Mr. Tony O'Brien:

As my colleague, Mr. Liam Woods, confirmed yesterday, what we are talking about here is a memorandum prepared by the office of legal services for his information. The memorandum was shared only by him with a group of chief executives and for some reason was disseminated more broadly. From where does it come? In 2012, a particular case arose in a particular hospital that I will not name. It was related to a patient whose acute care phase had been long completed and who was refusing to leave the hospital and move on to a more appropriate care setting. The staff in the hospital, which included nursing staff, sought guidance as to what rights, obligations, duties and powers were available to them and a senior counsel provided advice at the time.

This issue is not about a general policy but about cases which are very rare in the context of the total number of patients who pass through Irish hospitals. In exceptional circumstances, it occasionally arises that there is a refusal to move on from a hospital for whatever reason. There have been other instances more recently which gave rise to similar inquiries to the office of legal services. As a result, based on that advice provided by a senior counsel, a memorandum was prepared and sent by legal services to the national director setting out various steps that would need to be taken to ensure every possible step had been taken to make appropriate provision and provide appropriate care to each patient and what steps might be available thereafter.

I emphasise that this is not about patients who have recently completed their care but about rare and exceptional circumstances which arise perhaps a handful of times each year. They occur when patients or former patients have, for whatever reason, a desire to remain in a care setting occupying a bed which they do not need but another patient may need and refusing to move on to another more appropriate care setting that has been provided for them.

The memorandum should not have been distributed as widely as it was. It was only available as a background note to advise people of the appropriate steps that should be taken to ensure patients get the right care in the right circumstances in these rare and exceptional circumstances. The memo had already been withdrawn from circulation almost two weeks ago because the person who received it took the view, which I share, that it should never have been distributed in that way. To the extent that it has caused distress to any staff member who received it or to members of the general public as a result of being disseminated, we absolutely regret and apologise for any concern to which it has given rise.

I am pleased to have an opportunity to make very clear that this is not about something that happens in the generality. It is about exceptional circumstances which, in a hospital system as wide as the Irish system, will arise only a handful of times each year. It is necessary, in the context of patients occupying beds that they no longer need while other patients may be waiting for those beds, to have a clear understanding of the appropriate steps that should be taken in such circumstances. I am not sure if Mr. Woods wishes to add anything.