The worst-kept secret in the country is now out in the public.
espite repeated denials to the contrary, the tensions at the heart of the response to the coronavirus crisis are out in the open.
Chief medical officer Dr Tony Holohan and his team were the subject of direct criticism from the HSE to Health Minister Simon Harris.
Letters finally released by the Government show the HSE's anger at the actions of the all-powerful Nphet, the National Public Health Emergency Team, the group setting policy on the lockdown.
The correspondence, described as "explosive" by Labour Party leader Alan Kelly, reveals the strained relationships at the top of the response to the crisis.
All sides are now admitting there are tensions and playing down the impact. But those tensions came to a head last month when Dr Holohan and Nphet announced that Covid-19 testing would be expanded to 100,000 tests per week for a minimum of six months.
The move prompted a rebuke from the HSE, with chief executive Paul Reid saying he was "extremely disappointed" in the chief medical officer after the figure was announced at a press briefing.
The board of the HSE expressed "disquiet" and demanded "changes to the nature of the relationship between Nphet and its stakeholders, including the HSE".
Dr Holohan now says he didn't publicly announce the 100,000 test target to put pressure on the HSE, which was the subject of Nphet discussion and was communicated to the HSE.
"There have been communication difficulties and so on but you're talking about an Nphet meeting that goes back almost a month ago. It would be implausible to think that there weren't disagreements from time to time," he said last night.
Mr Reid didn't see it that way in mid-April when he wrote to the Department of Health, saying: "regrettably, I was taken very much by surprise by Dr Holohan's letter" on the expansion of Covid-19 testing.
In his letter, he tells the department's secretary general Jim Breslin: "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.
He says "generally speaking" he has a good sense of the general direction of travel, until he was taken by surprise. Mr Reid says the actions are "at odds" with the process engaged with at Government level.
"They are also at odds with the process in place with the HSE Board," he writes.
Mr Reid said he attended a meeting 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."
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 got a response.
"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 said the HSE was facing challenges on testing and tracing.
"All in all, I think this points to the need for far greater co-operation 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."
HSE chairman Ciarán Devane wrote to Health Minister Simon Harris 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".
In his letter, Mr Devane complained that Nphet did not take account of HSE capabilities.
The letters have been seized upon by the Opposition as evidence of dysfunction. After forcing the Government to publish the letters, Mr Kelly said there is firm evidence of Nphet announcing policy without consulting key stakeholders.
"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 said.
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 Nphet: "Nothing is perfect but it works well."