Paul Hosford: Holding the health emergency team to account
Questions raised about NPHET’s accountability have remained unanswered, writes
Throughout the six weeks of the Covid-19 outbreak, Irish people have become familiar with a number of new terms.
We can wax lyrical about reproduction numbers, talk about the complexity of contact tracing, and most of us can now pronounce NPHET.
The National Public Health Emergency Team is a collection of clinicians and medical experts whose advice has led to social distancing, hand-washing, and 2km zones becoming part of our lives.
However, while the general consensus in Irish public life is that health experts are to be listened to and trusted, questions have arisen about what NPHET is, who it reports to, and the transparency with which its decisions are made.
During Thursday’s sitting of the Dáil, Labour leader Alan Kelly put a number of questions to the Taoiseach about NPHET.
“Who is NPHET ultimately accountable to?” he asked. “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?”
Mr Kelly also asked the Dáil about why only notes are recorded of meetings and not detailed minutes.
“There is a difference,” he said.
“Minutes reflect the record of the meeting and must be agreed at the beginning of the next meeting. Notes could be a subjective view of what happened.
Were all these notes agreed by all the participants after each meeting? Future generations will want to know where people stood on decisions.”
Due to time constraints, however, Taoiseach Leo Varadkar was unable to answer all the questions that came from the opposition benches, leaving the chamber to attend a European Commission teleconference at Government Buildings. He did ask deputies for understanding about a perceived lack of transparency.
“I ask for their understanding,” said the Taoiseach.
“People are busy and they are swamped. They are struggling to read their emails and to read the interesting and important documents that are being sent to them every day from people all over the country who want to help and make good suggestions.”
Asked at a press briefing a day later for answers to Mr Kelly’s questions, Health Minister Simon Harris said he had full faith in the group.
“NPHET is chaired by the chief medical officer — it’s not the first public health emergency team we’ve had,” he said.
“It’s a mechanism we use when there’s an issue of public health concern, to pull together the relevantofficials and expertise and clinical leaders. They’re doing a really, really excellent job.
“When we get through this pandemic — and God willing we will prevail — when we get through this there’ll be a time where of course we will sit down and we will all look back on how structures worked.
"That will be entirely appropriate but I am satisfied that not only is the National Public Health Emergency Team, which reports to me as a minister and links into Government through that, is doing anexcellent job.
"They’re working flat out. They were working on this long before people were talking about it or we were being asked about it.”
Much has been made of the NPHET’s position now, as the desire to see some easing of restrictions grows, but it is important to know where it started.
The NPHET in its current form was established within the Department of Health on January 27 this year, to discuss the coronavirus.
At that meeting were 12 medical professionals and a member of the department’s communications unit.
The meeting noted the latest data in the outbreak of the 2019-nCov2 virus, which would later become known as Covid-19.
At the time, there had been just over 2,000 laboratory-confirmed cases of the disease and 56 deaths.
The group was told that the European Centre for Disease Control (ECDC) had listed the chance of transmission as low, if appropriate measures were in place.
NPHET agreed it would take its guidance from both the WHO and ECDC. It was also agreed that laboratories would be added as an agenda item going forward.
The January 27 meeting was told that the country had adequate PPE.
“A sufficient supply of personal protection equipment [PPE] is available for the coming weeks and contracts are in place to access further equipment, as required,” it was told.
Some 15 days later, the Government issued the terms of reference for NPHET going forward.
It listed seven responsibilities of the group, chief among them to “oversee and provide direction, guidance, support, and expert advice across the health service and the wider public service, for the overall national response to coronavirus”.
In the final lines of the terms of reference, two things were agreed — that NPHET will meet weekly — which has since been updated to twice-weekly — and that “expert advisers and other stakeholders may be invited to attend meetings”.
This, clinicians feel, gives the group the chance to hear from as wide a range of voices as possible in the battle against Covid-19.
The most recent note for NPHET meetings, dated March 31, lists 42 people in attendance, showing the scale of the challenge.
Some of the names will be familiar to the public, such as Philip Nolan, who is president of Maynooth University and is overseeing all of the modelling data.
When NPHET first met in January, there was no reason to think wide-scale modelling would need to be done.
Likewise, the fact that the Covid-19 challenge now incorporates the entirety of the health system — more than 100,000 staff, countless specialities and different stakeholders — means that new members are added as the weeks go on.
At the last meeting, Colm Bergin, a consultant physician in infectious diseases in St James’s Hospital; Mary Favier, president of the Irish College of General Practitioners; and Michael Power, a consultant physician in anaesthetics/intensive care medicine at Beaumont Hospital, all joined.
Their addition will strengthen a group already replete with some of the finest medical experts in the country, including laboratory experts, emergency medicine consultants, GPs, and public health specialists.
Still, questions remain about the group’s decision-making process. Because it publishes notes and notminutes, there is no record of how many people are in favour or against proposals.
The asked the Department of Health about this question but no response was received.
Likewise, Mr Kelly has written to the Taoiseach to clarify his questions around the group and how it reports to Government, but a response may take a week or more.
In that time, NPHET will likely meet twice and on Friday may recommend the easing or continuation of restrictions on movement.
