to the house until the assessment was done. The Deputy referred to common sense and empathy. I am glad this was the approach that prevailed in this instance but it took a little work on the part of our office. The assessment was done, the wheelchair was provided and the person moved into his new home. We need more joined-up thinking generally to make those things happen. It is good that we can intervene to make them happen but they should happen organically.

The Deputy mentioned the bureaucracy associated with the cross-border initiative. I was surprised to see some of the reasons listed in the complaints that came to us as to why people were refused reimbursement. Some related, for example, to the referral from a GP. As we know, GP offices are busier than ever. A doctor might dictate the referral and have the secretary sign it on his or her behalf. A person will go off and pay for treatment abroad on the basis of that referral. Upon return and having made an application for reimbursement, the person is told the letter should have been signed by the doctor or it was not dated by the doctor. There are other reasons for refusal, such as issues regarding proof of travel. There is a whole range of things on which people are falling down. I am not saying the complainants are falling down but, rather, that the bureaucracy is making life difficult for them. For that reason, we have gone into an in-depth investigation on this matter. I expect the Deputy will be interested in the report we provide, which we hope will be in a few weeks. Even more importantly, I am hopeful the HSE will take on board our recommendations, in the same way it has taken on board recommendations from other reports we have done, and find a way to make these schemes more accessible. The schemes are more necessary than ever now. People of senior age who need a cataract procedure, for instance, cannot wait. They need it done without delay and where it can be done in another jurisdiction, they should be able to avail of that.

Interestingly, there is no cost to the Exchequer under these schemes because people can only be refunded either the amount they paid for the procedure or what it would have cost the HSE to do it here. If they pay more, they will get back only what the HSE would have paid for the procedure to be done in Ireland. There is no additional cost. It really is about facilitating people and taking what the Deputy described as a common-sense and empathetic approach to these matters. Nobody is asking for people to get a refund they should not get. What is being asked is that they not be penalised because somebody else made a mistake. Another problem we found was that a doctor might refer a patient to the ear, nose and throat, ENT, department of a hospital, for example, and somebody might decide in processing the claim that the patient should have been referred to a named consultant. In fact, as far as I know, the scheme does not require that. We have dealt with all of these kinds of issues. I am hopeful that the recommendations we make in the report will be accepted by the HSE and the schemes will be made more accessible to people.

The Deputy referred to the risk of somebody becoming homeless. In the particular case referenced, the person had applied for the HAP scheme. Local authorities are able to give a discretionary top-up in such instances. In a number of cases, we have gone back to local authorities and asked whether they can use that discretion. What was interesting about the specific case the Deputy mentioned is that the rent was approximately €650 a month, if I recall correctly, which means the person was getting exceptional value. I would like to be shown where accommodation can be had for €650 a month at this stage. It is not as though the person was seeking funding for expensive, elaborate accommodation. Thankfully, empathy and common sense prevailed in that instance.

These are important examples. We do not do full investigations. What Ms Hanrahan, her team and all of the people in the office are trying to do is get this resolved for the person as quickly as possible. HAP is a good example. If we have to go to a full investigation, there is a risk the person will have lost a property in the meantime. We prioritise certain complaints. If a person is at risk of becoming homeless, our people pick up the phone immediately and contact the local authority. We prioritise cases in that regard.

The Deputy mentioned cross-Border homelessness and resistance. No particular body comes to mind which is particularly resistant, but we encounter pockets of resistance within an organisation. This sometimes comes down to individuals who may be very rigid in their interpretation and see their job very much as dotting the i's and crossing the t's, and they leave out the common sense and empathy. I meet the Secretaries General of Departments and will shortly meet local authority chief executives. We are constantly trying to meet organisations and point out to them that they have a problem within them which they need to look at. I am happy to say that I cannot think of one organisation that I would say to the Deputy is resistant to us. However, I can certainly think of little pockets of it in organisations and we work on those and try to get them around to our way of thinking and to co-operating and working with us. I hope I have covered all of the areas the Deputy mentioned.

That is perfect. It is a story of hope today.

I thank the Ombudsman and Ms Hanrahan for being with us today and all of their teams for everything they do. One thing which rings true every time I speak to anybody who has had dealings with the Ombudsman is the trust they have in him and his office and team. That is important. Unfortunately, trust sometimes breaks down with different elements of our public service and that is why people end up going to the Ombudsman. The Ombudsman put it very eloquently that sometimes his office cannot resolve the issue but can explain it as an independent and impartial person, entity or body. Sometimes that at least alleviates concerns.

The Ombudsman in his last contribution answered one of my key questions. I would like to run through his statement. Local authority issues are high on his agenda. Am I right in making the assumption that there are administrative delays, which probably come back to a resourcing issue?

Mr. Ger Deering

Yes.

The Department of Social Protection figure seems quite high, at 579 cases. Are there any trends regarding that Department? The Ombudsman delved into local authority cases and health complaints. I would be keen to understand whether there are particular trends.

My main question concerns special reports, that is, what happens after they are published and how that changes things in a system or organisation. The Ombudsman has given us two good examples of this, referrals when it comes to treatment abroad and assessments in nursing homes, which sounds bonkers. I commend the Ombudsman on being able to identify and resolve that issue. Are there other such examples? It would be good for the Ombudsman to be able to articulate the work he does in terms of that long-lasting impact or change.

I refer to the two-year anniversary of the publication of the report Wasted Lives, and the report the Ombudsman is going to do as a follow-on to that. I sit on the Committee on Disability Matters. We would gain valuable insight if the Ombudsman came before the committee after the publication of the report in order to understand it a little bit. I am not sure whether I should do so, but I would like to extend an invitation to the Ombudsman on behalf of the committee. I will speak to the Chair to see if we could extend an invitation to the Ombudsman to discuss that.

On the medical treatment report the Ombudsman is working on, I would like him to give us information on referrals, the cost of transport and the small things that can have a really big impact on the person filling out forms. It sounds really interesting. The more we can remove those small hurdles the better. It might be a good opportunity for the Ombudsman to come before the committee and explain the hurdles when the report is published. In the meantime, we are probably all aware of situations in our constituencies that we can put forward.

I refer to the complaints about the Department of Social Protection. What are the key trends? It is great to hear the Ombudsman talk about referrals and assessments in nursing homes. Are there any other examples which he and his team are really proud of?

In his last contribution the Ombudsman referred to discretion with regard to HAP. Did he mean the discretionary payment in respect of homeless HAP or to discretion around being able to approve somebody more quickly because he or she is in a homeless or particularly vulnerable situation? I would like some clarity on that. If it was the latter, I did not know that was the case and I am keen to understand more from the Ombudsman or local authorities about that.

Mr. Ger Deering

I thank the Deputy. I will deal with one or two of her questions and then hand over to Ms Hanrahan on the HAP discretionary payment and various reports.

On social protection, there is no particular trend. The report covers one of the pandemic periods. There were complaints about access to some of those schemes. I am pleased to say that the number of complaints about the Department of Social Protection has been dropping. It is one of the organisations that works well with us. Some of the outcomes are extremely important. For example, a particular complainant came to us who had been in receipt of carer's allowance. Her entitlement to that payment ended and for a number of years she continued to be in receipt of it. The Department sought about €13,000 in arrears of payments that were due. When our investigation examined the case, we discovered that she should have moved from carer's allowance to a disability allowance. The difference was perhaps €13,000 or €15,000. The point was that the person was in a much better position than she had been.

We get a lot of co-operation when we engage with the Department of Social Protection. It is fair to say that it is not one particular scheme that is an issue. The number of complaints is not high, given that every week the Department of Social Protection pays out huge amounts of money to a significant number of people. The number of cases is not disproportionate, if I was to put it that way.

Given that there are nearly 600 complaints in this area, I will appreciate if the Ombudsman cannot answer my question or not know the relevant information offhand. Does his office receive any or many complaints from women around pensions? In my constituency, a wife is in receipt of a pension through her husband's pension. He is now in a nursing home and she does not qualify for the living alone allowance, even though she is living alone. Does the Ombudsman get many queries from people who are living alone but do not qualify for the allowance because of the payments they receive in their own right?

Mr. Ger Deering

I will let Ms Hanrahan answer that.

The Deputy has shown quite an interest in our special reports. The work we do in terms of dealing with complaints is very important, but it is especially important for the individual who has made the complaint. The special reports have a broad benefit. They benefit people who will never have made them into our office or may never even have known about our office. For that reason, I am very heavily committed to the reports that were done by my predecessors. Ms Hanrahan can list them for the Deputy.

We do not just do a report and move on; we continually monitor the previous reports and keep updating ourselves and asking bodies to update us until we are satisfied that all of the recommendations have been implemented. Ms Hanrahan might mention Learning to Get Better and those kinds of reports, in terms of the benefits they bring to the HSE and so on. I will leave the question on pensions and special reports to Ms Hanrahan.

Ms Jennifer Hanrahan

I would not be able to give the Deputy a figure on the number of complaints involving pensions from women. It is definitely a complaint that could come to us. Usually people have to contact the social welfare appeals office and once they go through that process they can then come to us. I would not have a figure off the top of my head, but it is the type of complaint we would look into once a person has gone through the social welfare appeals office system.

On HAP, there is a discretionary uplift which increases the rate from 20% to 35%. That is it. If we receive a complaint from someone who is at risk of homelessness, we will contact the local authority and see if it can examine the case as a matter of urgency. We do that directly.

Does the Ombudsman receive many complaints from people about the potential purchase of a property where there is a tenant in situ situation?

Ms Jennifer Hanrahan

Normally the ones we get are those where families are about to be made homeless for some reason or other. We have had people living in their cars who ring us, and they are looking for homeless accommodation. I am not sure about the tenant in situ purchase example. On the other reports, we do a lot of work in our office that we are obviously very proud of. Looking back at older reports, the one that comes to mind is the A Good Death report. I think the initial report was done in 2014 and a follow-up report was done in 2017 or 2018. It was about complaints about end-of-life care in hospitals. The Ombudsman had received a number of complaints about end-of-life care. He did the report and it was mainly a commentary and digest of the complaints, and a commentary on the type of complaints we were receiving. Recommendations were again accepted by the HSE. On foot of that they have an end-of-life forum, which involves the HSE and the Irish Hospice Foundation. One of our investigators sits on that forum. They have done a lot of work in recent years producing information booklets for families to know what will happen around the end of life. There is a lot of different guidance and we feed into that. We keep an active eye on that too because we like to see what is happening with our complaints about end of life, so we can feed back into the end-of-life forum.

The other report was the Learning to Get Better report from 2015, which was one of the first own-initiative investigations ever undertaken by the Department. It was initiated on foot of health complaints, but was more to do with the level of health complaints we were receiving. The then Ombudsman was not certain if the percentage we were receiving was equivalent to the number of interactions people were having with the health service. It looked into whether people could access the complaint system. It looked at the complaint system to see if that was the reason we were not getting complaints, at whether people knew how to make a complaint and at whether it was easy for them to make a complaint. A lot of people felt their care would suffer if they made a complaint and things like that. Recommendations were again made, and actually the year service was updated after that. We have worked with the HSE on that, and we go to a quarterly complaint managers forum. We follow up with them quarterly and then one of our investigators attends the quarterly complaint managers forum as well. We follow up on them to make sure the recommendations are followed up.

That is good to hear. It is also great to hear that there is a constant loop, and they are constantly making sure that gap is being closed. I want to thank Ms Hanrahan for that, because it is not just about improving services and access to them; it is about improving and changing people's lives. I thank Ms Hanrahan for all that she and her teams do in that respect.

I will address the report due to be published shortly about the HSE administering schemes designed to assist patients. What are some of the grounds on which the HSE has refused to reimburse patients? What reasons are they given for not being reimbursed?

Mr. Ger Deering

There have been bureaucratic and administrative reasons. One of them could be that a referral letter from the doctor was not properly dated or signed. It could have been addressed to an emergency medical technician, EMT, or a discipline within the hospital rather than to a particular consultant. Perhaps Ms Hanrahan can think of some others.

Ms Jennifer Hanrahan

There is a pre-consultation with your consultant. If you go abroad, you need to have a consultation with your consultant the day before the treatment. People often fall foul of that one.

Mr. Ger Deering

It actually says "in advance of your treatment." There is a debate about what constitutes "in advance of your treatment". If you have a consultation on the morning of the treatment, is that "in advance of your treatment"? There is sometimes a view taken the morning of the treatment is not in advance. There is a need for greater flexibility. The approach needs to be that we assist people to benefit from these schemes, rather than being overly bureaucratic in terms of how we assess the applications when they arrive. We should be encouraging the use of these schemes and making it easier for people who use them to get refunded. One of the problems is that people will already have spent this money. You do not apply in advance for some of these schemes. You go and have the treatment done. You do what you believe is right, but you could unfortunately find yourself quite considerably out of pocket. Some of these people get loans from credit unions. We have also found cases where the HSE is looking for proof that someone got a loan from a credit union, or from their sister or wherever. We think that is probably a bridge too far. If people are able to access money to get it done, they need that money refunded when they get the treatment.

An important consideration is that we have sometimes heard the term "health tourism". I am not saying it was from the HSE. Speaking as somebody who has unfortunately been through some health procedures, I cannot imagine that anybody really wants to go abroad to have treatment unless they really have to do so. It is a traumatic and difficult time for people. If you could get it done locally or in this jurisdiction, you would get it done in this jurisdiction. The mere fact that people go abroad and pay to have this treatment means they are in pain and are suffering. They need the treatment, and as Deputy Buckley has said, they need a bit of compassion, empathy and understanding when they come back to get their treatment refunded.

When silly bureaucracy and red tape has stopped them from getting it, if they have produced documents subsequently has the HSE been forthcoming, or do they just continue dragging their heels because the paperwork was incorrect initially?

Mr. Ger Deering

This is one of the areas where we have the most engagement in trying to get these matters resolved. If we take the referral from the doctor, the difficulty we sometimes come up against is that the HSE takes the view that it cannot be corrected. We have had situations where doctors have come back and confirmed that they absolutely made the referral, and produced the letter to confirm it. However, they were supposed to have signed the letter on the day and sometimes the view is taken that they did not sign it on the day. We engage quite heavily and sometimes we have success and sometimes we do not. I am the eternal optimist. I am hopeful that when we have completed our report, we will get improvements and the recommendations we are making will be implemented.

Did Covid play a big part in the number of complaints received? Has a big drop in the number of complaints been seen since Covid has passed?

Mr. Ger Deering

I think it played a part, but it might have created complaints and caused people not to complain as well. We all found ourselves with cabin fever and you might have been at home and a little more cross at times. It did encourage some people to make complaints. The trend has also remained up. When we do our 2022 annual report, it will be seen that the number of complaints has remained at a similar level. I would like to think that is down to people being more aware that they can make a complaint, rather than services necessarily disimproving. A lot of services are improving, but some are not.

In the 2021 reports, reference was made to the number of complaints about the disability access route to education, DARE, system. Can I get the witnesses' thoughts on that, and the manner in which the State is succeeding or otherwise in implementing that?

Ms Jennifer Hanrahan

I think with DARE complaints, we get complaints both about the higher education access route, HEAR, and the disability access route. A lot of it is sometimes down to people not ticking a box. For disabilities you are looking for information from the education psychiatrist where DARE is involved. We had engagement with them this year so they could explain the process. We go back and make sure they have taken everything into account in reaching their decisions from an administrative point of view.

For the benefit of people looking in, DARE is the disability access route to education.

Ms Jennifer Hanrahan

HEAR is the higher education access route. It is for disadvantaged people.

Mr. Ger Deering

I want to make a general point about which public bodies need to think. If public bodies find that people are making a lot of mistakes in an application process, the body needs to look at the application process. That applies more generally than this particular question. If a lot of people are making the same mistakes, maybe the question is not as clear as it could be. Maybe the process should be a little easier. It is really important when people design services that they design them from the very start.

The start is usually the information that is provided to the person about the service, and the application form is the next step. There is a tendency to design things from the inside out. They are designed from the organisation's administrative point of view but there is a need to start out by considering what is the first thing a customer - a member of the public who wants to use the service - needs to know. The first thing they need to know is whether they are eligible, so organisations should be setting out the eligibility criteria in the simplest form possible. When it comes to application forms, there is a need to reflect on what information is needed in order to assess the application and to ask only for that information.

I totally agree with Mr. Deering, as would all public representatives. Some of the forms we help people to fill in are mind-boggling.

As regards the White Paper on direct provision, all present agree in respect of the need to do away with or scale down direct provision. Instead of the numbers reducing, however, they have increased by 80. Has the Office of the Ombudsman received correspondence from people currently in the direct provision system with regard to the situation there?

Mr. Ger Deering

As the Chair mentioned, complaints rose in 2022 but they had dropped off considerably so overall the number of complaints stayed the same. We got access to direct provision before Covid, but then it changed a little during Covid. We firmly believe that conditions improved. As time went on, the complaints we received were less serious. As in many other areas, some of the more serious complaints we dealt with at the beginning were fed back into the system and the centres very much improved what they wanted to do. We all wanted to see an end to direct provision. That was the plan and it is where we are going but the world has been a very different place in the past year compared with when those commitments were made. Our commitment at the moment is to ensure that what is currently happening does not dilute the standards. The complaints we are currently getting in respect of direct provision do not indicate there is a lowering of standards. I visited a centre this year to meet a complainant. A family was unnecessarily being separated and segregated. I met with the family and the centre staff and we then spoke to the International Protection Accommodation Services and the people concerned and got a resolution. Again, it is about the fact that we get co-operation. We are conscious that the people running those services are in an extraordinary situation at the moment in terms of trying to provide accommodation not just for refugees and asylum seekers coming through the international protection system but also for Ukrainian refugees. We have to show understanding in the context of trying to find solutions to unprecedented developments in an emergency situation.

Has the Office of the Ombudsman received complaints in the context of the 60,000 plus Ukrainian refugees who have come to Ireland under the temporary protection directive? I have seen some of the accommodation with which they are being provided. Has Mr. Deering's office received complaints about the conditions of some of the accommodation?

Mr. Ger Deering

We have not received such complaints to any extent. We have engaged to a certain extent. Many of the Ukrainian refugees are receiving social welfare payments and things like that and we are dealing with a small number of complaints in that regard. In the context of the number of people who are coming in-----

The number of complaints is very small.

Mr. Ger Deering

-----the number of complaints is small. It is kind of an acknowledgement that those involved are trying to do their best with the limited resources. When I say “limited resources”, I am not talking about money; I am talking about the availability of accommodation and the difficulty with which people are trying to deal. There is a lot of goodwill being shown by officials and others trying to resolve this. I visited a centre where people were being received. I was struck by the fact that even though they had only been at the centre for a very short time when I arrived, they knew the staff and people working there and had built relationships. It was interesting because that was one of the centres that people were saying should not be used for accommodation. On the day I arrived, the last of the people who had been put in temporarily were being bused out. They were concerned about where they were going to; they wanted to stay in the centre. It is an area where a lot of empathy and compassion is being shown. I am not saying that everything is okay - it is not - but we have to try to work with the hand people are dealt at the moment.

A matter connected with direct provision is the outreach programme provided by the Office of the Ombudsman. Does Mr. Deering intend to extend it to Ukrainian refugees who may have issues that need to be raised in order to ensure the system works as best it can?

Mr. Ger Deering

As the Chair pointed out, we provide the outreach to a number of areas, including direct provision. It is a logical conclusion that we will extend it to Ukrainian refugees but a problem is that until things settle down somewhat, their priorities may be slightly different. Very often we are dealing with people with whom we have to do a lot of work in advance so that they trust us. I am not necessarily speaking about Ukrainian people but those coming from certain other jurisdictions who do not have an automatic trust in the State. Even though our office is independent, we have to build relationships and work with people to get into the level of outreach we need to do.

Mr. Deering touched earlier on the investigation in 2010 by Emily O’Reilly, his predecessor, into the charging of people in nursing homes. Without going into the finer details, does Mr. Deering have a view on the manner in which that issue has been addressed since the 2010 report?

Mr. Ger Deering

It is an interesting one from our point of view. The report is extensive and sets out a significant amount of detail. In fact, much of the subject of current discussion on the matter is covered in the report. The Ombudsman at the time came to her conclusions and made the recommendations but the report was brought to the Oireachtas and it was left to the Oireachtas and the powers that be at the time to devise a scheme to deal with people who had an entitlement to a nursing home and had been charged. The report stopped short of saying how compensation and so on should be dealt with. I am happy to stand with the report as it is at the moment. It is really a matter for others. I understand this is being looked at in the context of a number of areas and we will watch with interest the outcome of that.

Did Mr. Deering state earlier that all the recommendations of the Wasted Lives report are being taken on board?

Mr. Ger Deering

Yes, they are, although perhaps not as quickly as we would like. They are being taken on board, however. We will be having a meeting with the HSE on the matter shortly. It is an example of how things should be done. The HSE put in place a very high-level committee with senior people on it to make this happen. Covid intervened and a number of other things happened but the HSE is moving people out of the facilities. I should stress that not everybody necessarily wants to move. The most important thing is that people who want to move out of nursing homes and are able to do so have that option. We are not too happy with the speed at which they are moving out but that is something we are willing to work with the HSE to improve.

Mr. Deering referred to the HAP system. Does he see any big failings in that system?

Mr. Ger Deering

It is too early for me to say. We are doing an investigation at the moment. What we are hearing anecdotally is that there probably are areas where decisions could be reached more quickly. In addition, there is a three-way interaction, with the Department, the local authorities and the shared centre in Limerick. We will be considering whether there is anything in that process that could happen to make it more accessible, efficient and effective in terms of achieving its aims.

Two issues come to mind. With any ombudsman’s office, one bugbear I have when asking about power, additional resources or whatever is mental health respite for older people. There is no oversight in that regard. When one tries to reach out to access information or help for families, it is not available. To cut a long story short, I reached out to the European ombudsman on this issue and was told it has no remit. It sends you back to the Mental Health Commission or some other organisation. You get the run-around, with no oversight. Is there a way to create an ombudsman's office to deal specifically with long-term respite care for older people with mental health difficulties? It could be similar to what has been proposed in the context of protected disclosures. There is a significant gap there.

The other issue I wish to raise is nursing home deaths and so on. I have raised it as a Topical Issue matter and asked the Minister to hold a public inquiry into it. There seems to be a lack of oversight in this regard. In the context of the Ombudsman's report, I mentioned earlier that when the Ombudsman sought information, the nursing home management said it was not obliged to respond.

As Mr. Deering said, this is about doing the right thing, improving services, finding out where the mistakes were made and addressing them to make sure they do not happen again.

Mr. Deering mentioned that where people are not happy about medical bills or something else, they can eventually go to the Ombudsman. Before I even open my mouth about the proposed enhanced medical cards, in light of the fact Mr. Deering mentioned cross-Border issues, I know they will not cover cataracts. I will try to find out tonight from whatever Minister will be in the Chamber what this enhanced medical card for the survivors of the mother and baby homes will cover. This is a human rights issue. The majority of the people affected are elderly. We know what problems are coming down the line for them, and cataracts are certainly among them. Will there be an option in future for people to contact the Office of the Ombudsman to look into this as a rights-based issue?

Mr. Ger Deering

In regard to the medical card issue, we cannot set policy nor tell the Government who to include in a medical card scheme. When the scheme is in place, if people apply and believe they did not get something they would be entitled to under the scheme, that will certainly be something we can deal with.

I will let Ms Hanrahan talk about mental health in particular. In regard to older people generally, it is important for people to know that we can deal with anybody’s complaint at any age. As regards separating them out, I would say one of the problems we have is that sometimes older people are already segregated. For example, if a person has a disability and is 60 years of age, there is a range of services available to him or her. However when the person hits 65 he or she is no longer considered a person with a disability, but an older person, and the services are withdrawn. I would be loath to set up any separate system for older people because we will find that people who have a complaint with the Ombudsman at the age of 64 will suddenly have to take it somewhere else. I am confident that we can deal with complaints from older people about the services. We do not divide people into demographics, statistically, but many of the complaints we have would be from older people directly or from their families, including those in nursing homes. If people do not have the capacity to make a complaint themselves or do not want to do so, they can nominate somebody else. Alternatively, if they do not have the capacity, we can get a certificate to say they do not have capacity and somebody else can then make the complaint on their behalf.

On the nursing home case, even though we gave that as an example, at this stage the vast majority of nursing homes understand the power of the Ombudsman to deal with complaints. That was more of an outlier where somebody did not seem to understand that they had to deal with us. We engage with their representative body, Nursing Homes Ireland. Ms Hanrahan did two webinars last year for nursing homes. They attended to understand what it is. This year, we will issue posters, which we expect nursing homes to put up to tell their residents that if they have a complaint, they can come to the Ombudsman. We certainly will actively engage in that area.

We are also conscious that sometimes the relationship is there and for the residents the nursing home is their home. We have to find a way to make sure residents are comfortable in making a complaint against the place that is their home. We are sensitive to that and how we handle it. We always reassure people that they should come and talk to us and we will deal with any sensitivities they have. However, it is very sensitive for a person when living in the place against which they are making a complaint.

I asked that question because, specifically in relation to older people and respite mental health services, local community services are being closed down on the basis that buildings are non-compliant, yet the people in them are being taken out of what Mr. Deering calls their home and moved into other places that are actually less compliant. Does the Ombudsman have the power to investigate that and ask why this is happening? This is personal to me because it is happening in my home town. I cannot understand how you can take somebody from a hotel and place them in a tent and tell them they are fine. What is happening is the HSE blames the Mental Health Commission for its report and it, in turn, passes it on to somebody else. The European Ombudsman said it cannot do anything about it, which brings us back to where we started. There is no line of communication. I asked the question because if this is a human rights issue, a failing of State services to find proper accommodation, why is it right to put people in a place that is less compliant than where they are now? The services are getting away with this. If I contact the Office of the Ombudsman to say this is the story - all the work has been done and unfortunately the file is very thick - does the ombudsman have the power to investigate and ask questions?

Ms Jennifer Hanrahan

It would depend on whether the facility Deputy Buckley is talking about would come under our remit. We will take a complaint and screen it in the first place to see if it is something we could look at. Is the Deputy referring to someone who has been moved out of a nursing home?

An awful lot of people have been moved out and put into places that are less compliant. It goes against policy, community integration and community-led services. It is the Owenacurra Centre in the town of Midleton. People are being moved to a place that is 15 miles away. They cannot even access a shop. It has to be detrimental to their health and their families' health also. It is a huge case. I will email the details.

Ms Jennifer Hanrahan

Yes, the details will tell whether the facility comes under the remit of the HSE or a section 38 or 39 organisation.

I would say it is both. It is under the remit of the HSE.

Ms Jennifer Hanrahan

We would have to see.

I will email the details because I am conscious that we have a lot to get through. I thank Ms Hanrahan.

I thank Mr. Deering and Ms Hanrahan for their presentation. I am sorry I was not here for the full meeting. I had another meeting that conflicted with it. I appreciate them taking time to appear today. The report is extremely interesting. I commend the Ombudsman and his office on the work they do. There are some very interesting cases in the annual report, particularly in regard to passports. That will create great sympathy in this House because during the height of the backlog in the Passport Office and the period of catch-up post Covid, a huge amount of work was done by the Ombudsman's office in providing assistance. One of the cases is specifically mentioned in the report. Congratulations to the Ombudsman and his team on all the work they are doing and have done in the recent past.

On nursing homes, which were discussed earlier, how successful has the Office of the Ombudsman been in the past year in upholding the Ombudsman Act 1980, which states that the providers have an obligation to respond to requests demanding transparency in relation to nursing homes?

Mr. Ger Deering

As I mentioned, at the outset of some of our complaints, nursing homes did not realise that they came within our remit. Nursing homes are an unusual case in the sense that they are generally privately owned. I believe there is only one nursing home that does not come under our remit and that is because it does not receive State funding. The rest of the nursing homes come under our remit because, as we know, the vast majority of people, or a great many of people in those nursing homes, are funded by the State. The first job we had to do was to inform the nursing homes that they actually come within our remit. As I mentioned, we have done webinars with the nursing home owners. We have also worked with Nursing Homes Ireland to make it aware that nursing homes come within our remit.

In regard to the number of complaints, I will ask Ms Hanrahan if she knows how many we had against nursing homes.

Ms Jennifer Hanrahan

In the 2021 report, there were 83 complaints. The figure had increased from the year before. In the 2020 annual report, the numbers went down because of Covid-19. In 2021, the numbers increased. Obviously people have to make their complaint to the provider in the first instance before coming to us, which means there is always a bit of a lag. As Mr. Deering said, when nursing homes came under our remit in 2015, they were not used to dealing with the Ombudsman because they were private entities. At the time, we did a number of information sessions, some in Dublin and some around the country. We ran about six of those. As Mr. Deering said, we did not have as much interaction owing to Covid and the number of complaints fell in 2020 due to the pandemic.

Therefore, in 2021, we carried out a couple of webinars, which were really well attended by nursing home providers. As I am sure that the Chair and members experienced, we found webinars to be a very good way of contacting people because they did not have to give up a whole day to travel to Dublin or do something like that. Participants found it easier to log on for a webinar.

This year, the health in care regulations were updated and the regulations concern complaints handling in nursing homes. Also, from 1 March, nursing home providers must have a more streamlined complaints process, which involves appeals. They already had them but it is now a side that has been introduced. We are going to work with nursing home providers through further webinars and education programmes.

Mr. Ger Deering

Over the last four years we upheld, partially upheld or provided assistance for 56 complaints out of about 268. Obviously if a complaint is upheld or partially upheld then it is straightforward. We aim to get complaints resolved informally and as quickly as possible. When we provide assistance, it usually means we resolved the complaint and it did not have to go on to a full investigation.

Very good and I thank the Ombudsman. On the nursing homes issue, the HSE had 2021 transition goals for adults with disabilities under the age of 65. The Ombudsman had a stated target of steering them away from nursing homes and into more appropriate living accommodation. I apologise if I am going over old ground that the Ombudsman has spoken about but has the HSE met its target?

Mr. Ger Deering

I do not know if the HSE has met the broader target. The area that we have examined has been people under 65 years who are in nursing homes but really do not need to be in them. Our report, Wasted Lives, set out, I think, 16 recommendations, which the HSE accepted and are implementing. As I stated earlier, unfortunately, that is not happening as quickly as we would like it to happen. A big part of this, unfortunately, is that this issue is linked to the housing crisis generally because many of the people whom we want to see moved out of congregational settings need, hopefully, their own front door in many cases-----

Mr. Ger Deering

-----or other more suitable accommodation. A bigger issue is trying to find the supports that people need in the community. As the Deputy will know, it is not a matter of just moving from a congregated setting or a nursing home into a community setting because the support needs to be put around these people. There is no doubt but that implementation is happening, the policy is there and there is a commitment to it. I suspect, however, it is not happening as quickly as anybody would like it to happen.

The Ombudsman referred in his annual report to the special investigation into the HSE's scheme to fund the necessary medical treatment in the EU. How is the investigation going, to date?

Mr. Ger Deering

We have almost completed our investigation and I hope to publish the report in the next few weeks. It has already been suggested that we would discuss our report with this committee and we would be very happy to do so. We are finding that there are administrative and bureaucratic issues that we think could be lessened, thus making it easier for people to get refunds. Nobody goes abroad to have treatment for the fun of it. They are going there because they really need a treatment.

Mr. Ger Deering

People may have borrowed the money from their credit union to pay for the treatment for a relative and they really do not need the stress of not being able to have that refunded in the most straightforward way possible. We are very hopeful that the recommendations from our report will be implemented by the HSE but time will tell. We certainly will do everything we can to see can we make the scheme easier and more accessible for people to get their refunds.

Very good. Mr. Deering mentioned the proactive measures that followed his housing workshop with NGOs in 2022. Does he have a further update on that?

Mr. Ger Deering

As you can imagine with housing at the moment, it was a very broad-ranging discussion on the day and a lot of issues were raised. As we distilled things together, the area that we identified where we could probably make the best and quickest intervention that would have an impact is in respect of the housing assistance payment, HAP. One of the things we decided to do was to instigate an investigation that looks at how the Department and the shared service in Limerick and the local authorities are integrated and working together and at what improvements can be made in terms of HAP.

We had another issue, which shows the benefit of listening to people on the day. A circular from the Department of Housing, Local Government and Heritage had become outdated and was causing a certain difficulty for NGOs, particularly for people who had come to this State in need of housing. We drew the issue with the circular to the attention of the Department and its officials updated their circular and issued a new one. That might seem like a very simple example but it is an important one, if issues are causing a problem. We also have, as a result of the workshop, decided to improve our outreach to the Traveller community and we are going to do some very targeted interventions in terms of working with Travellers. There were very definite actions that came out of the workshop. We have also kept in touch with the NGOs that attended the workshop and have informed them that we are taking these actions.

That sounds highly productive. I suggest that the Chair invites Mr. Deering to come in here in the next little while, once his special report on medical treatment across the EU is finalised and published. Finally, I thank Mr. Deering and Ms Hanrahan for attending.

Yes, Deputy Higgins also suggested earlier that we invite Mr. Deering to come back in here when the reports are published. Does Deputy Buckley wish to comment?

No, I think I have grilled the witnesses enough.

Does the Ombudsman wish to make a closing comment?

Mr. Ger Deering

No. I again thank the Chair for the opportunity to come in here. We think it is really important that we interact with the committee. I welcome the suggestion that we return to discuss my report on treatment abroad because it is clear that members have heard about concerns from their constituents. If there is anything members want to add to it or for us to inform them about what we are doing, then we are very happy to return.

There is a consensus that once the reports have been finalised, we will invite the Ombudsman back in again. I thank Mr. Deering and Ms Hanrahan for attending. We have had an informative meeting and we look forward to taking things further but the next time, we will ensure that Deputy Buckley starts at the front of the book.

Mr. Ger Deering

I thank the Cathaoirleach and Members.

We will suspend the meeting for a few minutes to allow the witnesses to depart.

Sitting suspended at 3.08 p.m. and resumed at 3.10 p.m.
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