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The recently released correspondence shows serious tensions at the highest levels of the HSE over what it saw as attempts by the National Public Health Emergency Team (Nphet) to pressure it to provide 100,000 tests of Covid-19 per day without adequate prior consultation or preparation. .
HSE chief Paul Reid wrote to the secretary general of the Department of Health and its chairman, Ciaran Devane, wrote to health minister Simon Harris in mid-April to express concern over an Nphet announcement about the level of tests for Covid-19. it will increase to 100,000 people per week, operating seven days a week, for a minimum of six months.
Mr. Reid in his letter to the department on April 19 said that the Nphet leadership “was nothing like what we discussed earlier and has not taken into account what can be accomplished by when.”
He also said that the announcement of plans to evaluate all residents in extended-stay facilities, “in the absence of detailed operational considerations and clear prioritization guidance requirements, introduces considerable risk to continuity of service in these settings.”
Mr. Devane said in his letter to the Minister that “it had been clear to me and to the HSE board for a time that operational requirements have sometimes not been adequately considered at the core of Nphet’s decision-making.”
The Irish Times reported in late April that there were serious tensions between HSE and Nphet about plans to scale up the evidence and that the chief executive and president had written to the department to complain about the announcement.
The department released the letters Thursday afternoon. The letters had been requested for several weeks by Labor Party leader Alan Kelly.
HSE surprise
In his correspondence, Mr. Reid said that he had been very surprised to read a letter from the department’s medical director, Dr. Tony Holohan, just before 9 p.m. Announced.
“The instructions set forth in the previous letter and press conference are at odds with the process in which we have jointly participated both in the Government Cabinet committee and in subsequent meetings with Secretary General (Martin) Fraser. They also disagree with the process established with the HSE Board.
“At the Cabinet Committee on Tuesday, April 14, I presented a document establishing current capacity regarding testing and tracing. Following this, Secretary General Fraser called a meeting for the afternoon of Friday, April 17, which was attended by Dr. Holohan and you and me.
“One action of this meeting was that the ‘Department of Health confirmed the position re (i) ability to test and trace contacts and (ii) capacity of the health service on Friday, April 24” The instructions were not mentioned in this meeting they were supposed to cast NPHET that night.
“A Cabinet Committee meeting is also scheduled for Monday, April 20, at which we must provide an additional update on testing and traceability. Apart from this, and at the request of Dr. Holohan, we undertook to develop a document for your consideration and approval at the Nphet meeting on April 21, 2020. That in itself is not a small task, and we have been working intensively to ensure that the Department receives a complete response and capable of rapid implementation.
“I have updated the President and the HSE Board in this regard on Wednesday April 15th and I must present the same topic to the HSE Board on Friday April 24th.
“Since all of this was agreed, I am extremely disappointed that these understandings appear to have been disregarded. I do not know why this address from the Nphet to the HSE was given and communicated publicly without completing the jointly agreed processes and without taking proper governance into account. The established instructions effectively attempted to engage HSE at an intensity of implementation that is not at all like what we discussed above and has not taken into account what can be accomplished by when. “
Process Advance Process ’
Mr. Devane in his letter to Mr. Harris said that the letter from the medical director and the press conference had “gone through and advanced the process that had been agreed to develop the implementation plan to meet and exceed the goal of 100,000 tests per week “
“This document was to be presented to Nphet, the HSE Board, and the Cabinet Committee next week.”
Mr. Reid in a separate note to the department said that expanding to provide 15,000 community referrals per day, seven days a week would require engaging with GPs and GPs regarding demand volumes and model weekend service.
He said at the time that the maximum consumption of samples from the current community was approximately 7,000 swabs. He said it would take several days to scale this up with the full-time operation of 48 community test centers.
Reid said expanding to 15,000 would require 30 labs working at full capacity.
“Some of the new laboratory capacity is completely new and will take time to expand the production of the tests.
“The significant risks regarding the supply of reagents for hospital laboratories have yet to be managed and will have to be managed in the coming months for HSE partner laboratories as well.
“A comprehensive laboratory testing strategy would take this into account, prioritize actions to mitigate risks, and ensure that we have a robust prioritization guide and protocols that enable us to ensure that all available capacity is directed at all times to the areas of greatest need. “
Reid said HSE at the time did not have enough evidence from the mobile community or the ability of the National Ambulance Service to evaluate all residents and staff at long-term residential facilities over the next ten-day week.
“This is a huge and complex company.”
Work began on developing a plan to increase this capacity on the night of April 17.
“The announcement of this decision, in the absence of detailed operational considerations and clear prioritization guidance requirements, introduces considerable risk to service continuity in these environments.”
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