El Departamento de Salud está considerando incorporar nuevos mecanismos que permitan a familiares o personas autorizadas gestionar trámites sanitarios en nombre de terceros

La síndica de greuges de Cataluña, Esther Giménez-Salinas, ha pedido al Departamento de Salud que amplíe las opciones de representación disponibles en la aplicación móvil La Meva Salut, la plataforma digital del sistema público de salud catalán. El objetivo es facilitar que las personas mayores o con dificultades digitales puedan recibir el apoyo de familiares o personas de confianza en la gestión de su información y de sus trámites sanitarios.

Esta petición surge a raíz de la queja presentada por un ciudadano que exponía las dificultades que encontraba para ayudar a sus padres, personas con dificultades tecnológicas, pero plenamente capaces desde el punto de vista jurídico, en la gestión de citas, pruebas médicas y comunicaciones con el sistema sanitario. El ciudadano explica que los problemas comenzaron con la implantación del sistema de doble autenticación, que le impedía acceder al portal si no estaba físicamente con ellos.

La síndica valora positivamente la voluntad del Departamento de Salud de reforzar la protección de los datos personales y sanitarios mediante la doble autenticación. No obstante, considera que esta protección debe ser compatible con la realidad de muchas personas que necesitan ayuda para relacionarse digitalmente con la Administración sanitaria.

La institución defiende que esta situación va más allá de un caso individual y que debe abordarse de forma general, ya que responde a una realidad cada vez más extendida en una sociedad envejecida, en la que muchas personas mayores prefieren delegar determinadas gestiones sanitarias en sus hijos o personas de confianza.

En este sentido, la síndica ha reclamado que se estudien fórmulas que permitan a las personas autorizadas acceder a la aplicación y realizar gestiones en nombre de un familiar con todas las garantías de seguridad y protección de datos, sin necesidad de compartir contraseñas ni credenciales personales. Según la síndica, la falta de estas herramientas puede llevar a muchas familias a buscar soluciones informales, como compartir credenciales de acceso, que no son las más adecuadas desde el punto de vista de la seguridad.

En respuesta a esta demanda, el Departamento de Salud ha informado de que está analizando diversas alternativas que podrían implantarse de cara a 2027. Una de las soluciones propuestas permitiría a los representantes legales gestionar distintos aspectos de la salud de otras personas a través de la propia plataforma. La autorización correspondiente sería tramitada por el CAP de referencia, una vez acreditada la relación entre las personas implicadas.

La institución del Síndic de Greuges seguirá atenta a esta cuestión con el fin de garantizar que las futuras soluciones hagan compatible la seguridad digital con la accesibilidad y el acompañamiento que necesitan muchos ciudadanos en su relación con los servicios públicos de salud.

La Defensoría de la Infancia y Adolescencia de Andalucía ha sugerido a la Consejería de Inclusión Social, Juventud, Familias e Igualdad que impulse una regulación más clara de las obligaciones económicas de las familias acogedoras de menores y de los gastos que corresponde asumir a la Administración que ejerce su tutela.

La actuación parte de la queja de una familia acogedora que, entre otras cuestiones, trasladó las dificultades encontradas para conocer el procedimiento de abono de determinados gastos sanitarios extraordinarios de un menor.

En el caso analizado, la familia tuvo que afrontar los gastos de un tratamiento odontológico que no estaba cubierto por la sanidad pública para solicitar posteriormente su reintegro. La Administración explicó que estas prestaciones extraordinarias se abonan previa presentación de la factura, siempre que el tratamiento esté prescrito, no esté cubierto por el sistema sanitario público y se cumplan los requisitos establecidos.

La Defensoría señala que las consultas y quejas recibidas muestran las dificultades de las familias para obtener la compensación de estos gastos extraordinarios, así como dudas sobre qué conceptos están incluidos, la documentación necesaria, los plazos, la justificación de los pagos o el formulario que debe utilizarse. Además, recuerda que la compensación económica por la atención al menor constituye un derecho de las familias acogedoras y no una prestación graciable.

Por ello, la Institución propone desarrollar reglamentariamente el Estatuto de Familias Acogedoras para establecer con claridad qué obligaciones económicas corresponden a las familias y cuáles a la Administración, y detallar los requisitos, procedimientos y trámites para reclamar las compensaciones económicas extraordinarias. El objetivo es aportar mayor transparencia y seguridad jurídica y evitar cargas administrativas innecesarias para quienes tienen a su cargo el cuidado de estos menores.

• New report highlights fragmented care and regional variation in access to services alongside a more than 200% rise in complaints about ADHD and autism.   
• Government must introduce national guidance and stronger regulation to tackle delays in diagnosis and treatment, improve access to care, and clarify patients’ right to choose a provider.  
• One Ombudsman investigation found a man was referred to a local ADHD service that had not yet opened. He paid almost £4,000 for private treatment.    

ADHD and autism services are failing too many people because of the way they are designed, commissioned, and delivered, England’s Health Ombudsman has said, as complaints about care continue to rise.  

To address these growing issues, Paula Sussex CBE, the Parliamentary and Health Service Ombudsman is calling on the Government to publish clear national guidance to improve access to care and clarify patients’ right to choose a provider.  

The Ombudsman is also calling for more support for Integrated Care Boards (ICB) to make consistent decisions about ADHD and autism services that meet the needs of their local communities.   

The Ombudsman also recommends that NHS-funded providers delivering ADHD and/or autism assessments, but not ongoing care, should be registered with the Care Quality Commission. Currently, these providers are neither inspected nor monitored, creating a regulatory gap that must be urgently addressed to make sure patients receive consistent, safe, high-quality care.    

In its new report, Improving ADHD and autism services: commissioning with confidence, the Ombudsman shared its findings based on 3,000 complaints. It found recurring issues including uncertainty about patients’ right to choose a provider, inconsistent recognition of diagnoses across NHS and independent providers, and lengthy waits for assessment and treatment.   

In one investigation, Rich, who has asked to only be referred to by his first name, was wrongly refused access to ADHD care with his chosen provider, despite this being a legal right. He was instead referred to a local service that had not yet opened.   

The Ombudsman has seen an almost 206% rise in complaints about ADHD and autism over the past five years, from 410 to 1,257.   

Ombudsman Paula Sussex CBE said:  

ADHD and autism services are under significant pressure, with demand outstripping capacity. While commissioning cannot solve these supply constraints, the way services are designed, commissioned and delivered can compound the pressure people experience and make it harder to make the best use of available resources.   

 

"When these decisions work well, people can access high-quality care wherever they live. Right now, the system is too complex and inconsistent, leaving too many patients falling through the gaps."  

The report shares several stories of the impact these failings have on people.   

In one case, Rich, 48, asked to be referred to Psychiatry UK for his ADHD treatment. Under Right to Choose legislation, patients in England can choose any NHS-funded provider offering a specialist service for their care.   

South East London ICB denied Rich’s request and wrongly insisted he be referred to a local ADHD service which was still being developed and had no opening date. The Ombudsman found his NHS treatment was delayed by five months. Rich felt he had no choice but to pay for private care amounting to almost £4,000.  

Rich, a student from South London, said, 

Trying to navigate such a complicated system was completely overwhelming. It is particularly challenging for an ADHD patient who, by definition, may find it difficult to manage and navigate needless complexity.  

 

“I had to do a lot of work and research into the system to get the care I was entitled to. I even provided my GP with the contact details of the person responsible for overseeing patient choice, but it made no difference. I was repeatedly told, without any reason being given, that I could not possibly access ADHD care via patient choice. I knew this was not true, which was extremely frustrating.   

 

“It felt like gaslighting. My ADHD diagnosis was a positive thing, as I’d found a framework for understanding myself better and accessing support. But my GP and the commissioners turned it into a punishing and abusive assault course as I tried to get the care I needed. It made me very anxious and I had terrible insomnia. I also worried that these symptoms, combined with my ADHD, would lead to a mental health misdiagnosis.”  

In another investigation, South London and Maudsley NHS Foundation Trust removed a woman from the ADHD medication titration (the process of adjusting medication to find the right balance) waiting list without warning or valid reason, leaving her without specialist monitoring support for around six months. This delay may have affected her symptoms and her ability to carry out everyday activities, causing frustration and distress.  

Ombudsman Paula Sussex CBE added:    

People should not have to fight their way through a confusing system to get ADHD and autism care. We have seen clear evidence that this has created a postcode lottery, with too many people’s access to care depending on where they live.  

 

“The way services are organised has real consequences for people. Patients are navigating confusing pathways, facing long waits, unclear decisions about their right to choose, and inconsistent access depending on where they live. Too many are left feeling they have no option but to pay privately. That is not what good public services should look like.  

 

“I welcome the Government’s commitment to improving support for people with ADHD and autism via an ongoing independent review. Local NHS bodies cannot solve these challenges on their own. The current approach has led to a postcode lottery in care. ICBs need clear national guidance, backed by practical support, to help them balance patient choice, local services and limited resources. Only then can we build ADHD and autism services that are fair, consistent and easier to navigate.”  

Henry Shelford, CEO of ADHD UK, said, "

We welcome the Ombudsman's intervention wholeheartedly. Every day we see a wild difference in care across the country: whether you are seen in months or left waiting for years depends almost entirely on where you live. That is not an accident of demand — it is the direct product of wide variance in how ADHD services are commissioned. Some ICBs commission well; others have failed for years - creating enormous local backlogs.  

 

"Behind every one of these 3,000 complaints is a person whose life is on hold. ADHD is not a trivial condition. Unsupported - it often costs people their education, their jobs, their health and sometimes their lives. When someone finally asks for help, the answer should not be a multi-year wait, a refusal of their legal right to choose, or a referral to a service that has not even opened.  

 

"The Ombudsman has diagnosed the system correctly, and we urge government to follow the Ombudsman's recommendations."  

Dr Simona Drenik Bavdek, the ombudsman for human rights, wishes all pupils, students and education staff a safe, curious and successful year. She emphasises that quality, accessible education is a fundamental human right and one of the most important foundations of a democratic, solidarity-based and inclusive society.

"Knowledge is a superpower. In Slovenia, everyone can access it through the public education system, but even the best school cannot impart it. It requires curiosity, effort, perseverance and collaboration with classmates. School enables not only the acquisition of knowledge, but also the experience of community,' says the ombudsman. At the start of the school year, she encourages pupils and students to seize all the opportunities that school offers them.

According to the ombudsman, children and young people can develop another important 'superpower' – empathy – in the community. School is a place where you meet people with different experiences, abilities and views on the world. Here, children learn to listen to others, understand their needs, express their opinions, engage in respectful debate and collaborate. By doing so, they learn to take responsibility for the community, as defined by Article 29 of the Universal Declaration of Human Rights, and to become active citizens. This article promotes mutual respect for the rights of others, as well as active citizenship. The ombudsman for human rights says that young people can use this 'superpower' to resolve disagreements verbally, understand others' positions and seek help when needed. This creates an environment where there is no room for peer conflict, humiliation or violence. School must be a safe space where nobody fears coming to class, speaking up, or being themselves.

"Human rights are not just learned from textbooks. Children learn about them primarily through experience: when they are heard, when they can participate, when their dignity is respected, when they see that equal opportunities do not always mean the same approach for everyone, and when they feel safe because they know that violence has no place in their school. An inclusive school is also a safer school. Where differences are understood and respected rather than excluded, there is less room for stigmatisation, exclusion and violence.' An inclusive school recognises the needs and abilities of each child and provides the support they need to progress,' says Dr Simona Drenik Bavdek. She therefore believes that inclusive education should be a shared commitment of society and present in all schools. A child's special needs should not prevent them from fully participating in lessons and in the school community, and an individual approach should be seen as the basis of quality education, not a privilege.

"In Slovenia, it seems almost self-evident that children will be in school in September, but this does not apply to all children around the world." Many children around the world still do not have equal access to education, particularly girls. It is therefore important to recognise the value of public, accessible education and to protect and develop it,' says the ombudsman.

Alongside acquiring knowledge, nurturing relationships, and active engagement, it is also important to take care of health. The ombudsman emphasises that schools must contribute to creating an environment in which all children have the opportunity to grow up healthily. This includes providing all pupils with access to quality, healthy school meals, with reasonable consideration given to health and other legitimate dietary requirements, as well as encouraging participation in creative activities and ensuring they get enough daily exercise. "I would like to see progress in sports education records next year. Not for statistics and comparisons between children, but because more exercise significantly improves health,' says Dr Drenik Bavdek.

Caring for healthy development also involves taking a considered approach to digital devices. Screens are a fact of life for children and young people, and an important tool for learning and communication, but they must not replace movement, sleep, reading, creativity, or interpersonal relationships. "Digital skills are essential, but it is equally important to know how to put down your phone, look at the person next to you, and give them your attention. This is also a life skill,' says the ombudsman.

At the start of the school year, she pays special attention to road safety. She calls on all drivers and other road users to be more careful and reminds parents to review the rules of safe behaviour in traffic with their children. "For a child, the journey to school is also a journey to greater independence. It is the responsibility of adults to ensure that it is safe. When children are on the road, safety must take precedence over speed.'

The ombudsman encourages teachers to educate children, promote critical thinking, and demonstrate that collaboration is always a better choice than conflict. They should encourage children to take care of their own health and the health of others, as well as the environment, and to respect human rights and dignity. 'To all of you returning to school after the holidays, especially the first-graders, I wish you to gain as much knowledge, skills, and empathy as possible in the new school year,' says Dr Simona Drenik Bavdek, the ombudsman for human rights, at the beginning of the school year.

by the Parliamentary Ombudsman, Judge Joseph Zammit McKeon

There are times when, in the interest of the institution, an Ombudsman has to hold back and remain silent when faced with statements made in public, especially in uncontrolled social media experiences.  There are other times when an Ombudsman has to show publicly that he is resolute by speaking clearly for all to understand and act without fear. 

There is nothing conflictual in such an approach.  Rather this perspective represents two sides of institutional responsibility: the values of courage and wisdom.

Several are the instances today where public offices operate in a social environment inclined towards reactive immediacy. Every debate, real, perceived or otherwise instigated, consequential to events happening or otherwise, could instinctively generate instant reactions. But instinct should never be a reason or consideration to react, certainly not where public constitutional offices like the Ombudsman are concerned.  An Ombudsman does not speak always on anything.

The circumstances where the Ombudsman has a positive institutional duty to speak include: where fundamental principles of good administration are being disregarded by public authorities without reason verging on the violation of the human rights of persons; where persons are treated unfairly; where systemic maladministration persists despite repeated warnings; where administrative authority is exercised arbitrarily; where vulnerable persons cannot effectively defend themselves; when the disadvantaged have little power to make themselves heard; when silence could reasonably be understood as being acceptance of conduct that should be rejected in principle; wherever raising an awareness in the promotion of human rights and vigilance on the protection of human rights so require.  When an Ombudsman speaks, intervention is not casual, but necessary especially to prevent issues of public interest from crossing red lines. 

When an Ombudsman decides to remain silent where such fundamentals are at stake, the Office risks diminishing the purpose for its existence. An Ombudsman will not seek conflict for its own sake. Firmness is constructive in its essence. Protecting the dignity and credibility of the Office is legitimate. An Ombudsman should not speak simply to be heard. 

The Ombudsman may cause discomfort from time to time whenever scrutiny proves effective. There are moments when the institution must stand visibly and unmistakably for the principles of fairness and justice.  One principle should remain the same and always: whether to speak or remain silent should never be dictated by fear of consequences but by the mandate of the institution. 

The Ombudsman is effective and strong in principle and action because, within its mandate,  the institution stands for administrative justice without fear or favour.  This approach has been consistently the case in this country, because Ombudsmen (past and present), Commissioners (past and present), Investigators (past and present) and Office staff in all grades have placed commitment to justice, vis-à-vis the public service and the public administration, especially where the vulnerable are concerned, at the forefront of their operations, always heads high and without expecting recognition in return.

There are times when protecting the institution means refusing to be drawn into controversy. There will be other moments when patience, confidentiality and silence serve justice best.  Restraint gives substance to the institution.  If an Ombudsman responds to every criticism or enters every public debate touching even remotely upon his mandate, the distinction between independent oversight and ordinary public controversy could be made difficult to determine.  An independent institution will never allow itself to be drawn into a controversy merely because someone invites or provokes the institution to enter the arena.  There is dignity in restraint. Silence is not equivalent to uncertainty, weakness or acquiescence. Institutional authority requires both restraint and courage.

The strength of moral authority (as alternative to coercive authority) is central to the Ombudsman.  Strength derives through the exercise of restraint and silence where necessary.  There is also strength when the Ombudsman publicly insists that there are principles on which the institution cannot compromise.  Silence protects moral authority when speaking would be out of place, premature, unnecessary or institutionally inappropriate. The institution does not acquire authority merely because the law establishes that authority but is patiently built over time through independence, fairness, consistency and courage.

There is a time for institutional silence and a time for an institutional voice. Wisdom lies in knowing the difference.  Independence lies in making that choice without fear.

This article was published on newsbook.com.mt on 25th August 2026