The Taoiseach’s intervention while abroad on official business to “pause” the appointment of the chief medical officer Dr Tony Holohan as Professor of Public Health Strategy and Leadership at Trinity College Dublin is damning.
Damning for the Minister for Health Stephen Donnelly because it exposes the casual contempt his most senior officials held him in. It is especially so for Robert Watt, the secretary general, because he has let the mask slip so far as to reveal that disrespect.
How after the row over his own appointment at the department and the increased salary that went with it he could be so deaf to public opinion or so contemptuous of political concern as to progress this appointment in the manner it happened, beggars belief.
The consequences are far greater than the issue. Every avoidable mistake drains the resources of an organisation, and its reputation. It is poor leadership, and it is has become habitual.
There was a time when officials cared about maintaining the fiction that ministers are in charge and ministers insisted on it; the fiction that is. The manner of Holohan’s appointment displayed new levels of brutalism from a senior civil servant.
That the Minister knew of the appointment for two weeks but was only told days after it was announced that it was a secondment, and his department would pay the salary indefinitely has damaged all involved.
It coincides with further news that Sláintecare, which was thought to be our national health strategy, is at best being cherry picked and diluted. Regional authorities will be established on an administrative basis only, not legislative. Real power remains at the centre.
The mess over this appointment is a cultural issue. It springs from a system intended to foster opacity around accountability
Healthcare is Ireland’s military-industrial complex. It overarches the State but is not effectively subject or accountable to it. Thanks to unprecedented cohesion and a blank cheque it performed admirably during a pandemic. Holohan gave good leadership in a public crisis, while dealing with private grief and his appointment at Trinity is a good idea. Why then is he damaged by a cackhanded, furtive approach to disclosure of the full facts? Specifically, why is the Minister humiliated publicly and belittled privately with his own political colleagues. Donnelly’s defence that he wasn’t told, is withering.
The depth of the mess was underlined by the spectacle of Ministers on the sidelines cackling concern as if speaking of a disconnected event. All share collective responsibility. The former minister for health Simon Harris calling for “clarity and information” is disinformation. He is a co-author of the dysfunction this mess is systematic of. The Minister for Public Expenditure and Reform Michael McGrath’s pious regret that “the matter could have been handled better “ illustrates more than it deflects from the systemic failures of his own department. McGrath busted Civil Service norms to give Watt another go on the merry go round at Health after a decade as secretary general in his own department, and at a hugely increased salary.
The difference in scale between what is at stake in Holohan’s appointment and the soaring costs of the new national children’s hospital is vast. But what resonates are attitudes to accountability and disclosure. The mess over this appointment is a cultural issue. It springs from a system intended to foster opacity around accountability.
The refusal to reform is a purposeful continuation of the system created at the foundation of the State and enshrined in the Ministers and Secretaries Act, 1924. In every respect except one, the State created then, has profoundly changed. Uniquely our administrative system – copied from Britain – survived intact through every crisis. Ministers remain a “corporation sole”. Stephen Donnelly did not have to know, to be responsible.
The system works after a fashion where there is a degree of co-operation and mutual restraint. In the no-man’s land between a minister and his secretary general there are almost no rules. It is a case of co-operation or the consequences of its failure. The latter in this case again. Robert Watt, a Cardinal Wolsey character, has made Wolsey’s mistake and made his master look weak. The Taoiseach’s intervention was a riposte to that. Only Donnelly’s head will be on the block if it comes to that. But if systems matter and culture is important, so is leadership.
The health budget has increased by more than €7 billion in five years. It is nearly €22 billion and rising. That is public money alone. Every one of us is dependent on its success but now that the crisis of Covid-19 may be over, what remains as a legacy except a bloated budget? From its inception Sláintecare was dismissed as improbable by a senior Civil Service, who are suspicious of the legislature forming policy and resentful of the pre-determination of major budgetary decisions. It is like a frog in warm water being slowly brought to the boil.
Gerard Howlin is a commentator and former Government adviser.