Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

The Travers report is a massive indictment of successive Governments and successive Ministers for Health since 1976. It is also an indictment of the ethos within the senior management at the Department of Health and Children in the same period. The Tánaiste and Minister for Health and Children has, initially at least, tried to shift the responsibility onto the shoulders of civil servants. While senior civil servants clearly cannot be exonerated, it is beyond question that primary responsibility rests with the Ministers who are supposed to be responsible to the Dáil and to the people.

We are expected to believe that the former Secretary General at the Department of Health and Children, Mr. Michael Kelly, was the chief culprit in this matter and as a result he has been penalised by being moved out of the Department. However, as has already been stated, the Government has moved him to another senior and well paid position as the full-time chairperson of the Higher Education Authority, despite the OECD report having recommended an extensive public recruitment campaign for this position. This needs to be explained. If the Government considers this civil servant culpable, why did it not take steps to dismiss him as it is empowered to do? If he was not culpable or negligent, why was he moved or required to move? Does the Government fear that a dismissal, if it were challenged in open court, might further expose the responsibilities of Ministers in this debacle? Who does the Government hold responsible? If all senior civil servants for 30 years were responsible then no one was responsible.

Has the Tánaiste any indication of how many people had charges stopped because they complained? How many received refunds as a result of their complaints being processed? Does the Tánaiste agree it is a scandal that charges were dropped for those who complained or who had somebody to complain on their behalf, while vulnerable and incapacitated people or those with disabilities, who had no knowledge of or ability to articulate their case and nobody to do so on their behalf, continued to face charges? Is it seriously suggested that, because charges were dropped in cases brought to the attention of the Department, the knowledge within the system did not make its way to ministerial attention over all those years? We must know how many cases were brought to the Department for determination and in respect of which charges were quietly dropped.

The Travers report observes, "Ministers should insist on full and periodic briefings on key issues of policy and operational performance". It is a scandal if Ministers did not do this in regard to the illegal charges. However, if they did so, we are clearly not being told the truth about the knowledge of successive Ministers for Health and Children. The report describes the illegal charging of people in care as the result of "long term systemic corporate failure".

It beggars belief that this could have continued for almost 30 years and that successive Ministers failed to take action over the lack of a legal basis for the charges. The report could not be clearer when it states the Department of Health and Children undertook "many reviews" of the charging practice over the years from 1976 to 2004. All these reviews concluded that the legal basis for the charges was at the very least uncertain and should be rectified by the introduction of amending legislation.

Even more disturbing are the wider implications of this report for the running of the health services over the last three decades. In this regard, I wish to highlight an important conclusion of the report and one that has received little attention. This goes to the heart of why this situation was allowed to continue for so long. As a former member of a health board, I am certain this is the case. The report makes findings about why it took from 1976 until 2004 for the Department of Health and Children to request legal advice from the Attorney General. Among the underlying reasons it finds "a strong desire to protect what was regarded as an important source of 'own income' by the health boards as a means of protecting the provisions of essential health services in a health system widely regarded as being underfunded". The import of that statement is very serious. The underfunding of health services by successive Governments contributed to the belief within the system that the illegal charges as a source of funding for health boards should not be threatened. It was judged better to continue to charge people illegally than to take the necessary decisions to increase revenue for the health system, to reform it and to organise public health services on a more equitable and efficient basis. This is a damning report.

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