Discretion has been driven out in health cutbacks, claims outgoing Ombudsman

Health cutbacks are being implemented by applying “the letter of the law” and removing the element of discretion that previously applied, according to Ombudsman Emily O’Reilly.

The Government has, however, denied Opposition claims that it is implementing cutbacks by stealth through a tightening up of the eligibility criteria for medical cards and other health services.

Ms O’Reilly said her officials’ examination of complaints about the removal of discretionary medical cards showed “nothing substantial” had changed in relation to the regulations that applied.

However, the element of discretion in the process was now being used to deny people medical cards in situations where in the past they would have been given one. She cited the example of people with motor neuron disease who were now finding it hard to qualify for a card.

In the past, in situations where a person’s income was above the threshold, appeals officers looked at other factors, such as their level of illness or need for equipment or medication, she said. Now people are being denied cards where their income exceeds the limit.

Files destroyed
She said that when officials sought to examine the circumstances in which a person was granted a card some years ago but was now being refused one, they were told the old files were gone or had been destroyed. As a result, it was impossible to compare past and present decision-making processes.

Applications for medical cards used to be decided locally, but the system has now been centralised on a national basis.

Ms O’Reilly acknowledged that the Government was “under the cosh” from the troika and had to make cutbacks. It also had an absolute right to govern, she said, and if it wanted to get rid of schemes that was its right. “But what is not right is if they are not clear and open and honest in relation to what they are doing.”

Ms O’Reilly said light-touch regulation had failed and there was a need for a strong Ombudsman’s office to provide an alternative voice when “groupthink” was taking hold.

Delivering her 2012 annual report, she accused some Government departments of hiding behind her office to justify cutbacks and said austerity could not be blamed for inequality and denial of rights.

On two occasions last year, in relation to the mobility allowance and children with ADHD, entitlements were curtailed after she had highlighted problems with the relevant scheme.

The Department of Health’s decision to scrap the mobility allowance and motorised transport grant “out of the blue” was quite shocking, she said, and underlined “moral dilemmas” facing watchdogs during times of austerity. “If they highlight illegality and inequitable treatment of citizens, they risk public services taking the easy option and abolishing the entire scheme, grant, etc for everyone,” said Ms O’Reilly.

“Twice in the last year, I have faced this dilemma, and on both occasions my worst fears were proven correct.”

'Ivory tower'
Ms O'Reilly said she hoped the department would soon resolve the situation regarding the mobility allowance and the motorised transport grant. The Ombudsman's office was seen by some bodies as an "ivory tower", she acknowledged, but the reason the Celtic Tiger fled was some regulatory bodies were not doing "what it says on the tin". After 10 years, today is Ms O'Reilly's last day in office and she takes up the position of European ombudsman next month. A successor will be appointed next week.