Nphet adds further conflict and complexity to an already-fraught health system struggling with pandemic
SOON after the creation in 2005 of the unloved behemoth that is the Health Service Executive (HSE), grave doubts were being voiced about its potential for success.
The 2004 Health Act which underpinned the HSE did try to clarify the distinct functions of the HSE, the Health Department and the Health Minister. But these roles remained blurred, and health services are often pilloried as consuming vast quantities of money and being poor at showing value in return.
The job of health minister, not helped by an off-the-cuff comment from Brian Cowen comparing the department to landmine-replete Angola, is often depicted as a poisoned chalice.
Now enter Covid-19 and the public health experts in the so-called Nphet committee. As we face a second nationwide tight lockdown, and the prospect that it could be the first of many more, Nphet’s clearly powerful role will increasingly be questioned.
To some critics, Nphet has eclipsed the sum of the HSE and the Health Department in its powers. There are clear and potentially dangerous divisions in a health system plunged into crisis by Covid-19 – divisions which cannot just be explained away by ‘natural day-to-day tensions’.
The admission in the Dáil yesterday by Taoiseach Micheál Martin that he learned of the serious flaws in the test and tracing system only on Tuesday evening via a text drawing his attention to a report in The Irish Times, is dismaying. We later learned that Health Minister Stephen Donnelly learned of the situa
tion in a similar fashion.
Thus we see a partial collapse in the test and tracing system. A situation where 2,500 people who tested positively were being left to do their own tracing. It is unthinkable because these people may be too ill, but even if they are well, tracing is complex and difficult work.
Mr Martin, who was health minister from January 2000 until September 2004, knows more than most that sinking feeling when you are dropped in the political manure. While Sinn Féin leader Mary Lou McDonald dusted down her best righteous indignation and Labour leader Alan Kelly rightly dubbed the situation “bonkers”, the Taoiseach resorted to a mix of admitting flaws and a strong defence of an improving system.
Ultimately, the Taoiseach argued the system is “getting there” with 120,000 tests per week and some 400 professional “tracers” being augmented at a rate of 70 per week, taking it closer to 800 tracers by year’s end. All countries face similar challenges and few countries are without their glitches.
That was a hard argument to sell hours before a nationwide lockdown was due to kick in, and newly-published legislation on stiff penalties for lockdown rule breaches. It was even harder to sell when it was clear there is such non-communication within the official system.
Anyone with a glancing interest in public administration will be familiar with the HSE vs Health Department clashes down the years.
The department, responsible for policy and legislation, has had a virtually annual battle over funding with the HSE which is responsible for service delivery.
These were battles which frequently spilled into the public domain. Last year, former HSE chief executive Tony O’Brien urged a merger of the two entities to end this.
Then last May at the height of the first Covid-19 wave, we learned via Labour leader Alan Kelly of serious tensions between the HSE and Nphet over testing targets which the HSE believed it could not achieve. Just a fortnight ago we learned the HSE did not agree with Nphet’s call for Level 5, arguing the hospital services, including intensive care, were coping well enough.
So Nphet is thrown right into the Health Department vs HSE divide. The buck stops, as always, with the Taoiseach and the health minister. But it is ordinary people who will suffer most.