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Revealed: The letter which proves tensions between health bosses


Medical chief Dr Tony Holohan. Photo: Colin Keegan

Medical chief Dr Tony Holohan. Photo: Colin Keegan

Colin Keegan

Medical chief Dr Tony Holohan. Photo: Colin Keegan

The extent of the tensions at the heart of the Government’s response to the coronavirus crisis is revealed in letters between the HSE and the Department of Health.

Chief Medical Officer Dr Tony Holohan and his team were the subject of direct criticism from the HSE to Health Minister Simon Harris and his officials.

The Government has repeatedly denied there were any tensions with the all-powerful National Public Health Emergency Team (NPHET). But letters released today show the HSE’s anger at NPHET’s actions.

The board of the HSE expressed “disquiet” and demanded “changes to the nature of the relationship between the NPHET and its stakeholders, including the HSE”.


Paul Reid. Picture: Photocall

Paul Reid. Picture: Photocall

Paul Reid. Picture: Photocall

In explosive correspondence, HSE chief executive Paul Reid said “regrettably, I was taken very much by surprise by Dr Holohan’s letter” on the expansion of Covid-19 testing.

The row centred on the NPHET’s announcement in the middle of April that Covid-19 testing would be expanded to 100,000 tests per week, on a seven-day week basis for a minimum of six months. The move was announced without clearance from HSE, which carries out the testing.

Following a phone conversation that evening on Friday, April 17, Mr Reid writes to the head of the Department of Health that Sunday.

“I wanted to set out my concerns in relation to the National Public Health Emergency Team (NPHET) directions from the above date as they relate to the HSE and the communications of same.”

Mr Reid said he is “accustomed at this stage” to receiving regular correspondence from NPHET through Dr Holohan, its chairman.

“Generally speaking, I have a good sense of the general direction of travel in advance of formally receiving the NPHET actions which are then progressed and monitored closely through the HSE’s National Crisis Management Team (NCMT) which I chair.

“Regrettably, I was taken very much by surprise by Dr Holohan’s letter of 17 April 2020 (received at 20:50) and also by the NPHET press conference which preceded the letter arriving.”

Mr Reid says the actions are “at odds” with the process engaged with at Cabinet committee level and in meetings with the country’s top civil servant, Department of the Taoiseach secretary general Martin Fraser.

“They are also at odds with the process in place with the HSE Board,” he writes.

Mr Reid said he attended a meeting, chaired by Mr Fraser, on Friday, April 17, where it was agreed the Department of Health would confirm its testing and tracing capacity a week later on Friday, April 24.

“There was no mention at this meeting of the directions that were to issue from the NPHET that evening.”

A Cabinet committee meeting was scheduled for Monday, April 20 to discuss testing and tracing capacity. And the HSE had agreed, at the request of Dr Holohan, to develop a paper for consideration and approval at the NPHET meeting on Tuesday, April 21.

Mr Reid said this was “no small undertaking” and his staff had been “working intensively” to ensure the Department receives a response that is both thorough and capable of rapid implementation.

“Given that all of this was agreed, I am extremely disappointed that these understandings appear not to have been respected. I’m at a loss as to why this direction from the NPHET to the HSE was given and publicly communicated without completing the jointly agreed processes and without regard to appropriate governance,” he wrote.

“The directions set out effectively attempted to commit the HSE to an intensity of implementation which bears absolutely no resemblance to that which we previously discussed and has taken no account of what can be achieved by when.”

Mr Reid also set out detail on the challenges the HSE has been working through and continue to face in relation to further increasing capacity on testing and tracing.

“All in all, I think this points to the need for far greater cooperation and collaboration on decisions from the NPHET in order to work to the best of our collective abilities to protect the health of the population, our staff and especially those who are most vulnerable.”

“My Chair, Ciarán Devane will separately be writing to the Minister to express his and the Board’s disquiet and to request changes to the nature of the relationship between the NPHET and its stakeholders, including the HSE. I would like to discuss the matters raised in this letter as a matter of urgency.”

Following Mr Reid’s letter, Mr Devane wrote to Health Minister Simon Harris the following Monday, April 21. He complained that NPHET did not take account of HSE capabilities.

“It has been clear to me and to the Board of the HSE for a while that operational requirements have at times not adequately been considered at the centre of NPHET’s decision making.

Labour Party leader Alan Kelly, who forced the Government to publish the letters, said the correspondence “demonstrate the obvious tensions between NPHET and in also the CMO and the HSE”.

“In particular the decision on April 17th to announce the capacity to test 15,000 people a day or a 100,000 a week which the HSE clearly knew they couldn’t deliver and had taken the Government through a plan on what they could and would do,” Mr Kelly said.

“Why did the Taoiseach, Minister for Health and CMO continuously deny that such tensions existed when they obviously did.

“There is now firm evidence of NPHET announcing policy without consulting key stakeholders, the most obvious and fundamental of all being the HSE.

“I'm concerned that we will face the same issue with wider stakeholders now that NPHET advice has to be balanced against non-COVID mortality and economic and social reopening of the country,” he added.

Speaking in the Dáil today, Mr Kelly said the letters are “explosive particularly the correspondence from April 19 where concern is raised at Mr Holohan's announcement that 100,000 tests per week would be carried out.

Mr Kelly argued that that Mr Reid was essentially saying that the process put in place by the HSE was not being respected by NPHET.

“They come to the nub of the issues with regards governance which I have asked about before.”

He put it to Health Minister Simon Harris that he had denied there were tensions as did the Taoiseach and Mr Holohan.

Mr Kelly said he has "real concerns" about governance.

He asked Mr Harris: "Why did you deny that these tensions existed? When we now have it in black and white there were real issues particularly in the roll out of testing."

He also asked why the minutes of NPEHT meetings aren't agreed at the start of each meeting in public.

Mr Harris said NPHET is chaired by Mr Holohan and he gives public health advice but the government "makes decisions".

He pointed out that NPHET is a "collaborative body" and nine of its members come from the HSE.

Mr Harris said: "You are right about the minutes. They should be published. They are now being published."

But he took issue with Mr Kelly's remarks about the letters.

He said: "I don't think the letters are explosive.

"I think what the letters show is people working extraordinarily hard in real time."

Mr Harris added: "I said on a Saturday at a press conference that of course there’s tensions...

"I’ve been Minister for Health for four years. You’ve been in Cabinet.

"When has there never been back and forth between officials working their backside off to try in a global pandemic to save people’s lives?," he asked.

He also said the letters shouldn't be selectively quoted from and that other pieces of correspondence see the HSE's chairman praising work that's been done.

"I’m very satisfied that the NPHET is working extremely well with the HSE," he said.

Mr Kelly said that Mr Holohan's announcement ramping up testing was outside of the process that was agreed.

He put it to Mr Harris that it was an "error" and it "should not have happened that way".

Mr Harris praised the HSE and NPHET for their response to the pandemic saying they're "patriots" and represent "the very best in public service".

He added: "They’re not infallible. None of us are.

"And there are constantly ways to improve processes".

Mr Harris said there's a back and forth between officials to reach the right outcomes but that doesn't mean there's "a conspiracy theory or a negative tension."

He said of the NPHET: "nothing's perfect but it works well".

More to follow....

Online Editors

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