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Departure of Breda Smyth as CMO leaves Ireland exposed in the event of new medical emergency

Smyth’s time as country’s top doctor focused on State’s preparedness for new pandemic, while she had just one of four deputies to help

Outgoing Chief Medical Officer Prof Breda Smyth. Photograph: Nick Bradshaw/The Irish Times

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Paul Cullen
Fri Feb 2 2024 - 17:10

To lose one chief medical officer (CMO) may be regarded as a misfortune; to lose two in 18 months looks like carelessness – the old Oscar Wilde quip aptly describes the circumstances in which the Department of Health is losing a brace of CMOs in such a short time.

The departure of Prof Breda Smyth may come as a surprise to many, but it is unlikely to shock those acquainted with the challenges faced by her office since she started in 2022.

The State’s top doctor is supposed to have four deputies, each with a specific set of responsibilities. Prof Smyth has had to soldier with just one; two deputy CMO posts remain unfilled, while another member of staff is on sick leave.

[ Chief medical officer Prof Breda Smyth to leave role ]

Put it down to the law of unintended consequences. The Covid-19 pandemic highlighted the crucial role public health doctors play in combating disease outbreaks. Buoyed by public support after their heroic efforts during the crisis, the sector fought a successful battle for improved work conditions, and more than 80 public health positions at consultant level were created.

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Soon after came the new consultant contract, offering salaries of €250,000 and more for doctors limiting their on-site work to the public sector. Almost by definition, public health doctors only work in the public sector.

As earnings for public health doctors in the Health Service Executive became more attractive, those on offer to deputy CMOs in the department started to look relatively less interesting. The €114,00-139,000 pay-band for the post is about half of what a public health consultant can now earn in the HSE.

The two unfilled posts in the department have been vacant for more than a year, and the last time it sought expressions of interest in filling them, there were none.

As for the CMO post, it is paid at the level of a departmental deputy secretary general, currently about €202,000. In contrast, a medical academic professor could expect to earn €275,000-300,000. This suggests the department may struggle to fill the CMO post after Prof Smyth leaves.

Last year, it told The Irish Times there is a “considerable differential” in remuneration between the new consultant pay scale and the current pay for public health doctors in the CMO’s office.

The department – whose secretary general Robert Watt is the country’s highest-paid public service with a salary of almost €300,000 – has made a business case for raising the salary of the deputy CMO posts to take account of market conditions, but so far without any success.

Prof Smyth of course isn’t the first CMO to plan a move to academia; her predecessor Dr Tony Holohan hoped to leave for a professorship in Trinity College Dublin but this plan fell apart in 2022 in a welter of controversy and he ended up retiring from the public service.

A CMO’s main role is to plan for and deal with crises. In his 14 years, Dr Holohan had quite a number – dioxins in food, baby deaths in Portlaoise, swine flu, the CervicalCheck controversy and, biggest of all, Covid-19.

Prof Smyth’s time as CMO has focused on Ireland’s preparedness for a fresh pandemic, should it occur. Her departure, and the low level of staffing in her office, leaves the country exposed to the risk of a new medical emergency – despite all that was said during the pandemic about the importance of this.

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