Date released: 20.12.2011
The Ombudsman, Emily O'Reilly, has today (Wednesday 21 December 2011) published the report of her investigation of a complaint against the Health Service Executive (HSE) and against the Appeals Officer (Health Repayment Scheme).
The complaint was made on behalf of an elderly woman who had a medical card. She had been charged for nursing home care during the period 2003 - 2004 at a time when health boards had no legal basis for imposing such charges. The Health Repayment Scheme (HRS) was set up in 2006 to repay medical card holders who had been charged illegally for nursing home care. When this woman (named as Mrs. Coffey in the report to protect her identity) applied under this scheme, her application was rejected. A subsequent appeal to the HRS Appeals Officer was also rejected.
On investigation, and as described in the report, the Ombudsman concluded:
- That Mrs. Coffey was a public patient who had been placed by the Northern Area Health Board (NAHB) in a private nursing home (in what is usually referred to as a "contract bed");
- That the HSE's contention that Mrs. Coffey was a private patient (and thus excluded from the HRS) was not credible;
- That the HSE had given incorrect information regarding Mrs. Coffey's status to those administering the HRS as well as to the Appeals Officer;
- That the charges paid by Mrs. Coffey to the NAHB were "recoverable charges" which should have been refunded under the Health Repayment Scheme.
The HSE changed its position when it received a draft of the Ombudsman's report and accepted that Mrs. Coffey was a public patient. The HSE then agreed to refund the illegal charges. The amount (including an interest element) will be about €24,000.
Other Issues
The report describes the highly unusual arrangements agreed to by the former NAHB in deciding to place Mrs. Coffey in a private nursing home. Though she and her family lived on the Northside of Dublin, the NAHB arranged Mrs. Coffey's placement in a private nursing home in Co. Roscommon. This arrangement was negotiated with the manager of the Roscommon nursing home who was a senior NAHB official, on leave of absence from the Health Board, who had recently been working in the area of services for the elderly.
The Ombudsman is critical of the HRS Appeals Officer on two counts. While he was given incorrect information by the HSE regarding Mrs. Coffey's status, he failed to take proper account of information provided by Mrs Coffey's family which suggested very strongly that their mother was, in fact, a public patient in a "contract bed". The Ombudsman found also that the failure of the Appeals Officer to keep any record of an oral hearing, attended by the Coffey family, reflected undesirable administrative practice and was contrary to fair or sound administration.
For further information contact:
Fintan Butler, Senior Investigator, Office of the Ombudsman
Tel: 01 - 639 5650, email:
fintan_butler@ombudsman.gov.ie
or
Ciara Burns, Investigator,
Tel: 01 - 639 5662
email: ciara_burns@ombudsman.gov.ie
For media enquiries contact:
Dave Glynn - Head of Communications and Research
Tel: 01 - 6395714
email: david_glynn@ombudsman.gov.ie
The following is a link to the investigation report.