Robert Watt may seek to rein in Tony Holohan

Tension between medics and mandarins has long been a feature of the Department of Health

Chief medical officer Dr Tony Holohan and deputy chief medical officer Dr Ronan Glynn pictured  at a Covid-19 update press conference at the Department of Health. Photograph: Colin Keegan/Collins Dublin

Chief medical officer Dr Tony Holohan and deputy chief medical officer Dr Ronan Glynn pictured at a Covid-19 update press conference at the Department of Health. Photograph: Colin Keegan/Collins Dublin

 

A feature of the coronavirus crisis has been the emergence of the chief medical officer of the Department of Health, Tony Holohan, and his deputy, Ronan Glynn, as major national figures giving advice in public that has not always been that welcome to the Government. Speaking for their department, they have dwarfed their Minister and there has been no secretary general in sight

The appointment of Robert Watt as secretary general of that department has attracted media attention on account of the outsize salary approved for the post by the department he has just left.

What has been missed is its possible significance as a move to clip the wings of the chief medical officer and control the advice he is allowed to put in the public domain.

It is a feature of the Irish civil service, inherited from “our Imperial masters” that control resides with an administrative corps of “civil service lifers” rather than with professionals who have technical, scientific or other expertise. To make clear who is in charge, top administrators are paid more than any professionals.

Its justification historically in Victorian England was that the mandarin class, who had typically read classics at the ancient universities, were endowed with qualities of perspective and judgment not found among narrow specialists. Its modern justification is that professionals are not equipped to be efficient and compliant administrators.

It works badly in departments where professional expertise is central. It slows up decision taking as administrators have to be instructed on technical matters. Advice can get garbled travelling to a minister up an ascending curve of ignorance.

Professionals of quality are discouraged by their subordinate role from seeking public service posts or remaining in them. The wonder is that some still do so.

It is a fallacy that professionals can’t be good administrators yet they are not allowed to aspire to senior administrative roles in our civil service.

When a Department of Health separate from the old Department of Local Government was created in the Custom House in 1946 the expectation was that the medics would run it. Their chief was the dynamic James Deeny, a 38-year-old general practitioner from Lurgan, who had been parachuted into the post.

He it was who masterminded the mother and child scheme and the control of the tuberculosis epidemic, for both of which Noel Browne got the political credit. Deeny gave himself a significant public profile lecturing and writing on public health issues.

He clashed with Browne, not on policy, but on a personal level after he objected to Browne’s vituperative attacks on the medical profession and witch-hunts against individual doctors. This is chronicled in Deeny’s enchanting memoir To Cure and to Care and was much noticed at the time of its publication in 1989.

Less noticed was his criticism of the marginalisation of the medical staff in the Department of Health and the frustration he felt having to work through lay administrators. He was denied access to the minister except through the powerful secretary – as secretary generals of departments were then more modestly titled. He found himself relegated to a passive advisory role. Initiatives from him were unwelcome, whatever their merits, and he was not allowed a public voice.

He took leave of absence several times in the 1950s to go on missions for the World Health Organisation to the developing world before joining them permanently in 1962. It was an organisation run by medical men and they were as glad to have him as the Sir Humphreys back in the Custom House were relieved to be rid of a man who disregarded rigid procedures and threatened their control of the department.

My father succeeded Deeny serving for three years before his own retirement and was responsible for having the post renamed chief medical officer, rather than chief medical adviser, hoping that this would enhance its role.

In the succeeding half-century until now the only doctor in the department I noticed committing the cardinal civil service sin of “making a bit of a name for himself” was Dr Jimmy Walsh who was to the forefront in the fight against Aids in the 1980s. He was never allowed to become the chief medical officer.

It will be interesting to see how things play out between Dr Holohan and Mr Watt, not to mention the even more handsomely remunerated Paul Reid who does a job once done within the Department of Health itself.

Charles Lysaght is a lawyer, biographer and columnist

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