O'Neill reviews the events and deaths at the nursing home in those years and concludes that what happened was nothing short of institutional abuse. But he goes further in identifying how the complex needs of elderly patients are still far from being met. The government, the Department of Health and the HSE are all castigated for failing the most vulnerable old people in nursing homes, either at policy level, through legislation, in management and in day to day systems.

Reform is on the way, we are assured by Mary Harney and the HSE. But it grinds along slowly . . .

too slowly for the old, vulnerable people in care. We are to get new legislation for nursing homes. We are to get an independent social services inspectorate.

None of this will be in place before mid-2007. How many helpless people will be dead by then?

This is not a cheap point. The death of 81-yearold Carlow man Henry Pollard shows that. He was left restrained overnight in a chair beside a radiator which severely burned his arm, resulting in a wound that developed MRSA. His inquest heard he was already old and sick but the burn and its infection may have "tipped the balance".

The defensive response of the HSE and the Department of Health to the Leas Cross report's criticisms does neither body any credit . The inspections they say are in place are inadequate, as are the systems for detecting failures when they happen.

A lot of nursing homes are excellent and provide an unrivalled standard of care. But too often, when things go wrong, concerns are met with a stone wall rather than a willingness to listen to what the family has to say.