No, there is every reason to believe that the neglect and abuse which occurred in Leas Cross was not an "isolated incident" and is taking place across the country "to a greater or lesser extent", according to Prof Des O'Neill who investigated deaths in Leas Cross for the Health Service Executive.

What does O'Neill's Leas Cross report find?

He finds that elder abuse was institutional in Leas Cross, a private nursing home in north county Dublin; older people were neglected; there were too few nursing, medical and non-nursing staff; that residents had exceptionally high rates of bed sores; restraints were overused; that the keeping of medical records and administration of drugs was very poor; residents had higher rates of hospitalisation and lived for shorter than residents in other nursing homes.

He found senior health services management ignored such findings as far back as October 2003. He says "with a few honourable exceptions, there has been a systematic failure by government, health boards and professional bodies to address the issue of quality of care for older people."

His findings are refuted by health services management and the owner of Leas Cross whose 13 responses run to 140 pages.

O'Neill's report is 64 pages with 25 pages of appendices.

Why wasn't the abuse spotted and acted upon at an earlier stage according to O'Neill's report?

Poor standards of care were identified as far back as October 2003 by families of residents and doctors in St Ita's hospital. In 2003, public patients from St Ita's psychiatric hospital were moved into Leas Cross and St Ita's continued to provide aftercare. Senior health board management were time after time made aware of these concerns but failed to act until after the Prime Time Investigates programme in May 2005. The home remained open until August 2005.

Why was Leas Cross not inspected?

There were no proper inspections of private nursing homes in place in north county Dublin prior to October 2004. After October 2004, inspections did not result in improved care. The pre-October 2004 inspections by one health board official focused on the physical surroundings.

After October 2004, the health board had a senior three-person inspection team whose reports consistently identified very poor care, inadequate nursing and access to doctors, high rates of bed sores, incompetent record keeping and drug administration. The inspection reports noted the willingness of Leas Cross to work with the health board to correct these deficits, yet Prof O'Neill says his investigation found nothing to prove progress in the quality of care between October 2004 and May 2005.

What about now, are nursing homes being inspected?

Yes, but it is not independent. The HSE , which is the service provider, also inspects nursing homes . . . a set-up that health minister Mary Harney admits is far from ideal.

Inspection is now required on all private nursing homes but is not compulsory for public homes. In May 2005, the government promised an independent inspectorate with legislative backing, originally pledged 23 years ago. This has not yet happened although it is in the Health Bill 2006. Aidan Browne, director of Primary, Community and Continuing Care says it is unlikely that independent inspections will begin until this time next year.

Why wasn't the report published before now?

O'Neill submitted his report 'A review of deaths at Leas Cross 2002-2005' in May 2006. The HSE delayed the publication of the report for "legal reasons". It could have been published without names of health service management and the recommendations should have been acted upon long ago.

Is anyone being held to account for what happened at Leas Cross?

No, no one in health services management, who are responsible for ensuring standards of care in nursing homes, has been held to account for the negligence.

However, Aidan Browne confirmed the report is being sent to the Garda Commissioner and he quoted the former CEO of the Northern Area Health Board who expressed her "deepest regret that a number of patients at Leas Cross were injured during their residency in the nursing home and that the board was unable to have in place sufficient robust systems that might have identified and resolved deficiencies".

Are private nursing homes the problem?

O'Neill expresses unease about the growing use of private care for older people and the lack of regulation. He draws attention to the change in numbers of older people in private care nationally. He shows disproportionate numbers in private care in North Dublin in 2004, where 75% of older people were in private care compared to 25 % in public care. O'Neill highlights how "this shift from public to private sector has occurred without any public debate, and may have important consequences for the health of older people in residential care."

The shift towards increased use of private long-term care for older people is reflected nationally. Research shows that out of 556 homes, 65 % were private. The other 35 % were made up of homes provided by the HSE, religious-run homes or by others in the not-for-profit sector.

Is there a difference in the public and private provision of nursing care?

Yes, private nursing homes are run for profit and may not have the care and wellbeing of the older person as their primary concern.

O'Neill refers to US research which shows "that for-profit nursing homes have lower operating costs but higher hospitalisation rates than non-profits". Irish research shows that private nursing homes have a significantly lower proportion of nurses and non-nursing staff to residents when compared to rates in the not-forprofit sector. In 2005, large private nursing homes had one nurse to every 40 residents at night.

Why does this matter?

Private nursing homes are not the best place for older, high dependency patients who require high levels of medical care.

O'Neill identified that 58% of residents in Leas Cross were of heavy or maximum dependency. His report shows health services management were made aware in October 2004 "that in some cases the nursing ratios are very low, just one nurse to every 40 or 50 residents".

Why is there increased use of private nursing homes if they are not always appropriate?

The shift in use from public to private care is a direct result of state-incentives since 2001. In order to free up public hospital beds, tax incentives are available on investment in nursing homes.

What needs to happen to ensure there are no more Leas Crosses?

Government needs to prioritise the care of older people. It needs to increase funding for services for older people, in particular in the public and not-for profit sector. It needs to set up the promised independent inspectorate and put into practice the other recommendations made by O'Neill.