HSE response to draft report

A copy of this report, in draft form, was sent to the HSE on 15 March 2013. In accordance with section 6(6) of the Ombudsman Act 1980 the HSE was afforded the opportunity to make representations in relation to the draft findings and also to draw attention to any factual errors in the report. The full text of the HSE response, dated 15 April 2013, is at Appendix 1. The points made by the HSE may be summarised as follows;

• The HSE has been working for over a year to end the disparity with regard to ADHD in the context of the LTI scheme. The diagnosis of ADHD is difficult and agreement on the use of different classification systems is problematic internationally. There has been an increase in the recognition and treatment of children with ADHD.
• The issue is not an administrative one. Medical Officers are clinicians and their decisions (including the choice of an internationally accepted classification system) are clinical decisions. It is misleading of the Ombudsman to suggest that varying administrative practices (local rules) were used for a national scheme as in fact, medical officers were consistent in their use of classification schemes. The disparity arose because the choice of diagnostic classification schemes was not consistent across the country.
• The Ombudsman’s report and findings could be considered as straying beyond her proper remit in that it denotes clinical decision makers as administrators and also questions the exercise of clinical judgement in connection with the diagnosis or illness in the care and treatment of a patient (a matter excluded by law from the Ombudsman’s jurisdiction).
• The Department of Health says it is reviewing the LTI scheme and the question of whether ADHD should be considered a mental illness for the purposes of the scheme is a matter best resolved in the context of the overall review.
• As far as the individual case is concerned, while retrospective payment of medical expenses was not made, neither was it refused. The HSE did not receive a quantification of the amount involved until January 2013. The suggestion that the decisions taken locally were not soundly based is rejected as is the suggestion that staff in HSE South were unaware that the LTI scheme is a national scheme.
• It is unreasonable of the Ombudsman to seek to have one case dealt with in isolation and then, when the HSE acts, to accuse it of treating cases in inequitable or expedient fashion. The HSE is concerned to ensure a consistent and practicable policy for the LTI scheme.
• Applications under the LTI scheme are considered in two steps; diagnosis and approval of products. The section in the report which refers to confusion about the scheme is itself based on a misunderstanding of the LTI scheme.
• The Ombudsman's suggestion that reviewing other cases would be the fairest course does not take account of the fact the Department of Health has not completed its review of the LTI scheme and any HSE decisions will be taken in the context of the Department's policy decision. Also, the HSE could not divert financial resources away from current services to cover LTI arrears without causing other service users to suffer as a consequence.
• The HSE does not have the authority to impose a matter of policy in place of the Department of Health. With the Department's agreement the HSE has decided as an interim measure that the issuing of new LTI books to children with ADHD should be suspended which will end the current disparity pending the Department's decision on the matter.