Political shortcomings in way nursing home charges handled

The transfer of the secretary general of the Department of Health should not distract from poor political behaviour over the …

The transfer of the secretary general of the Department of Health should not distract from poor political behaviour over the nursing homes charges, writes Mark Brennock, Chief Political Correspondent.

The Tánaiste and Taoiseach have been keen to portray the issue of illegal charges for public nursing home care as a generation-long failure of a Government department rather than one casting any doubt on the performance of serving politicians.

Indeed, the Tánaiste's account yesterday to the Oireachtas Committee on Health began over 50 years ago, when the State first began to charge people receiving long-term care in State institutions. And the only practical consequence so far has been the decision that secretary general of the Department of Health Michael Kelly will move to head up the Higher Education Authority.

Already forgotten, apparently, is that just last December, having confirmed that this money had been illegally taken - stolen - from largely voiceless and vulnerable people since 1976, this Government tried yet another illegal manoeuvre to hold on to most of it. This particular move was only stopped when the Supreme Court ruled it was unconstitutional.

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It was "entirely wrong" to take this money in the first place, Ms Harney said yesterday. Was it not more wrong to try to hang on to it in the full knowledge that this money had been wrongly confiscated from the State's citizens? Of course this report does not deal with this issue at all, not due to any omission by Mr Travers, who stuck scrupulously to his terms of reference.

The report details facts which do not support the Government spin that it is entirely blameless in the affair. Two junior ministers sat through a meeting in the Gresham Hotel in December 2003 which heard that there was now advice that this ancient practice of taking money from the elderly in State care was illegal.

The minister was briefed, possibly in a fairly cursory manner, on this matter when he arrived late for the meeting. But his special adviser had been present and he got the minutes later. And it was the Fianna Fáil/PD Coalition that introduced free medical cards for the over-70s in 2001. It was this action which made it impossible for the health boards to carry on the usual practice of simply confiscating medical cards from those in institutional care, so they could be charged.

This practice had been legally questioned back in the 1970s. But because from 2001 the over-70s were now entitled to medical cards automatically, they could not be taken off them by health boards for any reason.

Incidentally, the Government underestimated by 30,000 the number of people who would be entitled to these cards (and therefore underestimated the annual cost by €50 million).

There were reports yesterday of deep unhappiness among senior civil servants at the blame being put on the Department of Health, its officials and "the system" while politicians emerged unscathed from the fiasco.

There is no doubt from reading this report that there was a laid-back approach to this issue within the Department at crucial times. After the Gresham Hotel meeting Mr Kelly did show some urgency ("admirable speed", says the Travers report) when setting up a working group to prepare a background note on the legal issues surrounding the practice of charges for long-term care, to be sent to the Attorney General along with a request for legal advice. But then came the mysterious failure to send this to the Attorney General. Mr Kelly thinks he gave the file to the minister. The minister says he didn't. One official remembers seeing another official with this file in the minister's office.

However, that official in the minister's office says he or she never saw the file there. The location of the file would tell who was right, but the file is now missing.

Despite having been given information which, in the words of Mr Kelly, could have "significant potential legal, financial and political consequences", nobody in the Department seems to have taken responsibility for acting on it.

Even a Dáil question on the issue during 2004 failed to remind anyone that there was a rather important matter upon which the Attorney General's advice was required.

"Systemic corporate failure" is what Mr Travers calls what happened. Special advisers should have been "more active in examining and probing the underlying issues". And in the closest he gets to criticising ministers, he says: "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 of charges for long-stay care in health board institutions."

The report qualifies this, noting that "the analyses and briefings being provided by the officials in the Department of Health appears to have been deficient in many respects". And in a passage making clear that the blame lies primarily with officials, the report goes on: "These [ political] shortcomings were, however, of a nature, scale substance and order of magnitude considerably less than those of the system of public administration."

Perhaps these shortcomings were of less magnitude than those of officials. But the fact that there were serious flaws in how the issue was handled in the Department of Health should not distract from the political shortcomings.

Junior ministers and ministerial advisers heard full accounts of this issue. The matter was at least mentioned to the minister on two occasions, and he received minutes of meetings at which the seriousness of the matter was discussed at length.

And if, as the report says, the minister's advisers should have been more active, should Michéal Martin not have had a little curiosity as well? And whatever happened to the traditional notion of ministerial responsibility - the idea that a minister takes responsibility for what happens in his or her department? There was no sign of any of that yesterday as, aided by the Travers report, the Government treated the matter as a failure of a system rather than a political issue.

The Tánaiste's hesitancy yesterday when asked on several occasions if she had confidence in Mr Martin was striking. She said that if she hadn't confidence in him she would ask the Taoiseach to get rid of him. But having noted the clear conflict of evidence between Mr Kelly and Mr Martin, she said she would not adjudicate on who was right.

This could have simply been a wish to hold back and not be seen as having a further go at the departing secretary general. If this is not what she was doing, it leaves open the possibility that she believes Mr Kelly is right and Mr Martin wrong.

Today's Dáil debate, at the end of which Mr Martin and Ms Harney will both answer questions, may cast further light on the strength of the Tánaiste's belief in Mr Martin's account.