Ombudsman Emily O'Reilly has said that the nature of the relationship between ministers and senior civil servants requires urgent attention in the aftermath of the Travers report on illegal nursing home charges.
In a document, prepared for submission to the Oireachtas Committee on Health and Children and to be published later this week, the ombudsman said clear lines of responsibility and accountability between ministers and senior officials needed to be agreed.
"Whatever the situation may have been in the particular instance investigated by Mr Travers, the wider issue is that the model of government, meant to underpin and support the workings of government, is no longer fully relevant.
"It is primarily for the Oireachtas itself, and for its members, to deal with this situation and to take whatever steps are necessary to ensure that the model of government fits the practice," the ombudsman stated.
Ms O'Reilly said that in June 2001 her predecessor had stressed the importance of the Oireachtas holding the Executive to account.
She said that he had told an Oireachtas committee that there had been failures within many parts of the government system in relation to the nursing home charges.
He had pointed to a failure by the Oireachtas to supervise the making of the regulations and to ensure accountability of successive ministers.
He had also highlighted a breakdown in the accountability relationship between ministers and senior civil servants.
"The events of late 2004 within the Department of Health and Children more than justify the ombudsman in having chosen to make the remarks cited above. Regrettably, his remarks have not been acted upon," Ms O'Reilly's submission stated.
The report by Ms O'Reilly was sought by the Oireachtas Committee on Health and Children as part of its follow-up hearings on the Travers report.
However, it was not incorporated into its final report, published last Thursday, although the document was read into the record of the committee by Independent TD Jerry Cowley.
The full submission is to be published by the Office of the Ombudsman later this week.
In her submission, Ms O'Reilly also expressed concern that the office of the ombudsman had never been provided with legal advice and other evidence relating to nursing home charges which had been in the possession of the Department of Health when the office was investigating complaints made by medical card holders.
She contended that if the ombudsman had received this material it could have alerted the Oireachtas to take action over a decade ago and that much of the massive repayment bill - now estimated at around €1 billion - may never have arisen.
Ms O'Reilly said that her office had received frequent complaints over several years about charges levied on medical card holders in long-stay facilities.
The ombudsman believed that these patients were receiving "in-patient" services which should be provided without charge.
"What we now know is that throughout this extended period the department and, to a lesser extent the health boards, had solid and uncontroverted evidence to support the position taken by the ombudsman.
"Very regrettably, the ombudsman was never made aware of this evidence," the submission states.
The ombudsman said that disclosure of this information would have established that the department and the health boards were acting "without proper authority".
