Author: Ken Foxe

HEALTH Minister Simon Harris gave the green light to a controversial cardiac lab despite strong recommendations against it from senior departmental officials.

The second cath lab at Waterford University Hospital had been a key priority for Independent Alliance junior minister John Halligan and was given approval by Minister Harris in early July.

However, internal Department emails reveal that senior officials did not believe the lab – which is to be built in a prefab – was justified or fit in with national plans.

In addition, they said a business case put forward by the HSE was out of date, contained factual inaccuracies, multiple miscalculations, and could not be used as the basis for any decision.

On March 29, Minister Harris was given a preliminary briefing on the proposal, which advised against the plan on three separate grounds.

Despite that, Minister Harris asked for the idea to be investigated further in an email sent by one of his special advisers.

An internal email from the adviser said: “I understand that on a recent visit to Waterford this issue was raised with the Taoiseach who said he would ask Minister Harris to examine the issue further.”

The Department of Health subsequently looked for a business case from the HSE on the proposal and prepared a second briefing for Minister Harris.

Pressure for a decision on the cath lab intensified in June when the Taoiseach’s department also sought updates on the proposal, records reveal.

An internal email from Secretary General Jim Breslin on June 13 said: “Following the meeting with Minister and advisors (here and in D/Taoiseach) we have been asked to press the HSE to submit the business case.

“The submission should include the key steps necessary to commission such a lab, the associated timelines and costs.”

On June 21, an internal email from Minister Simon Harris’ special adviser said Mr Harris now wished to “proceed with the provision” of the second lab and wanted to update TDs in the South East on the news the following day.

A half an hour later, a health official urged caution: “We strongly advise against providing an update to the South East Oireachtas members confirming intention to proceed with provision of a modular cath lab in advance of receipt of the Department’s analysis.”

The following day, senior officials provided a second lengthy briefing on the proposal saying there were “factual inaccuracies” in it and that some of the information in it was out of date.

They also said there appeared to be “numerous miscalculations” in tables of costs that were provided.

“Given the miscalculations referred to above, it is also not possible to make a definitive determination on the value for money of the preferred option outlined in the business case,” it said.

The briefing then listed eight recommendations about why the plan should not proceed as outlined, the first two because of the mistakes in the business plan.

It also said the development – which could cost between €1.85 and €3.4 million a year – was not consistent with the “Herity Plan”, an independent clinical review that said a second cath lab in Waterford was not justified.

It said the South East catchment area could be served by extending opening hours of the existing lab and that staffing challenges would be a problem if it was developed.

It concluded by saying: “Acute Hospitals Policy Unit 4 strongly recommends that the project not proceed at this time, in advance of more detailed information on costs and timelines.”

In a handwritten note, Department Secretary General Jim Breslin also raised the issue of how the development would fit in with funding plans.

“Minister,” he wrote, “you will also be aware of the significant gap between available capital funding in 2018 and 2019 and the cost of existing commitments.”

The previous briefing from March of this year had also strongly recommended against proceeding with the unit.

It explained that waiting lists in Waterford were “demonstrating good performance” with the vast majority of patients waiting less than six months for procedures.

It said providing a prefab lab would take anything between twelve and sixteen months and was not a viable interim solution while a national review of cardiac services took place.

It also warned of possible staffing issues where industrial relations risks had arisen in the past when people were asked to work in “modular builds”, i.e. prefabs.

In a statement, the Department of Health said: “Given University Hospital Waterford’s status as a primary [cardiac] centre, the Minister believes there is merit in the proposal for a modular cardio-catheterisation laboratory [there].

“The HSE has submitted details of the costs and timescales for options for the provision of a modular cath lab to the Department for review and further details on costs are awaited.”

Campaigners in the South East strongly dispute the points of view expressed by Department officials.

For more information on their work for enhanced cardiac services in the region, you can visit: http://www.hefse.com/

STAFF in Met Éireann have been told to be non-committal when asked if specific extreme weather events in Ireland are linked to global warning.

The advice is contained in a guidance document for staff on what to do when hurricanes, droughts, heat waves, and snow storms are being blamed directly on climate change.

In their “climate attribution statement” Met Éireann said questions linking these specific events to global warming were to be expected.

“There is no simple yes or no answer to the question,” says the guide. “It is a fact that a current weather event is occurring in a climate that is approximately one degree Celsius warmer than pre-industrial times.

“But that alone does not mean that the event would not have occurred if the climate were colder by one degree (pre-industrial).”

The guide said extreme weather events are more likely to occur because of global warming, but that linking it to specific events was a problem.

It explained: “A comment along the lines of ‘we can’t say if the event is a result of climate change, but it is the type of event that is projected to occur more frequently in a change climate’ can be used if the question arises.”

The guide was much clearer on what to say when asked about the link between human activity and climate change.

It said the fifth assessment report of the Intergovernmental Panel on Climate Change (IPCC) had concluded that “human influence on the climate system is clear”.

“Societies around the world are faced with increasing climate change risks,” said the guide.

It also explained that new climate modelling technology was developed, which might give clearer answers on whether events like the “Beast from the East” snow storm, or Ireland’s summer heatwave, could be linked to climate change.

The guide said: “These model simulations are expensive to run computationally, so it is not possible to get information on attribution in real time.

“Results of attribution studies have statements like ‘the event is 30% more likely to have occurred in a warmer climate.’”

The documents were obtained by Right to Know using EU environmental information regulations.

Séamus Walsh, head of the Climate and Observations Department in Met Éireann, said: “There is no simple yes or no answer and often when we’re explaining this, we’re losing.

“Our forecasters deal essentially with the weather, which is the day to day variation. Everybody thinks because we all work in Met Éireann, we are all experts on climate change. But they are quite different skills so we like forecasters to talk on weather and our climate experts to talk on climate.”

He said that while the science was “more or less settled” on climate change, linking specific events to it was nowhere near as simple.

“The difficulty with these attribution studies is people want to know today and it’s really not possible to do that and it won’t be for a while,” he said.

“Focusing on extremes can muddy the water. The actual global temperature is continuing to rise even if on a day-to-day basis we don’t notice that.

“Man’s influence is written all over that one degree rise, and that does have a knock-on effect on events. However, if you start commenting on individual events, you kind of get caught.

“And while these events will become a lot more frequent in the future; it’s just not that straightforward to link day to day weather events to climate change.”

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THE country’s busiest motorway has witnessed more than 5,100 accidents and incidents since the beginning of 2017.

Dublin’s M50 ring road has recorded “incidents” at the rate of over 243 per month, according to a detailed list provided by Transport Infrastructure Ireland.

The events vary from low priority to major incidents with drivers falling ill at the wheel, wild animals on the road, and cases of motorists going the wrong direction all reported.

The most common incident was breakdown with more than 2,000 cars breaking down over a twenty one month period on the motorway.

Just over 1,000 collisions were also recorded while 643 incidents were reported where dangerous debris was found to be on the roadway.

A total of 49 drivers ran out of fuel on the busy motorway while there were 47 cases of wild or pet animals crossing the carriageways.

Transport Infrastructure Ireland also recorded 272 cases where a pedestrian or cyclist was found to be using the motorway.

Dead animals were reported sixteen times, which can cause motorists to swerve to avoid the carcass and lead to collisions.

Twenty three cases of drivers falling seriously ill were also recorded, while in 25 cases, somebody called for help but there was nobody on the line.

There were two cases of drivers headed the wrong way on the M50 while three cases of serious anti-social behaviour were also recorded.

Other serious incidents reported included heavy winds putting traffic in danger (ten times), 35 cases of vehicles on fire, 121 flat tyres or “blow-outs”, and 173 instances of cars being abandoned by the side of the road.

Less frequently reported but also listed in the database were spillages, flooding, and drivers hopelessly lost and looking for directions.

Of the 5,115 incidents reported, 28 of them were classified as “major incidents”.

These mostly involved serious collisions, or cars broken down in dangerous locations, with some incidents lasting for up to six hours.

Another 905 incidents were classified as “high priority”, a majority of them breakdowns and crashes.

A total of 2,137 events were categorised as “moderate priority” with another 1,779 described as “low priority”, often involving mechanical failures in cars but where the driver was able to get the vehicle to a safe place on the hard shoulder.

The time of year doesn’t appear to have much impact on how many incidents take place with numbers fluctuating randomly from month to month.

The worst month over the past twenty one months was in May 2017 when 320 incidents were recorded, more than 10% higher than any other similar period.

The “Beast from the East” snowstorms in March don’t appear to have had a significant effect on the numbers of incidents with 222 recorded that month.

That figure did drop however in April to just 174 – the lowest since the beginning of January 2017 – before rebounding again during the summer.

A spokesman for Transport Infrastructure Ireland said that with 50 million journeys a year, the motorway was no longer a ring road but rather within the city suburbs.

Sean O’Neill said: “Options for increasing capacity are not endless and eventually there comes a point when adding lanes and upgrading junctions is no longer feasible.”

He said incidents on the M50 combined with heavy traffic were a recipe for long delays.

“Incidents can include anything from simple breakdowns, or debris on the motorway right up to major collisions involving multiple vehicles,” he said.

“More serious incidents generally require the involvement of many different agencies including An Garda Síochána, Dublin Fire Brigade, the four Dublin local authorities, [ourselves] and the Motorway Traffic Control Centre.”

As part of plans to ease congestion on the road, Transport Infrastructure Ireland is planning to introduce “intelligent transport systems technologies” including variable speed limits as well as lane usage instructions by 2020.

“A regulated speed limit will reduce the need to brake suddenly in response to standstill traffic and reduce the number of ‘stops and starts’ that take place,” said Sean O’Neill.

“Additionally, by regulating speed you reduce the potential for accidents to occur as well as the severity. You can also manage lane usage before an incident, thus improving safety and recovery time operations.”

Raw data to come:

THE Information Commissioner threatened to use his legal powers to force the Department of Justice to have searches carried out on private emails between former minister Frances Fitzgerald and PR advisor Terry Prone.

The request was made as part of the handling of a Right to Know request for correspondence between Ms Fitzgerald and Ms Prone over a three year period.

Internal emails reveal that the Department believed the Information Commissioner were “pushing the boundaries” in asking them to contact Ms Fitzgerald to search her private email account for relevant records.

“The attitude they’re taking to this is unbelievable,” wrote one official.

Separately, the Department of Justice sought legal advice from the Attorney General on whether they should contact Ms Fitzgerald and ask her to search her Gmail account, which she occasionally used for official business.

In an email to Deputy Secretary General Oonagh McPhillips, a senior official said: “I have advice from the AGO [Attorney General’s Office] supporting the position that it would not be appropriate for us to contact her in relation to this matter.”

A formal email to the Information Commissioner repeated that point of view.

A senior official wrote: “These advices support the Department’s view that this would not be an appropriate step for the Department to take.

“I wish therefore to reconfirm the Department’s position that it does not feel in a position to go outside the scope of the FOI Act and seek such information from Deputy Fitzgerald in an attempt to respond to an FOI request.”

Despite the emails, the Department of Justice did end up contacting Ms Fitzgerald seeking additional records. It is unclear what prompted this change of mind (will update if I find out more).

The former justice minister sent back a number of relevant emails, many of which had already been discovered during departmental searches of official email accounts.

Records released in response to an FOI request also reveal that when the original request was made in March 2017, two special advisers to Minister Fitzgerald told colleagues handling the request they did not have any relevant records.

An internal email said: “You will wish to note that I spoke to [Special Adviser 1] prior to the MinMac meeting this afternoon – who indicated a nil obs return and [Special Adviser 2] after the meeting who also indicated that she did not have material in relation to this request.”

Special Adviser 2 was in regular contact with Ms Prone over an extended period of time seeking strategic advice and speech-writing tips on behalf of the justice minister.

In emails to the Information Commissioner, the Department of Justice described the additional steps they had taken to discover more than 70 relevant records, which in their original decision said did not exist.

“A decision was recently taken to search the archived email accounts of the former minister and her political advisers,” they said.

“A search of the archived accounts has now been completed and despite previous assurances, a number of relevant records have now been located and the Department has retrieved material which we believe falls within the scope of this request.”

You can read the Information Commissioner decision in this important case here.

You can also see some of the records quoted here in this Twitter thread. Unfortunately, the records have not been provided in a format that makes them straightforward to scan.

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