O'Neill challenged over his role and methods

Health reaction: Elements of the O'Neill report have been criticised by the Department of Health as well as by former and serving health service personnel.

Appendices to the report also reveal that consultants retained by the owner of Leas Cross maintained that the standard of nursing care at the nursing home was entirely adequate and said that of 30 cases reviewed at random, none showed any contributory negligence.

The consultants criticised the HSE for failing in its duty of care to both residents, families and the proprietor.

In a submission the Department of Health said that some criticisms of it by Prof O'Neill were made out of context and were not backed up by any evidence.

One former senior executive in the health service described parts of the report as "biased and inaccurate".

Senior management of the HSE (northern area) in a submission drawn up last month said it could not agree with the assessment in the report of the role played by it with regard to Leas Cross. The submission said Prof O'Neill had not interviewed any member of staff and could not be aware of the many discussions that took place between senior management and clinicians.

Another submission from an unidentified person said the report had displayed fundamental misinterpretations of the facts from their perspective.

The Department of Health rejected claims in the report that policy, legislation and regulations had failed to address the needs of older people.

The Department of Health said that this was "a very broad statement" and that there was no evidence presented to support the remarks.

It said that the Department of Health took the issue of elder abuse very seriously. It also said that it had provided €150 million this year towards improving services. The department said it had published legislation to put the Social Services Inspectorate on a statutory basis.

A former senior executive in the health service described aspects of the report as being "biased and inaccurate".

The former executive, who was not identified in the report, said it made no reference to the prevailing environment in which services to older persons were provided in the period concerned.

The former executive disagreed with the report's conclusion that senior management had appeared not to give due weight to written comments by clinicians about standards of care.

"High quality and standards require adequate support resources to implement. However much as we desired to achieve those standards of excellence our ability to do this was impacted on by the prevailing environmental macro and micro factors," the former executive stated.

The former executive said the report "ignores totally the prevailing environment at the time and the efforts and representations made by staff seeking an application of resources".

The former executive said it was not possible to appoint a nursing home inspectorate with the required numbers of staff and skill set due to official employment ceiling limits. The former executive said that at no stage was the quality of care relating to patients in Leas Cross made known.

With regard to concerns raised by consultants at St Ita's Hospital about patients transferred to Leas Cross, the former executive stated that the doctors could have readmitted them back into St Ita's.

"[ For Prof O'Neill] to reach conclusions from a number of letters circulated mostly within the consultant's own team and written over a fairly close period with a whole paragraph given over to a letter that was not sent to anyone and to cite these micro examples as an indicator of the status of the level of communication between senior management and the consultants is both inaccurate and biased", the former executive states.

Another former senior health service executive, who engaged Prof O'Neill, said that the consultant had gone beyond his terms of reference and failed to exercise due process.

"It appears Prof O'Neill has moved beyond the terms of reference to highlight his perception of systems failure at health board level through a limited desktop exercise."

He said Prof O'Neill had drawn conclusions from informal communication or access to files.

The former executive said that the report did not reflect the context and climate in which they were operating at the time.

He maintained that the report had failed to apportion due weight to the statutory obligations imposed on the proprietor and on the professional responsibilities of the medical and nursing staff.

"He has criticised the inspection process without appreciating that the new process was innovative and was in the course of implementation over a number of months before the events in Leas Cross took place," he said.

The former executive said Prof O'Neill was inaccurate in stating that management did not respond to written concerns by doctors in St Ita's Hospital about patients sent to Leas Cross. He said that no reference to the standards of care at the nursing home were made on the occasions of meetings with consultants.

The executive disagreed with the assertion that the documentation was consistent with a deficiency in the regulatory process.

With regard to the claims about a warning to the Northern Area Health Board from the Eastern Regional Health Authority about Leas Cross, the former executive stated that it had no communication, formal or informal, from "referrers" in relation to standards at Leas Cross.

Ms Rita Craig, who was retained by the proprietors of Leas Cross, Mr and Mrs John Aherne, said the patients who died after being transferred from St Ita's should never have been discharged from the hospital as they required medical and mental healthcare.

Another consultant retained by the owners, Dr Jonathan Levy, said that patients who were admitted to the nursing home and who subsequently died, were in a poor state of health.

"A possible criticism of Leas Cross is the fact that many of the cases they agreed to accept from hospitals in the area did in fact require high-dependency nursing and many of them required 24- hour nursing care," he stated.