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Irish Politics

Policy monopoly conferred on NPHET and the HSE was hardwired to fail us on non-Covid public health matters

It was inevitable, in some respects, that the relationship between NPHET and the Government would reach a point of crisis.  It was inexcusable for the Government and the nation to learn on the Sunday evening 9.00 news that the move to level 5 was being mooted for the following day.  It was, no matter how you call it, a political hand grenade thrown into the cabinet room.  NPHET must have understood its  effect.  Was  what done was a deliberate stratagem to impose its will on the Government and through it on the people. 

The inevitable aspect of this impasse arises from the prior willingness of successive Taoisigh and Ministers for Health to insist that they were simply “following the science” in accepting NPHET recommendations.  To that extent, politicians sowed the seeds and very nearly reaped the whirlwind.

The pandemic has massive implications for the State’s well-being – economic, social and public health.  The State’s response to the pandemic could never, and should never, have “followed the science” of epidemiology or the advice of epidemiologists alone.  Looking back, it is hard to remember any countervailing voice to that of NPHET being accorded the same weight or publicity in relation to the devastating effects of lockdown for cancer screening, prevention and treatment, for psychiatric illness and for social services to the disabled (mental and physical) and the families of the disabled.

It was as if public health had been reduced to protection from Covid alone. 

Psychiatric care, suicide prevention, and measures to deal with depression were effectively side-lined because they did not feature as aspects of the public health emergency within the remit of NPHET. 

Moreover, NPHET was permitted to dominate public perceptions of the pandemic almost to the exclusion of anyone else.  The broadcast media, in particular, became an extension of NPHET policy.  Opinion polls financed, in effect, by our health system reinforced NPHET’s view about  public perceptions. 

In view of the virtual monopoly of policy ideas and analysis which the broadcast media conferred on NPHET, it should come as no surprise that they were able to report to the Government that their advice enjoyed widespread public support.  

Those who queried any aspect of their advice ended up being challenged in the media (including the social media) as valuing wealth over life.  Doubt was equated with subversion of social solidarity.

The information made available to the public and the emphasis put on certain statistics were carefully choreographed to support the NPHET point of view.  A patient admitted to hospital with a massive heart attack or stroke who happened to die while Covid positive was counted as a Covid death, as one public health practitioner had to admit to the final meeting of the Dáil’s Covid committee.Maps showing Covid infections by electoral districts were left unrevised so that clusters appeared in places where the problem had greatly abated. 

While emphasis was put on Covid’s real danger to people of all ages, data such as the median age of persons recorded as dying with Covid was reluctantly described as “in the high 80s” (actually 88, I believe) in NPHET evidence to the same final meeting of the Dáil Covid committee.

In retrospect (and I accept that retrospect is always 20-20 vision), it was a huge mistake to convert NPHET from a purely advisory body into a self-regulating advocacy group.  While that, as I have mentioned, was politically convenient, the debacle at the beginning of this week was the entirely predictable consequence. 

At last, the many and not just the few, are asking the question as to whether the State’s hospital and ICU facilities were expanded since they were the justification for total lockdown in March of this year.  Who did what in the meantime?  Did NPHET speak about the urgent necessity to boost this capacity at its press conferences?  Were they asked about it by those attending?

Did they, as the HSE certainly did, flannel and bluff their way around the stark truth that little or nothing has been accomplished on that front in the last half year? 

Who is responsible for what appears to be a very mediocre test and trace system?  Does the Department of Health have any responsibility in these matters?  What was the reasoning behind the Government’s effort to interpose a filtering committee between the cabinet and NPHET?  Was last Sunday’s coup an effort to avoid such scrutiny? 

The policy monopoly conferred on NPHET and the HSE was hardwired to fail us on non-Covid public health matters and on supervising an adequate response in our health infrastructure. 

We need joined-up thinking, decision-making and implementation in our struggle to live with Covid. The economy is not a mere residual in public policy. There are huge costs too for lockdown in terms of lives lost, lives ruined, occupations destroyed, social and cultural activity, recreation, loneliness, depression, domestic abuse and psychiatric well-being.

All these must be at the centre of our political discourse. Political responsibility and accountability must always lie in our democratically elected institutions.

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