Paul Reid’s HSE exit the latest notable departure in wake of pandemic

Last Thursday, senior personnel gathered in the HSE’s boardroom to pay tribute to departing chief operating officer Anne O’Connor

Over tea and coffee, the salutes to O’Connor — who sought the chief executive’s job in 2018 — were led by the successful applicant for the role, Paul Reid. At that time, Reid was the only one in the room who knew he too would be leaving — joining an exodus from the top ranks of the healthcare system that has gathered pace as Covid-19 recedes.

Reid’s departure landed with little warning. Over the weekend, a small number of HSE officials were briefed, and chairman Ciarán Devane was told late on Sunday afternoon, after Reid appeared on RTÉ's This Week programme — addressing a contentious plan to close the emergency department at Our Lady’s Hospital, Navan due to long-standing concerns about patient safety.

On Monday, Reid told Minister for Health Stephen Donnelly and Taoiseach Micheál Martin. Word began to filter out of a meeting of the HSE’s top brass but managers only got short notice. “I heard about five seconds before his staff circular,” one said.

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The suddenness of Reid’s announcement raised eyebrows. There is speculation it is related to his RTÉ interview, perceived as critical of Donnelly, which prompted a statement from the Minister. Sources briefed on Reid’s thinking are steadfast that it played no role in his decision, but relations are bad: there were a series of fractious engagements, including between Reid and Donnelly, during Zoom calls last week.

Reid understandably wants to spend more time with his family, particularly his young granddaughter, who lives in Texas. It is also the case that he had a torrid pandemic. “We all aged five years in two years,” said one senior HSE source.

His stewardship of the health service during Covid earned praise, while his direct management style gained admirers in the HSE, where the culture has been marked by “an awful lot of waffle”, according to one manager. “You’d be in no doubt as to where you stood [with Reid] and that’s a real positive. You mightn’t like where you stood, but you knew.”

But his term also featured clashes with chief medical officer Dr Tony Holohan, while his high media profile irked the Department of Health. At one point, Donnelly intervened, suggesting he should feature less frequently, but Reid continued front and centre.

Reid’s salary, more than €420,000 in 2020, was also a bone of contention. His role must now be filled, and there will be questions over wages, which must be approved at a time when lavish public pay packets are toxic.

Post-pandemic, the normal diet of crises, controversies and firefighting has resumed — from the Navan row to prescribing practices in South Kerry Child and Adolescent Mental Health Services, teeming waiting lists to overcrowded hospitals and the reorganisation mandated by Sláintecare. The economic picture makes the return of pitched funding battles likely.

HSE veterans recognise a change in the tides. “We were rogues before, we were heroes for a brief moment, and we’ll be rogues again,” confided one.

Sources in Government, while acknowledging the impact of the pandemic, gripe that long-standing issues persist.

Waiting lists will continue to be a political weak point, although targets are expected to be hit. Insiders believe the real vulnerability is emergency departments. With hospitals “staggeringly” busy, pressure is expected from within the political system, where there are also misgivings over how the HSE has handled the Navan controversy.

Not backing down

Closing services are always politically volatile, but the Government also fears the impact on Our Lady of Lourdes in Drogheda which will receive emergency patients instead of Navan. Senior medics in Drogheda, who fear risks in Navan are simply being transferred, met Donnelly and highlighted their concerns in a letter after he requested a written note.

But the HSE is not backing down. In a statement it said it has been planning for the reconfiguration through “established governance” structures and that 80 additional beds have been created in Drogheda, with an increase in ICU and more acute medical beds planned.

“It is now necessary that patients who are unstable or seriously ill are brought to the right hospital, first time, rather than to a hospital that cannot provide them with the urgent care they need, risking poor outcomes for these patients,” it said.

HSE sources are frustrated, arguing concerns about Navan existed for years, unaddressed by politicians and the concerns of the Drogheda medics will be handled. “This is not a political game,” says one senior source. A second said the issue “left a very poor taste”.

The Government has the nuclear option of forcing the HSE to stop, while Reid has indicated to colleagues he will not take a backward step on Navan and in the outgoing chief executive, the Government is facing off against someone with little to lose.