For two decades health boards and governments have deliberately kept older people with medical cards in the dark over their entitlement to free nursing-home care, writes Carl O'Brien, Social Affairs Correspondent.
You don't always need to be a fly on the wall at the heart of government to know how officials and Ministers really think.
It emerged this week that several health boards last year stopped levying illegal charges on patients who complained about deductions from their pensions to pay for care in long-stay public nursing homes, but continued with the practice for thousands of others.
In short, health authorities recognised what they were doing was wrong. They agreed to stop charging those willing to kick up a fuss about the practice. But they were content to deliberately leave thousands of older patients in the dark over their entitlement.
Last week the Minister for Health, Mary Harney, ordered health authorities to stop charging pensioners with medical cards for their nursing-home care after she became aware that the practice was legally unsound. These patients were entitled to free inpatient care under legislation dating back to the 1950s.
So why wasn't anything done before?
Why were officials content to let an illegal practice continue unhindered?
Indeed, was there collusion on a grand scale across the health sector to allow the practice to continue?
Some of these questions will be addressed when the retired head of Forfás, Mr John Travers, examines the management of the issue.
Specifically he will look at the detail of why it took a year-and-a-half for the Department of Health to refer the matter to the Attorney General, but he will not have the opportunity to consider the mindset within Government that allowed this practice to continue.
Such legal advice would never have been allowed gather dust if more powerful lobby groups, such as the banking sector, unions or middle-class voters, were having their incomes illegally deducted.
Older people, however, are a vulnerable group. They are not organised. They don't wield economic strength. They don't benefit from the kind of professional lobbying and support that other more organised sections of the population do.
In essence, all indications are that health boards knew that what they were doing was wrong, but were content to continue with the practice because they knew they could get away with it.
The charges, after all, have been a lucrative source of income for the State. They have been generating about €8 million a month, and the Department of Health faced the prospect of finding an extra €100 million a year if the charges were axed.
Another issue Mr Travers will not be examining is why this was allowed to happen for not just the last one-and-a-half years, but for almost 20 years.
The issue of illegal charges was being raised repeatedly by the ombudsman over the last 20 years.
In an annual report from 1988, the ombudsman, Michael Mills, said he was happy to report that one health board had ceased charging a patient after he had raised the issue.
"The health board accepted that the patient was, in fact, receiving a hospital inpatient service and that, accordingly, there was no basis for imposing a charge. The health board agreed to refund the £2,400 which it had already been paid; furthermore, the health board agreed not to impose any further charge in this case."
In the following year, 1989, Mr Mills was disturbed once more when another health board ceased charging another patient after he had raised the issue. "I was immediately informed by the health board that, having checked the details of the case, they found that the account was issued in error. The officer who had prepared the account was not aware that the complainant had dependants. The account was struck out, and the board apologised to the patient."
Yet the practice continued on a widespread basis.
In 1991 the ombudsman went so far as to warn: "It was a matter of concern to me that charges had been levied on this patient when the governing legislation clearly did not provide for such charges . . .
"I am aware that the Department of Health is currently carrying out a comprehensive review of the regulations governing maintenance charges to ensure that the legislation, under which long-stay patients can be charged for maintenance, is interpreted uniformly throughout the country. Hopefully, the anomaly I have outlined can be appropriately addressed in the context of the Department's review."
It never happened. The issue continued to be raised by the ombudsman over the course of the 1990s.
Here's what Mr Mills's successor, Mr Kevin Murphy, said in 1994 after yet another case in which a health board agreed to repay a patient who had been illegally charged.
"Following the intervention of the Department of Health, at my request, the health board informed me that the case had been reviewed and that the maintenance charges had been raised in error.
"They said they would cease the practice immediately and that all charges paid would be refunded."
He added: "While the particular case has been resolved, I remain concerned about the practice in this area and I am continuing my examination with the health board in question."
The latest Ombudsman to issue an opinion on the matter was Ms Emily O'Reilly, who again pointed out the anomaly to a health board in the Dublin area.
"The board reviewed the case and agreed to refund the charges levied for the period in question. A refund of €7,746 was issued to the lady.
"However, it is my view that an individual should not be at a loss because of an error on the part of any public body, and all measures to restore an individual to the position he or she would have been in, had the error not occurred, should be taken."
And so it continued.
The issue started beeping urgently on the Government's radar screen when Fergus O'Dowd TD of Fine Gael and his party leader, Enda Kenny, repeatedly raised it in the Dáil in recent months.
Faced with the prospect of losing charges worth €8 million a month, the Government suddenly sprang to life with a dynamism that was in sharp contrast to its leaden-foot approach over the last 20 years.
Legislation providing for the introduction of the charges on a firm legal footing passed from the Cabinet to the statute books in just four days, possibly a record.
The Minister for Health insisted during the short debate on the legislation that it was clearly beyond the Government's financial and administrative ability to repay all charges since 1976, the date at which the legality of the charges were originally called into question.
"We have decided therefore by way of a goodwill gesture to make repayments [of €2,000] to people with full eligibility who have paid charges to date," she said.
Health authorities, however, may live to regret their dismissive stance towards older people and their entitlements over the two decades.
Many people are owed well in excess of €2,000, and there is widespread anger among older people and their families, while a number of solicitors are lining up to challenge the Government's attempts to insulate itself from potential legal actions.
A successful case could prove vastly more expensive than the Government ever imagined.