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commitments put forward that to say very detailed recommendations
               for a change but we also said that the health service had to produced
               action plans saying how they would they change things. They had to
               introduced new complaint forms, put a new complaint system in place
               and  after  a  year  we  have  said  that  we  will  re-inspect  to  make  sure
               that the implementation plans that they agreed to have actually being
               delivered on and sometimes as well you make recommendations and
               people implement the recommendations and it still doesn’t achieve
               the desired results. We’ve been looking not just to see is people have
               done what we asked them to do but whether it’s worked or not. And if
               it hasn’t we would be asking them to change it. So, I think it has brought
               about a big change in the whole culture of dealing with complaints.
               We now have properly identified complaints offices for every hospital
               in Ireland. Previously it was something somebody did as part of their
               other duties. We have forms and posters and leaflets on displays, we
               have standard text that they use in websites to tell people that they
               have a right to come to my office. So, it was an interesting exercise.
               I just want to make one other point, ex officio investigations can be
               very, if you go into them in that way they use a lot of the resources
               of your office. In my office, it is no different to anyone else’s. We do
               not have extra resources. So, we have to be very careful in choosing
               the topics for ex officio investigations. And what we’ve been looking at
               is people who because of their circumstances are very dependent on
               public services and might find it very difficult to complain. So, we are
               looking for instance at services for people with intellectual disparities
               and services for homeless people as two of the areas in which we will
               next conduct ex officio investigations because we had to think long
               and hard about how can we have the most impact. And how can we
               actually use the power in a way that gets us into places that complaints
               aren’t taking us. Thank you.


               CHAIR:  Thank  you  Peter.  Let  me  just,  give  me  one  second  please,  and
               highlight two points here. He talked about a change in culture, administrative
               culture. And we specifically talked about what essentially is an important
               aspect of an ombudsman job was how to promote best practice. And the
               best practice here was in fact to review what the administrations doing,
               recommend a change in policy and then say, “I’ll come back and check it
               again” which is exercising its best practice and also exercising control in an


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