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Who's calling the shots? - The role of Ireland's public health emergency team and its key players

The team was convened at the end of January this year to coordinate the country’s response to the Covid-19 pandemic.

Image: RollingNews.ie

QUESTIONS HAVE BEEN raised this week about how decisions are being made as Ireland responds to the Covid-19 pandemic – and about who exactly is behind the steering wheel.

Both Labour’s Alan Kelly and Fianna Fáil’s Micheál Martin challenged the Taoiseach in the Dáil, seeking clarity on a number areas relating to the National Public Health Emergency Team (NPHET). 

NPHET, chaired by Chief Medical Officer Dr Tony Holohan, was convened at the end of January this year to coordinate the country’s response to what would later become a global crisis. 

Members of that team are now front and centre, guiding the government in its actions and driving the public messaging around Covid-19. 

It was on the recommendation of this group of officials that the government on 27 March implemented the measures currently in place, restricting movement, introducing cocooning for over 70s and directing the closure of non-essential shops and services. And on 11 April, NPHET also recommended an extension of these measures to 5 May. 

“Who is NPHET ultimately accountable to? Who makes the final decisions? Do NPHET have to consult with you or the Minister for Health before making formal announcements that affect all the citizens of this country? I presume they do. But how does that happen?” Deputy Kelly asked this week.

He told Taoiseach Leo Varadkar that the group has grown substantially since it was convened in January with 11 sub-groups now operating. Kelly asked if the government had approved this.

Kelly also questioned why the notes of minutes of meetings are no longer being published on the government’s portal – the last to be published were minutes from 11 April, though the team has met at least twice a week since then. 

Micheál Martin raised similar concerns, calling for proper debate about future steps.

The Taoiseach said he accepted the points on transparency raised by the two deputies, but asked people to understand that this is a fast-moving situation, where officials are “swamped” with emails and important documents.

Who sits on NPHET?

There are currently 32 members of the NPHET, including the CMO and chair Dr Tony Holohan.

Other faces – which people may be familiar with from nightly press conferences at the Department of Health – include Dr Ronan Glynn, Deputy Chief Medical Officer and Dr Colm Henry, Chief Clinical Officer for the HSE.

At the evening briefings, Dr Henry provides details on swab-testing capacity, hospital resources, the management of outbreaks in nursing homes, supplies of PPE, guidance for healthcare workers, and other areas of the healthcare service.

Dr Cillian de Gascun, director of the National Virus Reference Laboratory at UCD, also sits on the emergency team and provides an update every Tuesday on lab testing numbers and capacity. As of midnight on Monday, 111,584 lab tests has been carried out. 

Professor Philip Nolan, president of the National University of Ireland in Maynooth, who heads up the modelling advisory group, is also a member of NPHET.

Source: Sam Boal

He provides an update every Thursday to the media on the group’s modelling work – this week he revealed Ireland’s reproduction number has fallen to between 0.5 and 0.8. This means half of those diagnosed with Covid-19 are passing it on only to one other person, while the other half are not passing it on at all.

Other members who have appeared at the Department of Health briefings are Dr Siobhán Ní Bhrian, lead for integrated care at the HSE, Siobhan O’Sullivan, chief bioethics officer at the department and Dr Máirín Ryan, deputy chief executive at Hiqa.

Communications officials from the department are also members of the team, along with officials and experts involved in emergency planning, primary care, infectious diseases, mental health and drugs policy, social care and intensive care.

According to the terms of reference for the team, it is tasked with overseeing and providing “expert advice, guidance, support and direction for the overall national response” on both a regional and national level.

NPHET is also responsible for conducting ongoing analysis, liaising with relevant organisations and directing the communications system.

When it comes to implementing or lifting restrictions, it is the government that will make these decisions, but the Taoiseach and Health Minister have both repeatedly stressed that they will be guided in their decisions by NPHET’s recommendations.

The team can agree on actions within the health service, such as the expansion of contact tracing capacity and processes, as was noted in a letter from the CMO to the minister on 16 March. 

Source: Leon Farrell/Photocall Ireland

The government and NPHET have appeared to be on the same page – at least publicly – on the vast majority of measures and guidance.

However, as the population grapples with the economic and social consequences of the measures and public fatigue with them increases, there may be increased pressure on the government to go in a different direction. 

During the week, the Taoiseach indicated the government had wanted to go further with childcare provisions for healthcare workers, but was reined in by NPHET. 

The eventual offer, described by the Irish Nurse and Midwives Union (INMO) as “worse than irrelevant” for most members, would allow partners of healthcare workers to take paid leave if they are working in the public sector.

There were no proposals that would assist single-parent families or those with two parents working in the healthcare sector. 

While Varadkar said further measures to allow child minders to go to the homes of healthcare workers were being considered, but these would only be brought in after restrictions are eased. 

“They’re not happy for us to do that right now,” he said of NPHET. 

Transparency

When asked this week about questions in the Dáil in relation to the transparency of NPHET, Dr Holohan said he would “never make a case that there wasn’t room for improvement”.

However he said they had made a lot of documentation available and had been “very transparent, I believe, in how we have conducted the business”. 

He said there were circumstances in which things couldn’t be reported for reasons of patient confidentiality.

“We have twice weekly meeting of our NPHET and to keep up with the scale of the task of servicing that is an enormous industry of activity. It’s not just the NPHET meeting itself, there are a number of subgroups working on major programmes of activity and we have a lot of individual members on them and with a significant range of documentation attaching to each.

“So there’s a little lag in terms of the publication. It does not represent a lack of transparency. 

“In fact the principle we would want to establish and uphold in terms of how we’ve conducted that business is to be as open and transparent as possible. Before anyone asked us to, we started publishing minutes, agendas and supporting documents.”

Minister for Health Simon Harris also defended the work of the team, telling reporters he believes it is doing an “excellent job”.

He said he has no doubt that when the country gets through this crisis there will be a time for reflection on “lessons to be learned and questions to be asked”.

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