Travers Report shows mind-boggling incompetence across the board

FOR rugby-loving Fianna Fáilers, this wouldn’t have been the happiest weekend. Thanks to St Patrick, though, at least some of them will be out of the country in the next few days.

So they’ll be spared the radioactive winners’ glow off Enda Kenny. It’d blind you, that glow.

Even before the results came out, Enda was fairly lit up. On the stump, he was beaming and joshing and marching around provoking promiscuous hugs. Off the stump, in the Morning Ireland studio, he wasn’t up for any hugs, least of all from the Minister for Foreign Affairs.

The two of them squared off about the Travers Report and even that most able of performers, Dermot Ahern, didn’t find it easy to handle a turbo-charged Enda Kenny who clearly had the corner of every relevant Travers page turned down and highlighted in neon.

It’s the job of Enda Kenny and Pat Rabbitte to behave like the Red Queen in Alice through the Looking Glass, yelling “Off with his head” in the run-up to even a small election. But how on earth did the rest of us get gridlocked around the guillotine, ever bleating for one more execution? We’ve become a bunch of Madame Defarges without the knitting skills.

Our reflex requirement is a head or two, preferably fresh and recent. We would rather have a couple of bloodied bonces in our basket than do the forensics on a complex, long-running problem like the illegal nursing home charges.

Here’s a situation where several ministers of different parties (including Brendan Howlin in that first health strategy) indicated at least vague knowledge of the problem and good intentions to do something about it, yet never delivered.

Here’s a situation where experienced and expert civil servants somehow allowed an issue to fester, like a chronic low-grade infection: always there, always causing malaise, never moving to an acute stage. Until now.

Concentrating on beheading the most recent holders of the key offices in the Department of Health could make us miss the dire threads of disaster running through this saga - threads of disaster it shares with the Challenger tragedy.

One of those threads is upward feedback. Upward feedback is making sure the guys who make the decisions hear stuff they may not want to hear. In terms they cannot miss. In ways which force them to acknowledge what they’ve heard.

In the aftermath of the Challenger disaster, it became clear that, every time a space shuttle came back down safely, there had been a hushed exhalation of relief at middle management level in NASA. At that level, they’d known how dangerous were the unaddressed problems of the spacecraft. They were agreeably surprised each time it came back to earth intact. NASA top management was regularly briefed by the worried lower level executives.

* But they were briefed in a context set by themselves: they didn’t want to know the bad news.

* They were briefed in a way that buried the pivotal facts in a mass of other data.

* They were briefed in a way that failed to make the consequences of component failure clear.

* They were briefed in a way which made avoidance of corrective action possible, if not probable.

Precisely the same pattern emerges from the Travers Report. In the early 70s, legal opinion questioning the legality of nursing home charges was expressed, and - it could be assumed - should have been clearly put to the minister of the day.

Except that opinion, even legal opinion, is just that: opinion. Legal opinions have not infrequently been waved at Government departments by health boards which didn’t want to implement a particular departmental policy. An unsought legal opinion does not carry the same weight within a Government department as legal ADVICE sought by a department itself.

So, although ministers in the 70s registered civil service murmurings about this awkward issue, the upward feedback, like the upward feedback going to the NASA top guys, was not heard as an urgent inescapable imperative.

Then came the cutback years, when no civil servant who wanted to live would have wanted to introduce to Government a costly time-bomb which might make the savings achieved through cutbacks look like small beer.

The cutback years were followed by the crisis years, when each successive minister encountered unprecedented challenges, like hepatitis C. Some ministers didn’t last long in the department, either, and some - most notably Dr John O’Connell - mistrusted department officials so fiercely that if one of them said “good morning” to him he’d have rung Met Eireann to check out the allegation.

WHILE Travers indicates it wouldn’t have killed ministers to have done a bit more probing, the fact is that by the mid-90s, the Department of Health was the seam at which all the strains of a radically changed nation were showing.

Expectations rose exponentially, unmatched by services. Patients turned litigious. The insurance system for consultants buckled. Cutbacks contributed to strangling the throughput of nurses. Waiting lists grew grotesquely as the population increased and aged.

AIDS, Sars, MRSA, CJD-contaminated vaccines, mutilation of women by the removal of their healthy wombs, the organ retention controversy all, in aggregate, caused the Department of Health to become a circus of competing crises.

Inevitably, given these more florid and noisy problems, the illegality of nursing home charges became a constant, but not acute problem, quietly growing. Starting like a little snowball, the accretions of the years built it into a meteor that, when it hit, was going to gouge a hell of a hole in the national finances. A meteor requiring no less than a dedicated day-long emergency meeting involving the minister, the secretary general, civil servants at several levels, together with legal and financial advisers.

Such a session, according to Travers, was never scheduled. Instead, the secretary general believed that he briefed the minister in the Gresham on the way into a meeting about something else. And the minister believes otherwise.

The easy and exciting response to this is to say: “Avast, me hearties, here lieth conflict of evidence between a solid senior civil servant (applause) and a minister (boos).” Easy, exciting response. But wrong. Here’s why.

It doesn’t MATTER that the secretary general says he briefed Micheál Martin for 10 minutes before the latter went into a meeting and that Micheál Martin says he didn’t. What matters is the inherent improbability of such a briefing.

Here’s a hole in the department’s finances then amounting at least to €1.5 BILLION, and not only is the minister apparently being let know about it as he marches up the stairs of the Gresham to a meeting about something completely different, but nary a note is kept of his reaction to what by any standards is a “Holy shit!” announcement.

It makes no sense, just as almost every stage in the three-decade sequence of actions leading to Mr Travers’s splendid report makes no sense, viewed retrospectively and in isolation. But that doesn’t mean the events amount to a conspiracy. They amount to a human reality so familiar, it even has its own axiom.

Remind me again about the thing that was paved with good intentions ...?