Mr. Travers said that special advisers should avoid becoming involved to a greater extent in the day to day operation of the administration of the Department. What are the views of the delegation on this issue given that this view was contradicted by the then Minister for Health and Children, Deputy Martin, when he came before the committee? He said the advisers were not involved in any way in the day to day running of the Department of Health and Children, yet Mr. Travers seems to think the advisers were involved in the day to day running and the line management of the Department of Health and Children. Mr. Kelly indicated this is the way he felt about it also. There is a contradiction between how the Minister, Mr. Kelly and Mr. Travers feel about this. There is also a contradiction in the opinions of Mr. Kelly and the Minister, Deputy Martin, about whether he was ever informed about this issue.
In his evidence to the committee Mr. Kelly also said there was an excessively formal role for the advisers within the Department, excessive to what was laid down in legislation. He said it had become commonplace for decisions and directions by the Minister to be conveyed through his advisers. I would like the witnesses to say whether advice from the Minister was being given by them to civil servants in the Department of Health and Children. A number of witnesses who have come before the committee made it clear that they expected that the Minister would be informed of the issues raised at the MAC meeting by either of the advisers who attended this meeting. There appears to be consensus among a number of people, political people, civil servants and public servants, that their role was crucial in regard to how issues were dealt with in the Department of Health and Children and there was an expectation by many, including Mr. Travers, that they would somehow have informed the Minister of crucial events like this if they were raised at any meeting.
I would like the witnesses' opinions on the issue of the legal advice given by the South Eastern Health Board and how it is being played down during the committee meetings. In some respects I feel it might have been held over until such time as the Minister and his Ministers of State were able to attend a MAC meeting with their senior civil servants and senior public servants who are the CEOs of the health boards. This was such a hot topic, it was possibly being held over for a general discussion with all the senior people who run the Department of Health and Children as opposed to how it is being portrayed here as a brief discussion or only a legal summary; it was actually considered to be a significant issue.
This brings me back to other roles the witnesses play within the Department of Health and Children. For example, Mr. Mannion in February, even before Mr. Kelly was circulated with the memo on the role of advisers, had a discussion with the Minister and senior civil servants in regard to what the memo refers to as "discussions on the tobacco Act and nursing home charges". We do not know what exactly are those nursing home charges. From reading the memo one gets a fair idea that legislation and legal opinion were considered, all of which are important, and there is the sense that the witnesses do not dismiss matters so easily if their is any chance that legal opinion needs to be sought. The tobacco Act was put in with nursing home charges — we do not know what they are — but we know what happened with the tobacco Act. It subsequently went through Dáil Éireann and was enacted in April 2002, almost two years after this memo was issued.
Contrast this with what happened to nursing home charges. We now know that in 2002 nursing home charges would have cropped up in a different manner, in the Ombudsman's report. They were obviously becoming a high priority within the health strategy that was to be published in November 2001. Much of the background work in regard to the health strategy would have been discussed at this time. We are also looking at the legislation which would subsequently go through the Dáil in regard to the over-70s.
I cannot believe that the whole issue in regard to nursing home charges, whether it has to do with subvention or the legislation which introduced the over 70s deal, changed quite dramatically the entitlement to nursing home eligibility. I cannot believe the witnesses were not up to date with this especially when we know that within the Department of Health and Children this issue would have been known. It may not have been a red flag issue, as it has been described in the committee. Also Mr. Pat McLoughlin felt that he would have become aware of this issue in and around 2002. During the time Deputy Martin was Minister for Health and Children senior civil servants and senior public servants were talking about this issue. Maybe it was boiling under the surface, maybe it was like a pot simmering on the ring and was not bubbling all over the place but I find it very hard that we are supposed to believe it never crossed the divide from the administration of the Department of Health and Children to the political responsibilities of the Department of Health and Children.
There is one question I would like the witnesses to answer on the health reforms and the issue of eligibility. Everybody from the Government side, especially from the political side, who has come before this committee has made a big play of the fact that the witnesses were instigating reforms of the health services and that these health reforms were dramatic and would change the world. Who made that judgment call? Who said we will sit down and look at reform of the health services along the lines of what is now the Health Service Executive? Who said all the other issues, such as eligibility issues, would be parked?
The memorandum regarding this legislation was drawn up within the Department of Health and Children in 2002 and 2003 but it was parked. They are Mr. Travers's words. Here is an issue that appears to have been well known across the Department and was parked in preference to the health reforms. Somebody must have made a judgment call on that. The witnesses may say they did not realise this was a €1 billion issue in the Department that was about to explode.
There were issues surrounding the nursing home subvention and other issues at which perhaps the witnesses should have decided to look first; perhaps they should have forgotten about putting all their eggs in the one basket and just looking at reform. What the witnesses appear to say is that everything focused on reform. For example, comments were made here and there during the course of this debate about how there were issues regarding care of the elderly going into the future. I believe there is still no Government policy on care of the elderly going into the future. I also believe the radiotherapy report has not reached a final conclusion as to where the two centres will be based, even in Dublin. The radiotherapy report took four years to publish. Many of what would be considered extremely important issues for the Department of Health and Children take years to see the light of day. I would like to hear a little more of what was going on within the Department of Health and Children.
I would like us to speak a little more about the so-called health reforms on which there may have been many meetings. Looking back, this does not stand out as being as dramatic as one would think. There would have been many discussions by the civil servants and the public servants as to how the health boards would be reformed and how issues would be dealt with but much of it appears to be similar to industrial relations issues. I would like to hear how the witnesses make up their minds on many issues. Did the witnesses ever hear there were concerns within the Department of Health and Children in the 1990s that health boards were charging people for orthodontic treatment to which they were entitled free of charge?
Also, when the legislation was being drawn up to provide for free medical cards for everybody over the age of 70 — I would be interested to hear whether the Attorney General's advice was sought — did anybody remark on whether the Equality Act would be an issue? As the witnesses are aware, there are two types of medical cards for those over 70. There is the gold card which is given to all those over 70 and the traditional medical card, which is given on the basis of one's means. That might not make much difference to the person holding the medical card but the doctors are paid substantially different amounts depending on the type of medical card. Did anybody ever examine the Equality Act to determine whether people who had the traditional medical card were being discriminated against because the payment for that service is somewhat different? Was that ever discussed in the Department of Health and Children? I would like the witnesses' views on that. I do not accept that this issue raised its head suddenly in December 2003, went away again and everybody forgot about it. The health reforms are important but the health strategy, once published, did not go far. Most of us have been Members of the Dáil since that was published because it subsequently became Fianna Fáil's health manifesto. The only body set up since then is the HSE.