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The bigger picture of an ugly row

And more than a few would have shared Minister Varadkar’s view that “it is not appropriate for Government agencies to be suing each other”.

However, to frame it solely as an argument between two jealous health fiefdoms would be to rob this episode of its seriousness, not to mention being incredibly disrespectful to the families who lost loved ones in this scandal.

According to media reports on the correspondence between the two bodies, HSE DG Mr Tony O’Brien said the draft findings would shatter confidence in the Executive’s ability to deliver services. More importantly, the HSE also said HIQA has no power to make findings which attribute or infer blame, guilt or liability to anyone in the HSE.

The HSE is worried about reputational damage — as well it should be — but surely that damage is already done? Born out of political fudge, the Executive is perhaps the most unloved State body in the country and every year it, through the State Claims Agency, pays out millions in compensation to patients, their families and members of staff.

However, there is a greater issue here than financial costs. The Executive and the Department are trying to decide what role HIQA should be allowed to play in the future, and both have very different visions of what that role should be.

At the beginning of the year, Ministers Varadkar and Lynch announced that agreeing a plan for extending HIQA’s powers, commencing in 2015 with private healthcare providers, would be a priority. While there is understandable concern about what this might mean for the smaller GP practices, for example, it does underline that the Government sees an expanding role for HIQA.

With this in mind, the dispute takes on a different hue. Some, including former Minister for Health Micheál Martin, have suggested that it is an attempt by the biggest health provider in the country to silence its biggest potential critic. The HSE strongly disputes such allegations.

Meanwhile, Minister Varadkar seems to be backing the regulator, telling the press that “to the best of his knowledge” no-one at his Department is disputing the findings and that the maternity services at the hospital were not adequate.

While this last point is tragically indisputable, we must bear in mind that the initial report by CMO Dr Tony Holohan pointed to “unrealistic clinical and administrative workloads” at the hospital.

“In order to fairly hold people to account,” Dr Holohan wrote, “then we must ensure that they [staff] have the tools, capabilities, authority and supports they need to be accountable. It is simply not good enough for the system to place people into such difficult and challenging roles without also putting in place the sustained supports they require to carry out their responsibilities.”

It is in everyone’s interest that this dispute is resolved as quickly as possible. However, the HSE’s decision to publish its letters to the Authority last week “to allow members of the media and the public to reach their own conclusions” suggests that this ugly argument is far from over.

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