Private Members' Business. - Health Ombudsman Bill, 1989: Second Stage.

I move: "That the Bill be now read a Second Time."

Since the last election the Progressive Democrats have taken the rare opportunities presented to us in Private Members' time to debate and promote issues of real importance for this country. In particular, we have introduced three important Bills, one on ministerial pensions which sought to end what remains a scandalous abuse, another, the Local Government (Planning and Development) Bill which tried to end the payment of compensation to land speculators where they were refused planning permission and deal with the problem of unfinished housing estates, and our most recent Bill on competition policy which sought to radically reform the economy into one which favoured, encouraged and controlled competition.

Tonight we are introducing another vital Bill. The Health Ombudsman Bill, 1989, deals with the whole area of health policy here and seeks in particular to create the office of health ombudsman responsible to the Oireachatas and having a supervisory role in relation to the provision of hospital services to the public. The establishment of this office is essential if we are to ensure that ordinary people have their entitlements to immediate health care protected.

Like the majority of Deputies in this House I have been inundated over recent months with requests from members of the public and the families of sick people to try to get patients into hospital. By the Government's own account there are over 22,000 people on waiting lists for hospitals. Many of these people have been waiting for over 18 months and are still no nearer a hospital bed. People are getting desperate and are contacting anyone they feel can help them. Who one knows and what pull one has is becoming more important than what is wrong with a person.

This is just one symptom of a very sick health service but a very worrying one. Throughout the country there are examples of abuse of power, whether with the allocation of national lottery funds or the granting of planning permissions. The common thread is that if one is in with the "in crowd" one will be looked after. This attitude is deplorable in any walk of life but when it enters the medical arena it is intolerable. This Bill seeks to tackle it.

The Bill aims to provide for the creation of a health ombudsman to investigate the provision of medical and surgical services in public hospitals. We have deliberately modelled the Bill on the Ombudsman Act of 1980 but there are a number of important differences. First, the sole function of the health ombudsman is to investigate complaints by or on behalf of persons with either full or partial eligibility under the Health Acts or who have policies of insurance with the VHI or who are the holders of health insurance licences in relation to the provision of administration by a public hospital or health board.

Second, the complaints must, in the main, demonstrate the procedures adopted by the health board are unfair or discriminatory or based on an improper method of devising a scheme of priority for the treatment of patients, or amount to a misdirection or waste of public moneys or are otherwise contrary to sound principles in hospital administration.

Third, the health ombudsman is empowered to give mandatory directions to the hospital or health board concerned. These directions may be appealed to the Minister for Health on the sole ground that the hospital or health board does not have adequate resources to comply with such a direction. We have allowed for appeals on this ground. If he does, however, he must present a statement of his reasons in writing for doing so before each House of the Oireachtas.

The objective of this Bill, therefore, is to provide some independent arbitrator for patients using public hospitals and to provide a check against improper or wasteful decisions of the hospital or health board bureaucracies. While the Bill has no financial implications in that hospitals or health boards may appeal against directions of the health ombudsman which they cannot meet out of their own resources, it will serve to highlight any deficiencies and undue waiting lists for the range of medical and surgical services available.

Section 1 provides for the establishment of the office of the health ombudsman and for his terms of office. Section 2 provides that he shall be independent in the performance of his duties.

Section 3 (1) provides that the health ombudsman may investigate complaints which he considers warrant investigation. Subsection (2) of this section specifies the grounds of complaint which might justify a preliminary investigation on the part of the health ombudsman.

Section 3 (3) provides that the complaint must be by or on behalf of a person with full or limited eligibility or with a VHI insurance policy and the complaint must relate to the provision and administration of medical and surgical services by a public hospital or health board. Sections 3 (4) and (5) are modelled on equivalent provisions of the Ombudsman Act, 1980.

Section 4 provides for a resolution of complaints procedure. Section 4 (1) allows the health ombudsman to give mandatory directions to health boards and hospitals in relation to the provision of surgical and medical services.

Section 3 (4) allows for an appeal to the Minister for Health on the sole ground of insufficiency of means or resources to comply with such a direction.

Section 4 (6) provides that if an appeal is allowed, the Minister must cause a statement of reasons in writing to be laid before the Oireachtas.

Section 5 is an interpretation section and the definition of hospital ensures that only public hospitals, in the sense of nonprofit making hospitals, are included within the remit of the Bill and, finally, section 6 provides for a short title and the commencement day.

Important as it is, I am under no illusion that this Bill will solve the problems of our health services. The fact is that these services are now in crisis. Two years after crawling to power on the backs of promises about "A better way" and a reformed health service, this Government have totally reneged on these health services. The Irish health services have been destroyed over the past two years by this Fianna Fáil Government. Although one of their main promises on the hoardings that were all around this country during the last election campaign told us that health cuts hurt the old, the sick and the handicapped, it is ironic that since this Government came to office their only policy in relation to our health services has been one of cutbacks, cutbacks and more cutbacks. Three thousand acute hospital beds have been closed since Deputy O'Hanlon assumed office, with the result that there are now an estimated 22,380 people waiting to get into hospital for essential treatment. Many medics have told me that some of their patients will die before they can get into hospital for much needed treatment. In Dublin it is now virtually impossible to get into hospital unless one is certified as an emergency. Family doctors are advising their patients to call an ambulance as that is the only way they can hope to be admitted to hospital. The city hospitals are now almost totally taken over by patients admitted to the accident and emergency services.

One of the country's largest hospitals, St. James's in Dublin, reached the stage recently where patients requiring surgical and diagnostic procedures on a one day basis were sent home because all the beds allocated to those services were taken up by emergency cases admitted the previous night when the hospital was on call. Professor David McConnell, chairman of the board of the Adelaide Hospital, said that the public patient is being deprived of proper hospital care by the State, that waiting lists run up to 18 months for some people and that doctors know that usually they cannot admit patients unless they are seriously ill and that the postponement of elective care prolongs pain and discomfort, and sometimes dangerously exacerbates the underlying problem. The private patient, according to Dr. McConnell, can sometimes arrange for prompt treatment but the public patient must always wait.

We are aware of the dreadful situation which arose recently in the Southern Health Board when money was so short that staff were told the board would have to defer payment of their salaries. In the face of political and trade union fury, the Minister ran for cover and the money was provided to meet the pay cheques, while officials of the impoverished Department of Health flew to Cork to arrange for the demotion of the board's acting chief executive officer. No solution has been found even yet for the Southern Health Board's problems.

Proposals to slash the number of beds at Tralee General Hospital at weekends were attacked earlier this month by Dr. Dick Shanahan, president of the Irish College of General Practitioners, as being dangerous and unworkable. He said that if they were implemented GPs could be left in the very frightening position of having patients with an acute illness on their hands and no hospital beds available to take them.

Up to recently I thought this dire shortage of acute hospital beds existed throughout the country, but I was wrong. It does not exist in at least one hospital. A report by the North-Eastern Health Board has revealed that in Monaghan County Hospital the number of beds is in excess by 65 of what is required to serve the area. It may be a coincidence that Monaghan County Hospital is in the Minister's constituency. However, other areas of the country and other people have not been so fortunate.

The national open heart surgery centre in the Mater Hospital in Dublin will only be allowed to carry out 700 operations this year because of a shortage of money. There are between 300 and 400 people on a waiting list and the number is growing daily. People have to wait months to get into the Mater for vital open heart surgery. Recently a cardiologist told me that he does not inform a patient of the need for surgery until he knows he can get the person a bed, because of the danger to health of having to wait many months before getting into hospital for surgery. This is an appalling situation that no Government should tolerate, and it is one I am sure the people will give a clear opinion on, whenever they are given the chance.

Very shortly.

The people have not forgotten what the hoardings said. They have not forgotten that they were promised a better way by this Fianna Fáil Government. Week in and week out, when they sat in the Opposition benches, Deputy O'Hanlon put forward motion after motion condemning what the Coalition Government were doing. Many people have said to me, come back Coalition, all is forgiven. They never realised how bad the situation could become.

Doctors estimate that this year they will have to turn away 12 patients who require bone marrow transplants from the national bone marrow transplant centre in St. James' Hospital, Dublin. These patients will have the additional trauma of having to go abroad for their transplants at a cost of £25,000 for each transplant in Britain. Even cancer patients are on a waiting list at St. Luke's Hospital, Dublin. At the moment there are 199 people awaiting beds in St. Luke's Hospital. When I raised this matter in the House with the Minister in February, he told me that all these patients would have a hospital bed by the end of March. The Minister now says they might have a hospital bed before the end of June. It is very distressing that people suffering from cancer, and those requiring open heart surgery and bone marrow transplants, should be treated in such an appalling way by this Government.

In some hospitals, for example, Our Lady's Hospital, Crumlin, and Cherry Orchard Hospital, Dublin, parents have to fill in because of the shortage of nurses. Many parents have told me that they had to sleep overnight at the hospital in order to care for their children because there were not enough nurses to look after them.

The Minister's response to the current chaos in the health services has been to try to dodge all responsibility. We are sick and tired of hearing Deputy O'Hanlon tell us that he does not close down hospitals or hospital beds or cut back services. The decisions to do this, the Minister assures us, are taken by the health boards or hospitals involved. Dr. O'Hanlon conveniently ignores the fact that all the cutbacks——

I hesitate to interrupt the Deputy, but the Minister must get his full title.

The Minister for Health, Deputy O'Hanlon, conveniently ignores the fact that all the cutbacks are made on foot of the financial allocations which he makes to the hospitals and to the health boards. It is not good enough for the Minister to cut allocations and then blame the health boards and the hospitals for cutting services. Ministers cannot opt out in that fashion. Deputy O'Hanlon's only response to the problems——

The Minister for Health.

The Minister for Health's only response to the problems which are now threatening to sink the Irish health services has been to set up committee after committee to review and examine each situation which develops. At the last count the Minister had established 21 such committees. Few reports of the deliberations of these committees have ever seen the light of day. They are undoubtedly a convenient way of long fingering decisions and diverting public attention. It is about time he who paid the piper decided to call the tune, and it is no longer good enough that this Minister and this Government simply pass on responsibility to others who are desperately trying to provide the people with some kind of health service.

The kernal of the problems which now besets our health services is that there is no forward planning, no new policies developed to meet the changing situation and decisions are taken simply by default. The Minister does nothing, either because he does not know what to do or does not want to take decisions. This may be politically opportune but it is not the type of Government needed here today.

About 7,000 jobs have been slashed in our health services since the Minister took office. The vast majority of them have been the jobs of front line health workers, such as nurses and doctors. The impact of these people leaving the health services has been far more dramatic than if bureaucrats or administrators had left. An Bord Altranais informed me that 2,500 nurses in 1987 and 2,000 nurses in 1988 applied for notification of registration in order to emigrate — this includes only nurses emigrating to the UK or the US. They estimated that a further 500 to 700 nurses have emigrated to Baghdad, Saudi Arabia and countries like that for which they do not require registration, and therefore there are no accurate figures. These are young Irish nurses who should be working at home. They are needed here and they are entitled to find work in their own country. It is a disgrace that these nurses are forced out of the country and that their skills and talents are being denied to sick people in our hospitals.

One example of the Minister's failure to tackle the problems is that this country is desperately short of acute hospital beds, but there are five new hospitals — one in St. James's, the Mater in Dublin, one in Cavan, one in Castlebar and another in Mullingar. All have been built at a huge cost to the taxpayer, at a cost of around £200 million, and they are lying idle. The Mater has been completed for over two years, and St. James's and Cavan for over a year but despite that fact, it is costing thousands of pounds each week just to keep them closed. The Minister makes no effort to open these hospitals and to ensure that their facilities are available for the Irish health services. It is a scandal that these new modern facilities are not in use. I am calling on the Minister for Health again, as I did recently, to have these hospitals opened as a matter of urgency. I have devoted a considerable part of my contribution to the hospital services. Although there are problems throughout the health services it is at the hospital services level that the real difficulty exists. Eighty per cent of the total budget spent on health services is spent directly on hospitals. It is blatantly obvious that some action must now be taken to make these extremely costly services available to the public again.

I am particularly concerned that the present funding system for hospitals, which gives hospitals a block grant at the beginning of each year, regardless of the number of patients they treat, is no longer relevant and encourages hospitals not to take public patients, who cost them money, but rather to switch beds to pay beds, if this is possible, in order to bring in more money. A public patient has to wait months or years to get into hospital as a result. Up to very recently a private patient could get in on demand. However, this will change as the VHI restrictions apply, particularly in the autumn of this year.

The Progressive Democrats believe that all the people should have equality of access to essential hospital services and that the health of the poor is equally important as the health of the rich. Rich and poor have equal rights to essential hospital care. The present system of simply block granting the hospitals and health boards very much militates against any hope of equality of access. The Minister hands out millions of pounds to hospitals and health boards each year with little regard either to their efficiency or the services they provide. These hospitals are then left to manage their services as best they can. Each time they admit a public patient it costs them money and each time they admit a private patient they make money. It is obvious why these hospitals give preference, indeed are forced by their archaic funding system to give preference, to private patients.

The time has now come for the development of new policies and for a fresh look at how our hospital services are funded. The Government should examine a radical new method of funding of hospital services through a national insurance scheme. Under such a scheme everybody in the State would be insured against the cost of essential hospital treatment. Their stay in hospital would be paid for by their insurance company. The immediate effect of this would be the abolition of the distinctions between public and private patients. There would be no such thing as a public patient. Everbody would be equal so far as access to acute hospital services is concerned. When admitted to hospital, instead of incurring costs through their admission, the hospital would gain an income from each patient admitted. Hospitals would only receive income for treating patients with the result that instead of patients queueing to get into hospital as at present hospitals would be queueing to get patients.

The funding of a national health insurance scheme would replace the existing health levy. We envisage the premiums being paid by way of a levy taken from one's income. The Government would pay the full insurance contribution of the lower income and part of the contribution of the middle income group while top earners, as of now, would fund their own health insurance. This would cover basic hospital costs. It would obviously be open to anybody who wished to and who could afford to to take out additional insurance to fund more luxurious accommodation.

Under our proposal hospitals would become totally autonomous, no longer dependent on the Department of Health for their financing. The Department of Health's role would be reduced to a licensing, standards and policy body. A scheme on these lines, which works very well in many European countries, would go a long way towards ending many of our present difficulties, would guarantee equality of access, make hospitals competitive and eliminate a considerable amount of costly administration. Such an insurance scheme would not be practical, however, if there was no competition for the VHI in the health insurance area. I support the opening up of the health insurance market to other companies who would be required to compete on the same basis as the VHI. Competition is one of the most effective ways of keeping the cost of premiums down.

As I said earlier, the hospitals service is just one aspect of the entire health services which are currently undergoing difficulties. The Government's blundering since they assumed office has adversely affected almost every facet of the health service. The decision to alter the free GP scheme for medical card holders, long the pride of joy of the health service, will lead to a two-tier health system at GP level also. Up to now GPs in the scheme were paid a fee each time they saw their patients. From now on they will receive a payment each year whether they see them or not. The Irish College of General Practitioners expressed reservations about the advisability of introducing this method of payment. A number of doctors have gone to the High Court to challenge the right of the Minister to introduce this scheme. The Minister has gone ahead with the scheme, which would appear to offer no advantage to patients and which he himself admits will cost £130 million to run this year, an additional £28 million on the 1987 cost of the GP scheme.

Much of the pressure on our hospital facilities could be alleviated if general practitioners were encouraged to group together to provide a comprehensive medical service at community level. Many routine tests could be conducted in a doctor's surgery for about 20 per cent of the cost of doing so in a hospital. The rate of surgery on a one day basis at 10 per cent of all surgery is very low by international standards, with the average being over 40 per cent. Although efforts have been made in recent years to move in this direction, lack of nursing care at community level together with the shortage of theatres is a prohibitory factor. Investment in additional theatres and surgical appliances would prove very cost effective in the long run and we need to move in this direction.

Consideration needs to be given also to the privatisation of hospital catering facilities. A consultancy study undertaken on behalf of the Committee of Public Accounts, into catering arrangements in some hospitals highlighted huge waste and inefficiency in the hospitals investigated. It showed that there were no proper stock taking or control mechanisms in place and that the food supply had not been put out to tender for many years in some cases. It was found that most of the catering budgets were in excess of £300,000 for a 200 to 300 bed hospital in the large urban areas, such as Dublin, Cork, Galway and Limerick. One Dublin hospital has nine chefs, probably more than are to be found in the biggest hotel in the city.

The difficulties I have outlined in the health service at present highlight very clearly the need for the public to have an independent watchdog who would fight for their rights and ensure that the services that are available are made available to the people who need them and not to people who have either money or are in the know. Many colleagues in this House do not like having to contact the hospital or a health board in order to get some basic health care for patients but very often they are forced to do so because the families of sick people become so desperate and so dependent on Deputies and others in order to get much needed facilities. Many problems have been brought to my attention in recent weeks. In one case a person, following an accident, was taken to Loughlinstown Hospital in Dublin where it was established that he had suffered a broken leg and needed to have a pin inserted but because no orthopaedic surgeon was available he was kept for one week in Loughlinstown Hospital and was only taken to the Meath Hospital when the family contacted some of the Deputies for the constituency. They were successful in having the patient transferred and he had a pin inserted in his leg about ten days after the accident.

Other people contacted me to say that, having been put through all the routine procedures on admission to hospital prior to an operation, they were then sent home. In one case a woman was taken into a Dublin hospital, kept fasting for over 12 hours and had all of the procedures for her operation completed, but then at 4 p.m. the following afternoon she was told they could not perform the operation as they did not have the necessary staff and she was sent home in a dreadful state. Others are not so lucky, their operations are cancelled before they even get to hospital. Many of them become desperate and wonder if they will actually get into hospital. There are also difficulties in relation to the admittance of women to maternity hospitals to have gynaecological matters attended to. Many of my constituents have told me that they made huge efforts to have their children and all their family affairs taken care of for the week or two they were going to be in hospital but then had to undo all of this when they realised the hospital could not take them.

Over Easter there were problems at the Adelaide Hospital in Dublin when operations had to be cancelled as no anaesthetist was available. In some hospitals in the city people are sleeping on what are called extra beds which have to be brought into the wards. Many wards have been closed down and extra beds have had to be put into the wards that are open as these are the only wards where they have staff. The morale of doctors and nurses is at an all time low. It is very unusual for medics to contact politicians. They do not like to get involved in what they believe to be political debate. The situation is so serious that many leading medical people are contacting politicians, trying to outline the huge difficulties under which they operate. They are frightened of the consequences for their patients and the health service which, for so long, was so good.

The appointment of a health ombudsman, a person with legal or medical training, who could act quickly in the interests of the public, would ensure that if somebody was not getting treatment to which they were entitled he could give a direction and the person could be taken into hospital when he or she needed medical treatment. That is essential if our medical service is to be fair, to command respect and if it is not to be operated on the basis of political or medical pull. It is not good enough in any kind of decent society, regardless of our financial position, that any Government would seek to deprive sick people of much needed hospital services. There are difficulties in relation to funding for hip replacement and cataract operations and ear, nose and throat operations for children. For the remainder of this year I suggest that the funds available through the national lottery are made available to clear the backlog and waiting list for these three categories in particular. Funds are needed in those three areas if the queues are to be lessened.

Very few people would argue against making available for the health services the £50 million which the Government now have to spend during the next few weeks on a political bonanza in an effort to buy votes in whatever elections we may have. It would be a disgrace if that money was not made available to hospitals which are desperately in need of funds. I call on the Minister and the Government to seriously consider for the remainder of this year — and perhaps into next — making that additional money available to the health services. I believe that those who so generously support the lottery would be very happy if they felt their money was going to a good cause like that, unlike some of the causes which the money has been spent on.

A new funding system for our hospitals, which would put public and private patients on the same basis as far as the hospitals are concerned, would certainly help to end the distinction the hospitals make because of financial problems between taking a private and a public patient. I firmly believe that if we were to be more imaginative and put some resources into the development of more theatres and so on many more operations could be carried out on a one-day basis.

Many people, particularly the elderly and psychiatric patients, could be better cared for in the community or by their families if some incentive were given to look after them. In moving this Bill I appeal to the Government to accept the proposal to set up a health ombudsman. There may be differences as to the precise details of the Bill but they can be argued at a later stage. It is extremely important to have an independent, public watchdog acting on behalf of sick people and their families and ensuring that the £1.2 billion which the State puts annually into our health services is spent wisely and fairly and that people do not have to go to the lengths they do at present by contacting public representatives and others, begging for much needed hospital treatment.

One has to question the real motivation behind the initiation of this Bill. I have to see this hastily assembled and poorly constructed Bill as no more than a launching pad for yet another ill-conceived attack on the health services, their administration and management. Given the timing of the Bill, it is perhaps no more than a cheap attempt to grab some headlines for the Deputy and her hard-pressed party. Nothing that Deputy Harney has said in introducing the Bill leads me to any other view. It is sad that such serious matters as the health services and the right of redress of the citizen should become the subject matter for opportunism and political gamesmanship.

This Bill proposes the creation of a health ombudsman to investigate the provision of medical and surgical services in public hospitals. This new official would have as his sole function the investigation of complaints in relation to the provision or administration of services by a public hospital or health board.

The Bill purports to provide an independent arbiter for patients using public hospitals and to provide a check against improper or wasteful decisions of hospitals or health boards. This new official would also appear to be given the function of highlighting deficiencies and undue waiting lists for medical and surgical services. It is not at all clear how an ombudsman would discharge the function of monitoring waiting lists.

A number of fundamental questions arise. First of all, there does not appear to be any real need for legislation additional to that already enacted in order to provide a framework for the redress of individual grievances against health agencies. The Ombudsman Act, 1980, provides a very wide framework for the functioning of the Ombudsman in the investigation of complaints. In 1984, the health boards were brought within the remit of the Act. It remains open to the Government under the Act to further extend that remit to include, for example, bodies established under the Health (Corporate Bodies) Act, 1961, such as St. James's and Beaumont Hospitals. If a review of the operation of the 1980 Act — and such a review may now be timely — were to suggest that there is a need to extend its scope, either in relation to health or otherwise, then the correct procedure would be to amend the original Act, rather than introduce separate sectional legislation.

The enactment of separate legislation and the establishment of a separate office, as proposed by the Deputy, would involve yet further bureaucracy, in the worst sense of that word, and avoidable cost to the public purse.

The explanatory memorandum of this Bill baldly asserts that it has no financial complications. Yet it ignores the costs which the running of a separate health ombudsman's office, with its retinue of investigators and officials, would incur. The Deputies should remember that the Bill explicitly disqualifies the present Ombudsman from holding the new office of Health Ombudsman in section 1 (3) which states:

A person who for the time being holds the office of the Ombudsman under the Ombudsman Act, 1980, shall while so holding the said office, be disqualified from holding the office of Health Ombudsman.

It is not at all clear why such a separate office and official is required. Is the Deputy casting aspersions on the manner in which the existing Ombudsman discharges his duties? Is there any reason why the party of the hairshirt and reductions in public expenditure are now advocating another unnecessary set of officials and investigators, causing a further drain on the already hard-pressed public purse? I presume the cost of this ombudsman would be borne by the Department of Health. The experience in the United Kingdom has exhibited no need for such a separate office of health ombudsman. In that jurisdiction those functions are adequately carried out within the structures of the existing office of the Parliamentary Commissioner for Administration.

It is strange that the mould breaking party who make a virtue of small Government should be proposing such a measure. Perhaps we should not be surprised that there is confusion in the positions now being taken by the Progressive Democrats in an attempt to avoid humiliation at the hands of the electorate.

This bill gives the proposed health ombudsman powers and functions far in excess of those normally associated with the office and it certainly goes way beyond the role assigned to the office in the 1980 Act.

The grounds for investigation of complaints set out in section 3 (i), (ii), (iii) and (vii) of the Bill virtually duplicate the existing provisions of the 1980 Ombudsman Act and would add nothing to the current legislative position.

The Deputy has rejigged some of the provisions of the 1980 Act and now presented them in section 3 of the Bill. As some sort of improvement on the existing legislation subsection 2 (i) of this section is exactly the same as section 4 (2) (b) (iv) of the Ombudsman Act, 1980, and allows the health ombudsman to investigate any action taken if it appears to him that it "was based on erroneous or incomplete information".

Similarly, subsection 2 (ii) duplicates section 4 (2) (b) (v) of the 1980 Act by allowing investigation of an action if it appeared to the health ombudsman to be "unfairly discriminatory". The 1980 Act uses the phrase "improperly discriminatory".

Again, subsection (2) (iii) of the Bill allows an investigation of an action if it appears that it "was based on an undesirable administrative practice" and this duplicates the provisions of the 1980 Act in section 4 (2) (b) (vi). Subsection (2) (vii) of the Bill also virtually repeats the 1980 Act in its section 4 subsection (2) (b) (vii). The former allows a complaint to be investigated if it appears to the Ombudsman to have been otherwise contrary to fair or sound administration. The Bill in this subsection simply adds one phrase to that formula and states that the action must appear to be otherwise contrary to fair or sound principles of hospital administration.

Deputies, I have gone into some detail on these provisions to show you clearly how little it adds to our legislative position. Many of the provisions of this Bill already exist in law and as such they are unnecessary. I do not think the time of this House should be wasted with the passage of legislation which merely reiterates the current position.

However, the Bill also includes a provision that "misdirection or misuse or waste of public moneys" is also a ground for investigation. This provision touches on issues which are more appropriate to a management audit concerned with administrative efficiency and accountability than an ombudsman providing redress for individual grievances. We already have a well-developed audit function in the health services under the aegis of the Comptroller and Auditor General and the Inspector of Audits. Is the Deputy now proposing that we replicate and duplicate the functions which these offices currently carry out with yet another office which could not but incur a significant amount of additional expenditure?

While it might be appropriate for an ombudsman to refer to examples of the waste of public moneys which he comes across in the pursuance of his normal investigations, it would be a total distortion of his functions if he were to make such reports the core of his work, to the detriment of those duties with which this House has given him. It is of no use to an individual with a justifiable grievance that the Ombudsman is making a report on matters of waste in general. The office of the Ombudsman was established to give individuals a means of redress for individual grievances and we should not allow the Deputy to attempt to side-track it away from that important role.

In addition, subsections (v) and (vi) of section 3 provide grounds for investigation which stray into areas of clinical medical judgment. They allow the health ombudsman to investigate a complaint if it appears to him that the action of a hospital or health board...

was based on a scheme of priority for the treatment of patients which was derived from improper or incorrect criteria, or

failed to have regard to the special medical needs of the complainant.

These provisions involve matters of medical judgement which were specifically excluded by the 1984 ministerial order so as not to involve administrative officials sitting in judgement on the clinical decisions of members of the medical profession. These subsections refer to improper or incorrect criteria of schemes of priority without stating who will determine which criteria are correct.

The Deputies should be aware that there are serious problems attached to straying into this area of clinical medical judgment. There could be dangers of a parallel jurisdiction between the office of the health ombudsman and the courts with respect to medical negligence. A complainant could use the health ombudsman for a "free" investigation and then if his complaint is upheld, take the matter to court and use the health ombudsman's report in support of his claim. If he lost, the credibility of the health ombudsman would be impaired: if he won, the health ombudsman could be said to have prejudiced the matter. Relations between the health ombudsman's office and the staff of the health services would be likely to seriously disimprove if its reports could be used in a legal action. Such a disimprovement would, in turn, impair the effectiveness with which the office could discharge its functions.

Section 4 of the Bill contains an extraordinary provision. Section 4 (1) states the following:

The Health Ombudsman shall never have power to direct that a hospital or health board shall provide specified medical or surgical services to a named eligible person or person with limited eligibility where he is satisfied that the complaint referred to in section 3 has been made out to his satisfaction.

It proposes to give to the ombudsman, an unelected official who is not directly accountable to any Minister, power to direct hospitals and health boards to supply services to individuals. As such, it runs counter to our whole tradition of parliamentary democracy. The Bill suggests a role for the ombudsman which is quasi-judicial, making his task more akin to that of an appeals tribunal than an investigation into individual grievances. The essential task of an ombudsman is to investigate and bring to the attention of the agencies and, if necessary, the Houses of the Oireachtas actions which have adversely affected individuals.

The Ombudsman Act, 1980 clearly states what the appropriate powers of an ombudsman should be. The Ombudsman, having investigated a complaint, may recommend to the Department of State concerned under section 6 that: (a) the matter in relation to which the action was taken be further considered; (b) that measures or specified measures be taken to remedy, mitigate or alter the adverse effect of the action, or (c) that the reasons for taking the action be given to the Ombudsman.

I should like to take this opportunity to pay tribute to the Ombudsman and his staff on the way they have discharged the duties given to them by the Oireachtas. I was pleased to have supported the legislation that set up that office. Deputies will be aware that in many cases the recommendation of the Ombudsman will be enough to persuade the relevant body that the action complained of be remedied. However, if the Ombudsman is not satisfied with the response of the Department or other body he may make a special report on the matter in the report which he lays before the Houses of the Oireachtas.

These provisions of the 1980 Ombudsman Act outline the appropriate role of the Ombudsman's office. It is not, and should not be, his task to make what amounts to management decisions, without any accountability for the implications of those decisions. The Bill then proposes a unique appeals arrangement, under which the Minister's powers are restricted in an unprecedented manner.

The mandatory directions of the health ombudsman to the hospital or health board concerned may be appealed to the Minister for Health on the sole ground that the hospital or health board does not have adequate resources to comply with such a direction. The Minister may allow the appeal on this ground, but if he does, he must forthwith cause a statement of his reasons in writing for doing so to be laid before each House of the Oireachtas. The proposed system of appeal is both cumbersome and unnecessarily bureaucratic, creating the possibility of ever more direct involvement of the Oireachtas in what are essentially executive functions of quite a minor order.

The Bill displays a fundamental misunderstanding of the true nature and range of health services. It focuses on the provision of medical and surgical services in public hospitals and ignores the difficulties which may arise for people in obtaining a whole range of other services, which are primary in nature and which address the day-to-day, less dramatic but crucially important health needs of the population. In this perhaps more than in any other aspect of the Bill, Deputy Harney and her party reveal the real intention behind their proposal. They are not interested in the low profile community based services that attract little attention either in their excellence or their shortcomings. They want yet another opportunity, with perhaps further structured opportunities in the future, to concentrate attention on those areas of the health services which are experiencing transitional difficulty in adapting to rationalisation and to changes in demand.

Let us imagine what the situation would be if the Deputy's Bill was accepted. It would mean that someone who had a complaint, for example, with regard to the way she was treated at an out-patient clinic at Beaumont Hospital, would be able to have the health ombudsman investigate that complaint.

However, if another person had a complaint regarding the home help service she received, or regarding her public health nurse, or indeed in relation to her child's school health examination, she would have no such opportunity of obtaining redress.

Once again, we are witnessing the problems which Deputy Harney's party have in matching their rhetoric and their behaviour. It is not all that long ago since we witnessed their agonising and posturing when they had to face up to the implementation in relation to Barrington's Hospital of what they had advocated in one of their policy papers. I quote from that document:

During periods of fast growth certain services no longer relevant to modern needs are allowed to remain in place, while new services tend to overlap existing ones. There is in this area a clear need to rationalise these services, to discontinue obsolete ones and to eradicate overlap. These are best achieved through good management practices.

There are, indeed, many other statements of the Progressive Democrats which I could instance but I do not propose to inflict them on the House. How does the statement which I have just read compare with the Progressive Democrats' stance on the Barrington's Hospital issue? Here we had the Government practising the good management which the Progressive Democrats called for: we were phasing out overlapping services and reducing the overall level of acute hospital bed provision. We were doing precisely what the Progressive Democrats said should be done, yet what did they do? They opposed it. Of course, they had parochial, not national, reasons for doing so. Indeed, this highlighted the hypocrisy of this party, which, unfortunately, was founded on hatred.

Now we have the party of the free market, the advocates of small government, the fearless antagonists of bureaucracy proposing a piece of narrowly focused legislation which would be of very little use to many people receiving health services; the establishment of another autonomous, expensive bureaucratic machine; and the extension of the detailed supervisory role of the Oireachtas because it happens to suit their perceived short-term political advantage.

We are opposing this Bill and I believe the House will reject it.

I welcome the opportunity to once again analyse and debate the difficulties currently being experienced in the Irish health service. I am glad that this measure has been brought to the floor of the House so that it can be fully debated as well as the need for some form of consumer accountability to be brought into the health service. In principle, this is something we must welcome.

It has been correctly said that the health boards are already under the ambit of the existing Ombudsman structure. I believe very strongly that that office is useful in terms of the accountability of public services and should be extended to cover a number of areas. Some semi-State companies are included in this area but some are not — for example, the ESB and CIE are not included while Telecom Éireann are. There is a very strong case to be made for the inclusion of other services in view of the fact that the Sale of Goods and Supply of Services Act, 1979, exempts State companies from the remit of the Ombudsman. I very much favour the allocation of more resources, a more thorough approach and an opening up of the Ombudsman's service. This Bill acknowledges that while there are some aspects of the health services accountable to the Ombudsman, there are others which are not, most noticeably our hospital services. For example, in the acute general care area most cases are not under the ambit of the health board but under the direct control, in terms of finance, of the Department of Health. There is no accountability whatsoever. I favour a consumer led approach to the health services and accountability. In principle, I support the purpose of this Bill.

It is a matter of debate whether it would be better to amend the Ombudsman Act, 1981, and to consider extending the powers in that Act but if we do we come across one important issue, that is — and I think the Minister of State correctly alluded to this — that one of the things which distinguishes the health services from any other public service is the role of clinicians. As a politician I am not in a position, nor is an ombudsman as a layman, to say that patient X should not have been discharged or that patient Y should have had a different course of treatment. We are not clinicians but we would have to address the issue of what would be the situation in relation to matters of clinical judgment which would have to be adjudicated on. There would have to be a professional medical input into these judgments but the nature of our civil law is such that if people are dissatisfied with clinical decisions they have a right of redress through the civil court process. I am not saying that is a very amenable or relevant process, but it exists. I would venture to say that if a health ombudsman secondguessed a clinician's decision it might reflect so much of his judgment that he would have no choice but to take action against an ombudsman to fight it.

I should like to focus on what I believe is the underlying basis of this Bill. Deputy Harney correctly asserted the type of problems which have been addressed and which we all experience as TDs. Initially, I should like to deal with one specific area where the existing Ombudsman has already made a clear recommendation, that is, the dental service. The Ombudsman received complaints that medical card holders could not get an orthodontic service and some years ago he made a recommendation in favour of those patients that that service should be provided.

A report, prepared under the chairmanship of the Minister of State at the Department of Health, Deputy Leyden, clearly said that under section 67 of the Health Act, 1970, health boards had a legal obligation to provide basic dental services to medical card holders, their dependants and school children, and that the health boards were failing in their statutory duty to provide that dental service. In many instances the waiting lists were so long that they were suspended. One example is the South-Eastern Health Board area. The situation is at its best in the Eastern Health Board area because people there have access to the Dublin Dental Hospital. However, in some areas the waiting lists are so long they had to be suspended. There is also the very tragic situation with regard to old age pensioners who had all their teeth removed. I hear about one case a week in my clinic, and I am sure I am no exception.

I understand that the committee on dental services to which I referred carried out a special study into the needs of the people in Roscommon. There is no doubt that the situation is totally unacceptable. If the attitude being taken is that because people will not die of dental decay we should not have a dental service, that is a disgrace and totally unacceptable. It is the poorest people who are being affected in this way.

Much mention has been made tonight of waiting lists. I have consistently said that this is the most serious problem in relation to the drop in standards in patient services. I should like to emphasise the need for some measure which would bring accountability into the hospital services. I should like to refer to a letter I received today, a copy of which has been sent to the Minister. I do not wish to mention any names but if we analyse this harrowing tale I am about to reveal it will come across very clearly that this is a desperate plea for someone to put some level of accountability and answerability into the system. I should like to briefly go through the details of this case, because very often the individual case makes the point. This letter from a person in County Limerick dated 19 May is addressed to the Minister and is on his desk.

This case relates to a young boy born with a hare lip and cleft palate. He was treated very well under the GMS at Doctor Steeven's Hospital from 1976, but then the hospital closed. His medical records and charts were left in that hospital. When St. James's Hospital was opened and the facilities of Doctor Steeven's Hospital were transferred there, unfortunately, this young patient's medical records were not moved and, to this day, cannot be found. To proceed with the history of this case, the basic request was that he would have an operation performed on his cleft palate. He was given an appointment for June 1988 but nothing could be done because there was no medical chart available. He was recalled two months later and seen by a consultant who was doing duty for a speech therapist. It was then that an operation was recommended after intensive speech therapy. He was called again some six months later. The family waited two hours in an outpatients' clinic to ascertain what could be done to make arrangements for the operation. Subsequently he was given an operation date two months later, 2 April 1989, and had to telephone to confirm the bed. His parents were never to realise the chaos that was to follow.

This family of seven children were from Limerick and had to get a lift to Dublin. They phoned several times to confirm the appointment for the operation. In fact they spent up to £46 in telephone calls, not being in a position to drive to Dublin, having no car of their own. They were left hanging on, telephone calls having been cut off and so on. At the end of April they managed to get a bed, which was not confirmed until the last minute. Eventually the child was rushed out of school and taken to Dublin, with train fares and so on being borrowed. The parents had to have an overnight stay in Dublin. When all was ready for the operation the mother was told by the consultant that they did not have sufficient notes and details on the patient to carry it out. This was almost a year after confirmation that an operation was necessary. The patient was told to return in a fortnight for definite treatment. The family were told the bed would not be cancelled. Foolishly they took the authorities at their word and a month later when they endeavoured to gain access to the hospital bed they were unsuccessful.

The story goes on and on of a bizarre set of circumstances. The upset caused to the patient's parents was quite remarkable. They are now asking how they could have been brought to Dublin and allowed to return home without any operation having been performed; why the patient's charts were not transferred; why much of the equipment at St. James's Hospital seemed to be out of order resulting in operations not being performed and why there are inadequate numbers of nurses.

That is a very sad tale indeed of somebody who has been a victim of this Minister's performance in relation to health management under which there is no planning but simply chaos; when people do not know from one end of the day to the other what will happen; when appointments are not being kept; there is no synchronisation of information or notes on patients. This has led not alone to much hardship for patients but appalling demoralisation of health workers, who must notify these patients saying: we are sorry but you must return home, there is no service available to you here.

The Minister of State is also right when he says that the problems are not restricted to the hospitals. For example, would it be the case that an old age pensioner, perhaps being minded by a relative in the community, suffering from Alzheimer's disease, who is doubly incontinent and told by the health board: "We are sorry but your incontinent pads have to be rationed" be a matter on which a complaint could be lodged? Surely such people have some rights of redress or complaint to somebody?

There is a very important underlying factor in all of this, which is that people do not like to complain to the front line of health care workers for fear that they might not receive the best treatment in the future. That is no reflection on health workers but is simply a matter of human nature. What we really need is not merely a system of accountability or an extension of the powers of the Ombudsman, though they go some way toward alleviating the type of personal hardship cases we all encounter. I could cite many other horror stories of young children, very ill,vis-à-vis access to Our Lady's Hospital for Sick Children in Crumlin. All of these people suffer a total sense of frustration. We do not need a fire brigade type of solution to the problem. Rather we need a planned response to deal with all of the problems of waiting lists nationwide.

As it is likely this debate will not be concluded I can assure the House that by the time this matter would have been adjudicated on my party will have put forward very clear proposals as to how we will meet the immediate crisis in the health service, how we will ensure not only that people's immediate needs but that the secondary need to reorganise the health services are met. The present structures cannot cope with the demands being made of them. For the money expended in the health service we have not had the type of investment in technology to deal with patient administration systems that could sort out the log-jam of problems from which patients are suffering.

As Deputy Harney correctly said, there have been vast inefficiencies in catering and other services that could be eliminated by implementing new technology and rationalising the services. Medical records are also very labour-intensive. I have been to the basements of many hospitals littered with thousands of files, all of which could be computerised. Why do we have to have eight to ten different finance and personal systems of administration? Indeed, why do we have to have over 7,000 clerical and administrative personnel employed in the health services? When we look at the voluntary early retirement statistics we see that the largest uptake within the health services over the last two years were front line nurses and para-medics — I elicited this information from a recent question I tabled to the Minister — while the lowest level of uptake was among the clerical and administrative personnel.

What people are crying out for is not only accountability, such as the provisions of this Bill would afford, but also a guarantee that the front line of health services are protected. The policy of cash limits and embargoes on hospitals and health boards is a proven failure in so far as it has not led to a shake-out of efficiency. Rather it has resulted in more inefficient practices. For example, if one has a 200-bed hospital and decides to close 50 beds on account of cutbacks, that does not mean that the remaining 150 beds will be well or effectively run or ensure that the maximum care is provided for the people who would like to avail of the services provided under this Bill.

There must be a root and branch reorganisation of the health services structures that have remained unchanged for 20 years. Would any Member care to give me an example of one organisation of the complexity of the health services that has the same structures in place 20 years later? We have a Department that have authority but no responsibility. There are different components within the health service, fighting in public vision — for example, the Southern Health Board, Temple Street Hospital, the Meath Hospital with another element of the management of the health services, namely, the Department. Why not have them all on the one team and cut out much of this nonsense? These issues of restructuring and reorganising the health services cannot be avoided any longer.

There is also the short-term consideration that better management could only result in utilisation of the advantages of the health service. After all, it should be remembered that we are huge consumers of the health service. For example, the number of bed nights provided in all our residential units, not only in acute general hospitals but also in psychiatric hospitals and so on, involves a huge purchasing power. But people involved in different elements of the health service do not know what others are paying for everything from cotton wool to eggs; they do not have a clue. This is a matter of straightforward professionalism that needs to be sorted out.

I and many health managers and workers regret that the difficult financial circumstances in which we find ourselves have not resulted in all of these changes being effected. Rather, it has led to the problems being passed down to the frontline health workers, resulting in the problems we have all encountered.

In the context of this Bill I should like to refer to the pyschiatric services because, to some extent, they constitute a hidden service. They are not something that attract media headlines. There has been the stigmatised element of high walls and people being put away, either voluntarily or otherwise, for long periods. I suppose that has been part of our history. However, all of that is changing. Something like 3,000 or 4,000 patients in psychiatric care have been moved out of hospitals into the community. If one examines the figures of day hospitals, night shelters and so on provided, one finds there are about 1,200 to cater for approximately 2,000 people. They are not all psycho-geriatric people who die, who are somewhere in the community. I very much question whether there are adequate facilities for them. what makes me doubly suspicious is the increase in suicide rates — now quite striking — which families do not like to investigate too thoroughly because of the very nature of their bereavement and so on. Quite frankly we have a lot of deaths by misadventure which could have been suicides so, perhaps, we do not have the full recording of it. I would like the bereaved families to have some authoritative independent structure to which they could go to assert their case, make their complaint and have it fully investigated — at present we do not have a formal structure of that nature where someone is dissatisfied — that might not be questioning a clinical decision but rather the effecitiveness of community nursing, the effectiveness of hostel care and so on. That is an area I would like to see taken up specifically in relation to patient services. In relation to the political job that needs to be done for health we need to clearly establish what are patients' rights. To some extent the Health Act, 1970, tried to do this. It set out the different rights of medical card holders in terms of GMS service, dental service and so on. But when the cutbacks have bitten deep what are actually patients' rights have been diluted and have become unclear. If you are on a waiting list long enough not to be able to get access to care, unless by joining the VHI or being able to pay for the bed, then your rights are only theoretical; they are not there in practice. That leads me to the point that there are many people who are suffering in a very quiet way.

I am referring to the mental handicap patients who are residing in psychiatric hospitals. It should be an absolute objective that the next Minister for Health would state very clearly — I would be prepared to give this commitment — that, within a year or whatever, all mental handicap patients would be taken out of psychiatric institutions and put into specialised services and that there would be a guarantee that no admission of such patients would take place into psychiatric hospitals because those institutions are totally unsuitable to their requirements. We have seen the development of specialist services for autism and autistic children and so on. That should be the future direction. If there were a number of recommendations from the Ombudsman it would highlight independently that it is wrong because mental handicap patients cannot speak for themselves. Who is going to speak up for them unless their relatives and politicians do so? I believe that would be a means whereby people could get a consistent series of recommendations from an Ombudsman which would have some impact and some impetus in reforming public health policy. I refer to the recent case and the prospects for haemophiliacs infected with the HIV virus. Given the recent developments in the Dunne case, which I am intimately aware of in relation to the Holles Street litigation, whatever about the rights and wrongs of that case, one thing is certain, that the legal bill on both sides will be of the order of £750,000; that is the cost of the existing High Court and Supreme Court case and the pending repeat High Court case and it can go onad infinitum. I understand the Dunne family have put their house up for sale just to meet the cost of the clinicians from England who are to give an opinion in the court; that does not touch any of the legal costs. If an Ombudsman structure is put there or some independent complaints service it at least affords people the opportunity of processing their complaint without the fear of expensive litigation costs which are simply prohibitive to ordinary people. The fact that many people have to rely solely on litigation shows an inadequacy and a failing in our present system.

We also have the problem of another group who cannot speak up for themselves. These are children at risk, children who have been the victims of sexual abuse and violence and who have had to be taken out of the family setting for their own safety and well-being. People who are members of health boards will know that we have a patchwork quilt of services. There are some areas where there are imaginative health boards and health managements who have developed childcare services but if one is unfortunate to live in another part of the country where there is a very conservative attitude to children at risk, what right do those children have, what vehicle do they have to develop a service in their area? The best they can hope for is that some TD in their local constituency will pioneer services. If it is not a particularly fashionable issue or if it is raising difficult issues relating to battered wives or areas that are socially stigmatised, there are difficulties. If people had the right of complaint, if people could see that their voice would be heard if they had a legitimate complaint and where recommendations could be made in their favour, I would support such a measure.

I do not wish to delay the House because I fear that we may not get the full time to debate this Bill. As you know, the two-week procedure may not apply in this debate so I am anxious to facilitate other Members of the House. In conclusion I would like to say that in my view there is a crisis in the health service. There is a very serious disaffection in relation to the public's perception of patient services, particularly manifest in relation to waiting lists, the abolition of some components of the health service such as dental and optical care, the lack of planned development of services for the elderly, the handicapped, for childcare services and AIDS patients. This Bill will not resolve all of those problems but it will, through new structures, focus on the problems and ensure that the Minister will not be able to say that Deputies or the public are scaremongering or that people are denigrating the quality of our health service. These problems are real and practical and they exist. Anything that would ensure that they were highlighted in an independent and fair way — they would not victimise staff in the health service because we have some excellent staff — is worth considering. In principle I support what is being proposed here but I would put in the caveat that perhaps we could consider looking at amendments——

We will be able to implement it in a month's time when we are on the other side of the House.


What a strange alliance.

I would look at the existing powers of the existing Ombudsman under the 1980 Act as a better way of pursuing it.

On a lighter note now that Deputy Yates has introduced clairvoyance into the Bill, would he not like to elaborate?

I do not think it is necessary.

It is not in fact my intention to introduce clairvoyance into the Bill but I would like to cast a little cold water on it. It is probably well known by Members of this House that I have been advocating bringing into effect a full blown Ombudsman system into Ireland for a long time. As far back as the late seventies I wrote about the 20 years of debate on the creation of an Ombudsman office and about the time for action rather than the time for talk. In 1980 we got an Ombudsman Act. My personal belief at the time — it is expressed in writing and it is a matter of public record — that we were rather too timid and subsequently the Ombudsman role was extended to health boards in matters of administration. I think this is the central issue. Deputy Yates to an extent took the point I wished to make about recent events.

The Dunne case, indeed, illustrates the need for an alternative system whereby complaints regarding the medical system or the medical services can actually be addressed. I do not think this Bill — which is good popular stuff more with an eye on the events of 15 June than with an eye on creating a proper Ombudsman system — addresses the problems. The Dunne's case does illustrate a major lacuna in Irish law. The major lacuna is that the Ombudsman system which we have created here has a number of invidious exclusions and one which this Dáil, or the next Dáil, needs of necessity to address. The most obvious shortcoming in the present legislative arrangements, so far as the health services are concerned, is the exclusion from the Ombudsman's remit of the concept of clinical judgment.

It is very difficult for lay people to secondguess a medical practitioner, a clinician. One of the arguments that can always be made is that it is very difficult to get two clinicians to agree precisely on the same issue. The approach adopted in this Bill is entirely wrong-headed. It is wrong-headed because it creates an additional set of institutions rather than seeks to improve the existing institution. An Oireachtas committee looked at the complaints system in the seventies and reported in 1977, on the day on which the Dáil dissolved for a general election. It is probably appropriate enough that we are discussing an Ombudsman institution at this time. It is interesting that a Government was going out of office and a Fianna Fáil Administration coming into office and perhaps history will repeat itself in that.

A change.

I do not wish to suggest that Deputy Harney has simply in view an electoral advantage in introducing this Bill. I am sure she is absolutely sincere in this, as in all matters. However, the approach here is entirely wrong-headed. If you are going to improve the complaints system which is available with regard to the health services or any other area of public administration the way to do it is to look at the existing institution and add to its powers. We have a problem and it is one which has caused me anxiety and about which many people have been critical. We have a problem with the Ombudsman and with the resources that can be allocated to that office in difficult times. If we are to fragment the Ombudsman service we will, first, of necessity, get less value for money from that service, but we will do one other thing — this is the major weakness in Deputy Harney's proposals — we will. create confusion. Many aspects of the health case could at one stage be a purely administrative matter and at another stage be a clinical matter. There would be the problem of whether a person goes to one ombuds-person or another. Unnecessary complications are introduced.

The issue of specialist ombudsmen is well covered in the literature, if the drafter of this Bill had cared to go to the Library and look into that literature. As far back as the late sixties the whole idea of an ombudsman institution came into vogue in common law countries. The ombudsman was seen as a widely applicable institution that, with the minimum of complication, could be applied to grievances in the public administration in the widest sense. The debate that took place at that time, oddly enough, was initiated in the United Kingdom. It was whether you could have a single ombudsman institution to deal with a wide variety of public administrations. As it turned out, the United Kingdom authorities took the view that you could not. First, they introduced a Parliamentary Commission and a very truncated version of the ombudsman was what they introduced in that office. They then introduced a Local Government Commissioner and subsequenty they introduced the Health Services Commissioner.

Something like 80 states have adopted the ombudsman institution since 1964, when the New Zealanders first took up the Swedish example. Of those 80 states, only the United Kingdom went the route that is proposed in this Bill. I continuously wonder at us in this House. Why is it that if the United Kingdom does something we must copy it? If the United Kingdom introduces an ombudsman, we have to copy that — although a debate had been ongoing here since Max Abrahamson produced a discussion paper on it as far back as 1960. When the British produce a health service ombudsman we automatically think along that route. We should break from this colonial thinking and strike out for ourselves.

It is my contention that we should extend the ombudsman institution not just because of the Dunne case — a family I well know and with whom everybody in this House must have sympathy in the sacrifice being made there — a young family, a young couple selling their house and all that they have in order to vindicate one of the most basic rights, the right to complain and have a complaint heard. It is clear when you look at that and other cases that we need to examine this issue. However, the way that is proposed in this Bill, while good populist stuff, is not the correct way.

I would like to make a couple of points arising from specific aspects of the Bill but before that I want to make a point about an omission on which Deputy Yates just touched. There is one major weakness in this Bill and that is the way in which we handle people in closed institutions. The Ombudsman Act of 1980 excluded closed institutions and this Bill follows the same very bad route. One problem that still remains to be resolved in our ombudsman system is how you deal with people in closed institutions, whether we are talking about institutions for mental patients, or prisons, or whatever. There is no power of inspection in our Ombudsman Act, and there is no power of inspection here. I merely use this point to illustrate that our ombudsman system is weak, could be bolstered up and elaborated on, but this is not the right way to do that.

The absolute concept, in section 1 (3), that you should have a law creating a health ombudsman, creating an office which is capable of being filled at the same time by the public administration ombudsman, is wrong. Duplication inevitably reduces two sets of administrations. Undoubtedly, it would create a degree of confusion in the mind of the public. It unnecessarily draws on the limited resources. The first weakness is the absolute illogicality there.

A second weakness is the way in which the Bill actually deals with complaints. If we are going to create a whole new ombudsman structure specifically geared for the health services, one would expect a little innovative thinking, but there is none to be found in this Bill. Section 3 is simply — if you pardon the phrase — a tarted up version of what appears in the Ombudsman Act of 1980. There is no imagination, no extension in this. One of the weaknesses about the way in which the 1980 Act defines a complaint is that it focuses unnecessarily on the administrative aspect purely on how the administrative thing is done. If you are going to create a whole new ombudsman institution in the health services, you must surely have some new thinking. It is not sufficient just to take the 1980 Ombudsman Act and tart it up ever so slightly. If you are going to create an ombudsman institution that can look into the health administration, you must think in terms of health administration, but you must think beyond that.

My understanding of this Bill is that the aim is to fill the lacuna created in the 1980 Act which excludes clinical judgment. That is not expressly done here. I am amazed by another section of the Bill. Section 3 (3) proposes that:

The Health Ombudsman shall not, however, investigate a complaint referred to in subsection (1) of this section unless the complaint has been made by or on behalf of a person with full or limited eligibility to medical and surgical services or who is the holder of a policy of insurance with the Voluntary Health Insurance Board.

It is not inconceivable that a person who is not eligible for health services and does not have VHI cover could be injured in a road accident. It is also not inconceivable that such a person could be treated in hospital in a way that would give rise to complaints, yet this Bill would specifically preclude that, because a private patient with no public health cover who finds himself or herself in a hospital would not be covered. That strikes me as the most extraordinary discrimination and one that surely illustrates the paucity of thinking that went into the Bill.

If we were, though I doubt we will have the opportunity to fully discuss the Bill, to go down this route, the provisions of section 3 (3) would have to be jettisoned. Likewise the provisions of section 3 (4) are similar to the Ombudsman Act, 1980.

Debate adjourned.