LAST UPDATE | 14 May 2020

LETTERS PUBLISHED TODAY show the HSE expressed concern over last month’s announcement by the National Public Health Emergency Team (NPHET) that testing for Covid-19 would be significantly expanded to cover 100,000 suspected cases a week.

The Chief Medical Officer Tony Holohan made the announcement in April that the 100,000 tests per week would be carried out on a seven-day week basis for a minimum of six months. 

The letters show that the announcement was made without clearance from the HSE, which is tasked with carrying out the testing.

A letter from the HSE chief executive Paul Reid to the department’s secretary general, Jim Breslin, states “regrettably, I was taken very much by surprise by Dr Holohan’s letter” on the expansion of Covid-19 testing.

The letters have been described as “explosive” by Labour leader Alan Kelly, who claimed that it shows that NPHET made a “solo run” on announcing the ramping up of testing without clearance from the Cabinet subcommittee or the HSE. 

‘Explosive’

In the Dail today, Health Minister Simon Harris denied that the letters were explosive, saying that ”back and forth” between officials doesn’t mean there is tension.

He said there are members of the HSE on the NPHET and that the process works well.

In the correspondence to the secretary general, the HSE boss says “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”.

He adds that Dr Holohan’s announcement around testing was “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,” states the HSE chief executive.

Selection of the letter sent by HSE boss Paul Reid to Dept of Health Secretary General Jim Breslin

This evening, Holohan responded to the letters saying that the HSE was involved in the decision-making process in which a recommendation was made around testing capacity. 

“The process of decision-making at NPHET is a process that’s collaborative and involves a senior team from both the Department and the HSE, and form a range of other organisations and experts. That’s the process through which this work is done, recommendations are made through that process,” he said. 

“The subject matter of the letters is a testing target which the HSE now has in place and has done a huge amount of work over the last couple of weeks to get us into that space. 

Reid says in the letter that he attended the Cabinet Committee meeting on 14 April, where he presented a paper setting out the current capacity with regard to testing and tracing.

He outlines that after this, he attended a meeting with Secretary General Fraser and Dr Holohan on 17 April, saying there was no indication the 100,000 testing capacity was going to be announced to the media.

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

In the letter, he adds that a committee meeting was scheduled for 20 April to discuss testing and tracing capacity, and at the request of Dr Holohan, the HSE said it would develop a paper for consideration and approval by NPHET later that week.

‘Extremely disappointed’

“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,” says Reid in the letter.

“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.”

“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.”

HSE Chair Ciarán Devane separately wrote to the minister to express his and the board’s “disquiet” and requested changes to the nature of the relationship between NPHET and the HSE. 

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In the letter to the minister, Devane complained that NPHET did not take account of the HSE’s capabilities in reaching the 100,000 figure. 

He raised concerns that the announcement made by Dr Holohan “went even further” than was agreed, adding that it “both cut across and pre-empted the process which had been agreed to develop the implementation plan in order to meet and exceed the target of 100,000 tests per week”.

He made suggestions for changing the process of communication, so as to “avoid misunderstanding”.

He also suggested that Dr Holohan and the Secretary General have a short call with the HSE Chief Executive and the Chair of the HSE twice a week “to ensure alignment and to anticipate issues which may cause problems for all of us down the track”. 

In an attachment to the letter, Devane says: 

There is a need for improved discussion and collaboration concerning decisions of the NPHET, so that the health system’s collective capacity can be best deployed to protect the health of the population, our staff and especially those most vulnerable.

Accountability

Speaking to TheJournal.ie, Labour Party leader Alan Kelly said the contents show serious failings of governance and accountability, and raises questions about how the Covid-19 testing targets were arrived at.

He said the letters show that denials by the Government and NPHET about tensions over governance were false.

“We still don’t know why the testing target was made public when it was obvious a pathway was still to be put in place, and that the HSE had made clear it would not be able to get to that. 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,” he said.

“I am 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.

Kelly said it is a huge issue that the chief executive of the HSE had to write such letters. He said further questions remain as to why NPHET have yet to publish up to date minutes of their meetings, and why no clarification has been given as to how people have been appointed to NPHET.