The Northern Ireland Health and Personal Social Services

	improving the quality of all public services in Northern Ireland;
	making services more responsive to the needs of individual citizens; and
	ensuring value for money.

	be treated courteously and with respect for your privacy, dignity and religious and cultural beliefs. This should include meals to suit all dietary requirements and arrangements for conducting confidential discussions with you or your relatives. Services should be accessible to all who need them, including people with special needs such as those arising from physical and mental disabilities. For example, all health and social services buildings should be easily accessible to people with disabilities and information about services should be clear, helpful and readily available;
	receive care and treatment on the basis of need regardless of your ability to pay. Most health services are free but there are some services, like dental treatment and prescriptions, or some social services like home helps or residential care in a nursing home or home for the elderly, for which you may have to pay at least part of the cost. In these cases there are special arrangements for people on low incomes;
	receive emergency care and treatment at any time;
	be given clear information about any treatment or care proposed, including any risks and any alternatives, and to have your own wishes taken into account as far as possible;
	be kept informed about your progress. Your relatives and friends are also entitled to be informed, subject of course to your own wishes;
	give or withhold your consent to medical or other care and treatment;
	choose whether or not you wish to take part in research or student training;
	see any reports made for insurance or employment purposes and information held about you on computer. Under proposed new legislation you will be able to see what is written about you. All information about you must be kept confidential.

You can help to improve your own health through:

	not smoking;
	eating a sensible and well balanced diet;
	taking regular exercise;
	reducing the amount of alcohol you drink to the recommended limits.

When you register with a doctor you are entitled to:

	a free health check on joining a doctor's list for the first time;
	a free health check if you have not seen your doctor in the previous 3 years;
	a yearly health check in your own home if you are over 75 years of age;
	be referred to a consultant acceptable to you when your doctor thinks it necessary and to be referred for a second opinion if you and your doctor agree this is desirable;
	obtain emergency medical care at any time through your doctor or the
	emergency ambulance service and any hospital accident and emergency department.

Many doctors are now offering their patients important extra services such as family planning services, well-women clinics and cervical cancer screening (smear tests). These services also are free. Your doctor must now produce a leaflet telling you about the full range of services available from the practice. Health and Social Services Boards also publish directories of local family doctors giving information about each practice and the services provided. You can find the address of your Health and Social Services Board at the end of this charter.

There are a number of ways that you can help your doctor:

	keep appointments made for you or notify the doctor as soon as possible if you are unable to attend;
	whenever possible go to your doctor's surgery rather than ask your doctor to visit you;
	only call your doctor out in an emergency;
	if you do need a home visit, try to let your doctor know before 10.00am;
	do not expect a prescription at every visit; many illnesses are short term and do not require medication.

As a registered patient you are entitled to:

	a treatment plan setting out the treatment proposed;
	emergency treatment outside normal surgery hours;
	an estimate of the cost of your treatment if you are an adult and liable to pay. Where a particular treatment needs to be repeated within 12 months, it may be possible to have this done free of charge.

The amount you pay will depend on how much treatment you get. The Government sets limits on dental charges and your dentist or your Health and Social Services Board can tell you what these are.

You have a right to free health service dental treatment if:

	you are under 18 or a full-time student under 19;
	you are an expectant mother or the mother of a child up to one year old;
	you are on income support or family credit.

If you are on a low income you might also qualify for help with dental costs. You can get a leaflet about this from your dentist or from your local Social Security Office.

	decide which pharmacist you use to dispense your prescriptions. Your medicines or other appliances should be supplied in suitable and properly labelled containers with clear instructions for use. Your pharmacist should explain these to you if you are not sure;
	have your prescription dealt with as quickly as possible. Your Health and Social Services Board is responsible for ensuring that there are arrangements for dispensing urgent prescriptions outside normal hours including weekends. These arrangements should be widely publicised at each pharmacy, in your doctor's surgery and in your local press.

	are under 16, or a full-time student under 19;
	are a woman over 60 or a man over 65;
	are an expectant mother or mother of a child up to one year old;
	suffer from certain medical conditions;
	are on income support or family credit.

Your pharmacist can give you advice and information on a wide range of minor health problems and can advise you when to consult your doctor. The advice you will get will be accurate and free of charge. You can ensure that medicines are used wisely and safely by:

	remembering that you do not need a pill for every ill;
	taking your medicines exactly as instructed and finishing any course of treatment;
	not 'sharing' prescription medicines;
	asking your local pharmacist for advice if you have any worries or queries about medicines.

There is a charge for having your sight tested. However, sight tests are free if you:

	are under 16 of a full-time student under 19;
	are on income support or family credit;
	having special medical needs which may affect your sight eg diabetes.

Once your sight has been tested you have the right to take your prescription for glasses to any optician or other retailer. In certain circumstances, for example if you have a low income, you might be entitled to help towards the cost of your glasses. Your optician or your Health and Social Services Board can provide you with details or you can ask at your local Social Security Office.

If you require community services you should receive:

	an emergency visit in your own home within 24 hours;
	in all other cases a visit within one week from the date you first asked for help;
	information in writing about the services that will be provided.

You will also be told the name and telephone number of the person(s) who will be responsible for arranging and providing the services - nurse, midwife, health visitor, social worker, or other persons.

From 1 April 1993 Boards will have even greater responsibility for assessing comprehensively the needs of all those who are particularly vulnerable and whose needs are complex because of age, mental illness, mental handicap or physical disability. Boards will also be expected to take into account the needs of those who care for people who require a lot of assistance at home. A named person will be responsible for seeing that the services are provided.

If you are being cared for at home your carer may appreciate a short break from caring.

This can be provided by:

	trained staff from your Health and Social Services Board or voluntary organisations;
	a 2-3 week break in a suitable residential or nursing home;
	a short break with another family.

Day care centres can provide opportunities for:

	recreation and leisure pursuits;
	occupational pursuits;
	education and training in skills for day to day living.
	specialist services such as physiotherapy, speech therapy, and occupational therapy.

	If you are a parent and you request or accept that it is necessary to have your child taken into care, no Court proceedings are required. However, if your child has been committed by a Court to the care of a Board, you have the right to apply to the Court to have the decision changed. In any case you will be told of the effect of the Court Order, your rights as a parent and the arrangements for access to your child.
	If your child is thought to have been abused in some way, either by a member of your family or someone else, you will be invited, where practicable, to attend part or all of the case conference held to discuss the future care of your child. You will be informed in writing of the decisions reached by the case conference.
	Children and young people in care have a right to have their wishes listened to and taken into account where possible. They are entitled to attend review meetings where matters affecting them are being discussed.

Health and Social Services Boards, and registered voluntary adoption societies, provide adoption services in order to assist children who have been adopted, their natural or adoptive parents, and people who wish to adopt children.

The services include counselling mothers who may wish to have their child placed for adoption, the placing of children for adoption with suitable families and providing counselling for people with problems relating to adoption.

Adopted adults (at least 18 years old) have a legal right to apply to the Registrar General for access to the original record of their birth. His address is shown at the end of this charter. If you wish to seek such information and you were adopted before 18 December 1987, you will have to attend an interview with an adoption counsellor before being given this information. If you were adopted after that date, you may choose for yourself whether or not to see a counsellor before applying to the Registrar General for information contained on your birth certificate.

	receive at least 2 weeks notice of the appointment along with clear information about when and where to attend and what to bring with you;
	be told the name of the consultant responsible for your care and treatment.

In accident and emergency departments you should be seen immediately and your need for treatment assessed.

	Waiting List Guarantee
	A Named Nurse
	Operations
	Outpatients

The only exceptions to this guarantee will be:

	certain specialised treatments, such as transplants, which depend on the availability of a suitable organ;
	cases of very low clinical priority such as minor cosmetic surgery (eg the removal of tattoos);
	where you choose to wait longer for personal reasons or refuse an offered admission or where you and your doctor agree to wait longer so that you can be treated by a particular specialist;
	circumstances of very exceptional strain such as a major disaster or epidemic or where services are disrupted by industrial action.

Northern Ireland has one of the highest rates of heart disease in the world and there is a particular difficulty in meeting the demand for cardiac surgery which greatly exceeds present capacity. Additional facilities have already been provided to help meet this demand and further urgent steps are being taken to honour the Charter guarantee by 31 March 1993.

Apart from the exceptions mentioned above and the temporary difficulty with cardiac surgery, 2 years will be the maximum time you will have to wait for admission to hospital. As at present, the vast majority of patients will be admitted much sooner. Health and Social Services Boards will be required to publish the maximum times they have agreed with hospitals for both inpatient and day patient treatment.

These may range from over a year to only a few months depending on local circumstances. Priority will be given to reducing waiting times for these treatments where waiting lists are largest and the pain, discomfort and general reduction in the quality of life are most acute. These include key treatments such as hip joint replacement, cataracts and hernia repairs, as well as cardiac surgery.

Emergency and urgent cases will continue to receive immediate priority treatment.

Your Health and Social Services Board will be responsible for ensuring that these maximum waiting times are met. This may include offering you treatment in an alternative hospital.

	receive a letter from the hospital within 2 weeks of your referral advising you of the date of your appointment;
	be given an individual appointment time and be seen within 30 minutes of that time or be informed of the reason for any delay;
	be seen by a consultant or other senior doctor on your first appointment;
	receive a report, through your family doctor, within one week of your attendance at the outpatient clinic.

The Local Charters must include information about:

	the main standards of service each Board has negotiated in its agreements with hospitals and other providers;
	details of the range of services that the Board has contracted for by type and location;
	maximum waiting times for inpatient, day patient and outpatient treatment by hospital and speciality;
	a named person you can contact if you want further information about the Charter Standards or about the services available and how to get access to them.

Local Charters also might:

	set maximum waiting times in accident and emergency departments after your need for treatment has been assessed;
	set waiting times for taking you home after you have been treated, where the doctor in charge of your case says that you are medically unfit to travel by public or private transport;
	ensure that you and your visitors are able to find your way easily around the hospital and other facilities through enquiry points and better signposting;
	ensure that every member of staff you meet face to face is easily identified by wearing a name badge;
	ensure that staff working in the community produce evidence of their identity as a matter of course.

Boards will be required to publish each year information about their achievements against these standards and to say what action they are taking to improve performance where necessary.

All providers of health and personal social services will also be required to set out clearly the range and standards of service they offer and to make this information available to all patients, clients and their families. Information on current waiting times by hospital, specialty and individual consultant should also be prominently displayed in health centres and doctors' surgeries.

The Health and Personal Social Services Management Executive will be monitoring the achievement of the Charter Standards in Northern Ireland and will arrange the publication of information which will allow you to compare the performance of individual Boards. Where performance is unsatisfactory the Chief Executive is responsible for seeing that action is taken to make the necessary improvements.

Health and Social Services Boards are required to consult widely about the services they are providing and about major new developments or changes. This consultation process should include:

	individual members of the public;
	local interest groups such as voluntary organisations;
	local Members of Parliaments;
	District Councils;
	Health and Social Services Councils;
	Staff Associations.

Boards will be extending this process of consultation as part of their new responsibilities for assessing health and social needs and ensuring that resources are better targeted towards securing improvements in the quality of life of their resident populations. You can find out more about these consultation arrangements by asking your local Board or Health and Social Services Council.

A number of hospitals and other units are already using questionnaires and surveys to find out what people think about their services. From 1 April 1992 all providers of health and personal social services will be involving patients and clients directly in assessing the quality of the services they provide and identifying any areas that need improving.

A Health and Social Services Council has been set up in each Board area to represent the interests of the public, patients and clients. The Councils are independent bodies whose members include District Councillors or Council nominees as well as other individuals appointed after consultation with local voluntary organisations, community groups and other interested bodies. Members of the public can also put forward nominations.

The Councils will monitor services and will be discussing any deficiencies or gaps with the Health and Social Services Boards, offering advice and suggestions for improvements. They have the right to:

	examine issues like waiting times, visiting arrangements and accommodation;
	visit any facilities in their areas which are owned or used by the Health and Personal Social Services;
	advise patients, clients or the public about how best to make a complaint.

By law, Boards must consult the Health and Social Services Councils about any substantial development or change in the way services are provided. This includes proposals for closure or change of use of hospitals and other facilities.

Each Council will publish an annual report on its objectives for the year and how these have been met. Health and Social Services Boards are required to publish their comments on the Councils' reports. Copies of the reports can be obtained by contacting the relevant Council or Board whose addresses and telephone numbers are at the end of this charter.

Every provider of health and personal social services must have clear arrangements for dealing with complaints. They must:

	publicise the name, address and telephone number of a senior officer responsible for handling complaints; and;
	make this information available to all patients, clients or their authorised representatives.

The complaints officer will conduct a full investigation and will provide you with a written report explaining what went wrong and telling you what action is being taken.

You may be asked to make a formal complaint in writing. You can do this yourself or ask a relative, friend or a member of staff to write it down for you to sign - this is one of the duties of staff under the complaints procedures. Your Health and Social Services Council can also help if you ask.

Your complaint should be:

	acknowledged by the complaints officer within 3 working days;
	dealt with quickly and a full report issued within one month.

If the complaints officer is unable to complete the investigation in this time, he or she will explain the reason for the delay and tell you when you can expect a full response.

If you are still dissatisfied when you receive the complaints officer's report, you can raise the matter with the Chairman or General Manager of the Board. If the matter is still not dealt with to your satisfaction you can write to the Chief Executive of the Health and Personal Social Services Management Executive at Dundonald House, Belfast. His full address is shown at the end of this charter.

At any stage you can refer the matter to the Northern Ireland Commissioner for Complaints (the Ombudsman) who is empowered to investigate all complaints of a non-clinical nature. Her address is at the end of this charter. The Commissioner will let you know if she can investigate your complaint further.

	complaints about the services provided by your family doctor, dentist, pharmacist or optician;
	complaints involving the clinical judgement of hospital medical and nursing staff;
	complaints made by children in residential care or their parents;
	complaints about community care services including services for children;
	complaints made by people with mental disorders or their carers.