The Department of Health was well aware that legal concerns surrounded the practices of charges for long-term care in health board institutions from the outset of the introduction of these practices in 1976
These concerns persisted and continued to be articulated anew on many occasions over the years right up to the present
These concerns were expressed by legal opinion external to the department, by legal opinion provided by the health boards, by officials within the department itself and not least, by the department's own legal advisers
None of the legal opinion in department files over 30 years provided support for the practice
The department "avoided" any opportunity to test the legal validity of the practice. Its approach was to advise health boards to settle out of court when the practice was challenged by individuals
The department prepared a draft Government memorandum and associated heads of Bill in 2002 which would have rectified the situation if presented to the minister and Government and the requisite legislation was enacted. But no submission was made to the minister on it by the department
When medical cards were given to all over-70s in 2001 the department "had full knowledge that this meant that such persons could not be charged for inpatient services in health board institutions". A number of health boards asked the department's advice on this and the department "ignored" them and did not make known to the health boards the conclusions it had itself drawn on the practice
At a meeting in December 2003 attended by health board CEOs, department officials and then health minister Michéal Martin and his two junior ministers, it was decided the advice of the Attorney General should be sought to see if amending legislation should be introduced to rectify matters
Officials in the department prepared a letter and background paper for submission to the Attorney General but it was never sent. "The secretary general, who was under intense pressure of work, did not send the letter to the Attorney General and cannot fully recollect what happened to the letter and attachment".
The letter and attachment were sent by the secretary general to the Attorney General on October 27th on the initiative of the Tánaiste following the raising of related matters in the Dáil
No documentary evidence was made available to Travers to show any memorandum was ever prepared and submitted to ministers which fully and clearly set out the legal, financial and other issues surrounding the practice.
There was no single reason for the delay of almost 30 years in getting the Attorney General's advice on the issue - there was a "constellation" of reasons
There were also "shortcomings at political level over the years since 1976 in not probing and questioning more strongly and assiduously the issues underlying the practices"
The department failed "at the highest levels" over more than 28 years to deal effectively with the issue.