OBJECTIONS BY HSE chief executive Cathal Magee about the role of the Minister for Health’s special advisers led to a number of strong exchanges between Mr Magee and the Department of Health this summer.
In correspondence seen by The Irish Times, Mr Magee and Minister for Health James Reilly clashed over the function of the advisers, their communications and instructions to the Minister and senior HSE management, and the level of their access to and influence on sensitive HSE plans.
Mr Reilly has two advisers: Sean Faughnan, a former Fine Gael official who worked on the party’s healthcare policy, Faircare, and Mark Costigan, Mr Reilly’s media adviser, who previously served as an adviser to former minister for health Mary Harney.
In an e-mail to the department’s secretary general, Michael Scanlon, Mr Magee raised concern about communications between the advisers and the Minister, and between the advisers and HSE national and regional directors. They were inappropriate, Mr Magee said, and potentially created “confusion and uncertainty around governance in our system”.
He drew specific attention to e-mails from Mr Faughnan to Laverne McGuinness, the HSE’s national director of performance and financial management, and Pat Healy, the HSE’s south regional director of operations. Mr Faughnan’s e-mails informed them “with the full authority of the Minister” that all hospital-reconfiguration plans were to be put on hold pending the Minister’s and the advisers’ review and approval of the plans, and warned that it was “clearly not acceptable” that local HSE officials were making statements that reconfiguration decisions had already been made, “when clearly this is not the case” and that this must cease.
Mr Magee consequently asked that the department put appropriate arrangements in place, “as a matter of priority”, that reflected the statutory responsibilities of the HSE and the issues outlined in the Travers report on nursing home charges. The 2005 report was critical of the growth in the number of external advisers to health ministers and said the advisers should not be involved in the line management of the department or undermine the accountability and reporting relationship between civil servants and ministers.
In response, Mr Scanlon told Mr Magee that while the special advisers had no executive functions, they needed to be fully briefed on developments in the health services, “so they would be in a position to provide him with informed advice”.
“It is important that information be shared with the special advisers and every effort should be made to keep the advisers briefed on significant issues. An adviser may also ask to be involved in a particular topic or issue,” Mr Scanlon wrote.
He added that where a decision is required from the minister it should be directly submitted to him and his decision obtained, but he admitted that in the department it was regular practice to accept “a particular suggestion from an adviser” in place of asking the Minister directly for a formal decision.
Mr Scanlon also told Mr Magee that the briefing of special advisers and their attendance at meetings should be seen as “complementary to the direct briefing of the minister: it cannot act as an alternative” to directly briefing him on important areas of policy and operation.
Mr Scanlon concluded that if Mr Magee was still concerned about the issue, it could be pursued further through developing protocols or as part of a wider review of the communications function within the Department of Health and the HSE.
Both Mr Faughnan and Mr Costigan are understood to be on salaries ranging between €80,051 and €92,672.