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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.
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.
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.
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Mortality rate amongst under 50s is less then 1% – this lockdown is a joke
@John Hoare: you did of course see the reports from Italy, Spain and New York of mass deaths, over run hospitals and general tragedy? We avoided that. Good enough for me
@John Hoare: source?
@D Mems: He’s not wrong with that statistic. https://en.m.wikipedia.org/wiki/COVID-19_pandemic_in_the_Republic_of_Ireland# But it doesn’t mean the lockdown is pointless. It does however mean we should be pushing to use these stats to our advantage and to let any business that can operate safely to do so. Anybody at risk to the virus should isolate until a vaccine is found. And everyone else should maintain social distancing until a vaccine is found. Tough measures on those who are at risk, but a much more realistic way to go about this whole process. The roadmap needs to be accelerated too in my opinion. The EU are pushing for tourism by June, we should be aiming much higher as well
@Séadna O’Grádaigh: under 50 , over 50. What’s the difference. Both human lives and ye talk about it like it doesn’t matter. Shame on you
@Macca Attack: No I talk about it because it does matter. Knowledge is power. And from them stats it clearly shows that healthy people under 40 years of age are actually very safe from this virus. That’s a fact. If anyone disputes it, go tell the CSO and Wikipedia to take remove the statistics because you don’t like them. We have to be realistic about this whole thing, the virus is going nowhere. It makes total sense to open up the economy where we can, that means businesses that have strict new plans for social distancing. There is also a massive case to be made for anybody under the age of 40 years old to go back to work. What is your ideas? Shut up shop until a vaccine is found? It will take upwards of 24 months to roll out a vaccine to the mass public…
@Séadna O’Grádaigh: We have to find a balance here. Social distancing needs to continue to limit interactions with strangers which will limit the spread. The economy needs to open to fund the health service to look after those that get sick. Believe it or not we are at a stage in this crisis where the deaths resulting from the lockdown could actually be higher than the deaths resulting from the virus!! That’s crazy, we could potentially be doing more harm than good as of yesterday. A balance needs to be found, it’s time
@Séadna O’Grádaigh: what makes you think a vaccine will be available ever, sars still hasn’t been vaccinated against and that was 18yrs or so ago. So young and old with underlying problems just need to cocoon. Ridiculous
@John Hoare: Gemma is that you Gemma ?
@Anthony Whelan: There’s currently 8 different groups at accelerated testing of 8 different vaccines, from reports they all are fairly confident that their own vaccine will work. So chances are likely that a vaccine will be found. But what people don’t seem to realise is how long the process will take. And after that long period, how many vaccines can be made a week? In the UK alone there is 66 million people. Even if Oxford University’s vaccine turns out perfectly ok to use, and a production rate of 1 million vaccines a week, it would take 66 weeks to vaccinate the UK… We are in this for the long haul. Anybody that cries for the economy to stay shut is fully deluded in my opinion
@Séadna O’Grádaigh: 15,000 people under 55 got sick. 7,000 over 55. Your figures not adding up. I get where your coming from but this virus is all about transmission. It would be impossible to segregate the ages. I fully believe lockdown was the only way to save lives and now we can start opening again. For me the right course was taken
@Séadna O’Grádaigh: under 45′s 10,000 infected
@John Hoare:
Mortality only down because we locked down. Idiotic Trumpalikes scouring all media these days. Hse bosses always useless and moaning if they have to do anything resembling work.
@Macca Attack: Fully agree that the lockdown was needed. Some may read my comments and think I don’t agree with a lockdown, that’s not the case, a lockdown was definitely needed, we knew very little 6/8 weeks ago. But my point is we know an awful lot more now, so we should be using what we know to our advantage. Like you say, 10’000 infections were under 45 years of age. About 1% of total deaths were under 40 years old, so that means about 12 people died under the age of 40. If 10’000 were infected, that’s a death rate of 0.12% for under 40′s. About time we took that stat very seriously to our advantage, because it is a huge advantage in opening up again
@John Hoare: clueless, utterly clueless.
@Séadna O’Grádaigh: you realise that if 1% of under 40′s die its 25000 deaths?
@NotMyIreland: Your maths is wrong, try again. The death rate for under 40s is 0.12%. And that is more than likely those with health conditions. The death rate is even lower again for healthy people under 40, probably close to 0%. And I’m not saying for everyone to go out and spread the virus like somehow you’re assuming I’m saying!!! I’m saying keep up social distancing. Protect the vulnerable but keep the economy somewhat afloat at the same time.
@Séadna O’Grádaigh: Like I’ve said many a time, young healthy people are genrally safe from the virus, that is a fact we know now.
@NotMyIreland: I’ve double checked the figures and the rate is 0.27% for under 45′s. I was assuming @macca’s figure of 10’000 was accurate. But my point stands nonetheless
@John Hoare: what is important is to ignore the facts and believe the hype. No the British monarchy are not lizards and all of the other bulls hit is guess what…bull
shit. Time to engage the brains and lose the conspiracy theories. The government isn’t trying to pull the wool over our eyes it is trying to manage a crisis that hasn’t been seen in a 100 years. So if they make a few mistakes so has every other government and I am thankful for the sure footed response of our leaders both medical and political. People in glasshouses shouldn’t throw stones.
@John Hoare: are u in contact with anyone who is over 50…..family or friends…or friends who have family that are over 50 that they are in contact with them
@Eoin Scanlon: Our figures aren’t much better than the US
@Macca Attack: why does it matter how many under 45s were infected? If they do not require hospital treatment and don’t die then the more that get it the closer we are to herd immunity. Is our education system that bad that people don’t understand numbers? More infections in under 40s = good news not bad
@Dino: that’s not how it works tho is it. We will tell the virus to just infect the under 40. Also immunity is not a cert.
@Séadna O’Grádaigh: So that’s 6750 people under 40 dead. Yes a lot would have underlying conditions but from data released of NY they showed that 25% of 18-44 year deaths were of people with no known underlying health conditions. So we could expect 1687 “healthy” people to die. Small percentages of millions still leaves larger numbers than I think is acceptable.
@NotMyIreland: Feels like talking to the wall with you, you refuse to read what I write so I’m not even replying to that comment. Refer to my above comments on how people do not have to get infected and the economy can continue at the same time
@John Hoare: So screw you if you are over 50 is your view
@Séadna O’Grádaigh: So intern people more lovely thinking.
@Séadna O’Grádaigh: |The answer is controlled response to work and not to rush things. As when that happens people die but they are over 40 so maybe they dont count as much.
@Marian Mahon: Read them again some of the figures are not and that is due to population size. The important ones are a lot better.
Goes to show they don’t talk to each other there is a serious lack of communication between the HSE , Mr Houlahan and the government I thought they were working together no wonder there are so many hic ups
@B: I’m fairly sure the government don’t even follow their own advice. The leaving cert has been cancelled this year. It was earmarked for late July. They ended up cancelling it and a few days later released a roadmap for opening the economy. In that roadmap it says pubs will reopen in August, two weeks after the LC could have gone ahead. That’s crazy to be honest, it makes little to no sense at all.
@B: Very true. Houlihan and his team are supposed to be Advisory. From what I’m seeing they’re running the country. Don’t remember seeing his name on a ballot paper.
I think after Harris realised there hadn’t been 18 previous strains of coronavirus, he lightened up about the whole thing and said “open the pubs”.
Seriously it shows Tony Holohan has lost the run of how a democracy works and the role of an advisory committee. Harris incompetence and ignorance on the subject does little to curtail this type of arrogance by an unelected advisor.
@Masses are awakening: clueless
@Brendan Cooney: clueless
@Anne Wedell Seerup: utterly clueless
Yet again this current government’s wish list at odds with the real world.
I’m with Tony Holohan on anything he says, I have no reason to doubt anything he or his band of Merry men says. That lad in charge of the HSE is no great shakes TBH, although he is trying. Thanks Tony Holohan.
@Richard Carroll: hear hear!
@Richard Carroll: don’t be yo with Tony Holohan.
@Richard Carroll: as a woman, I have difficulties with Tony holohan in light of his role in the cervical cancer scandal.
@Richard Carroll: he is failing to account for the morbidity and mortality of the draconian measures in place. He is supposed to be in charge of public health but is fixated on one issue.
What an interesting insight. Here’s some context.
Tony Holahan, as Chief Medical Officer, is employed by the Department of Health, which has oversight over the HSE.
There have always been tensions between the Department of Health and the HSE, which is no harm.
In a time of crisis when everyone is being pushed to be the best they can and save lives, there will be even more tension, good tension that benefits the country.
The only stories here are
1. Alan Kelly did not know that and
2. The Minister felt the need to deny tension exists which suggests he is out of touch.
PUT ‘EM UNDER PRESSURE TONY!
@Mick Flynn: Well said Mick
@Mick Flynn: Paul Reid shouldn’t have been surprised by the 100,000 per week in mid April, the minister had been promising 15,000 tests per day since mid March. They are the same result just counted differently. Ridiculous. HSE management are an embarrassment to their frontline staff, and the country.
They could be ramped up.
Me dad went into hospital Tuesd night & had Covid test, result negative, immediately had another yestd & result today negative. Had another this evening & result will be tomorrow. Can anyone explain that plz???
My uncle was in a different hospital 3 weeks ago. Had the very same, 3 tests – all negative.
What’s going on?
@Coole Swan: The false negative rate for one test is 20-30% , it drops to less than 10% for 2 tests.
Mortality only down because we locked down. Idiotic Trumpalikes scouring all media these days. Hse bosses always useless and moaning if they have to do anything resembling work.
The country is being run by bureaucrats who don’t have to abide by the lockdown because their “essential workers”, can’t lose their jobs because they’re public servants and their gold plated pensions are untouched by a stock market decline……
Wake up sheeple…..
Traveling 5Km in your own car to play a game of golf is ok. Traveling 6Km is not ok. That’s the level of logic governing their decisions.
We’re facing a national health crises in a years time because of cancer cases that are going undetected.
Maybe it’s a good idea that the LC was scrapped because this system of education is producing ivory towered thinking……and many of you will disagree because you’re also of that system….
Our health system gets 4700€ per head of population,Germany gets 4400€ per head , which system would you rather be in . But our health system is now running the country.
@Paddy Ryan: I think we get a very poor return for our investment here but there are obvious savings in the German system due to scale and population densities
@Paddy Ryan: We all know the HSE is run badly, nothing new with that. This may be a chance to get it sorted out.
It happened, so well worth the push!
have your say