In the chronicles of CervicalCheck, April 25, 2018 will be remembered for all the wrong reasons.
It was the day a 43-year-old Limerick woman publicly called out its failings, not as a screening programme, but as an agency unable to communicate honestly and openly with the women whose health it professed to protect.
Having settled her case, Vicky Phelan stood on the steps of the High Court, and told reporters: “To know, for almost three years, a mistake had been made and I was misdiagnosed, was bad enough, but to keep that from me until I became terminally ill, and to drag me through the courts to fight for my right to the truth, is an appalling breach of trust.
“I truly hope some good will come of this case and there will be an investigation in the CervicalCheck programme, as a result of this.”
Ms Phelan sued after it emerged her 2011 smear test, which showed no abnormalities, was found, in a 2014 audit, to be incorrect. She was not told of the audit until 2017.
As a result of her court case, it emerged other women who went on to develop cervical cancer had suffered a similar fate.
Neither had they been told of the retrospective audit, which identified errors in previous smear results.
When Vicky Phelan stood on the steps of the High Court, she was aware, from court documents, that 10 to 15 more women were in a similar position to herself, although the true scale of the number affected was yet to emerge.
When her solicitor, Cian O’Carroll, revealed that Ms Phelan was not the only victim, there was intense media interest and an immediate public outcry, with widespread support for Ms Phelan’s request for an investigation.
The reaction of the Government’s most senior health advisor was to let him handle the matter. Above all, Health Minister Simon Harris should not commit to a review.
“I strongly advise that you do not commit to a review of CervicalCheck, arising from the recent court case,” Dr Tony Holohan warned in correspondence to the minister, obtained by the Irish Examiner under FoI.
The “appropriate way forward”, the chief medical officer (CMO) said, was for the minister to “state that you have asked me to provide a report on the matter, including whether further actions or steps are required”.
Dr Holohan said there was “no evidence, at this stage, that there are quality or patient safety concerns with the CervicalCheck programme” and to announce a review “could unnecessarily undermine public confidence in CervicalCheck.”
Dr Holohan’s advice, of April 26, 2018, the day after Ms Phelan made her plea, was “noted”, but ignored by Mr Harris. He announced a review later that day.
Dr Holohan was right to express fears about undermining public confidence in the national screening programme, but the cat was out of the bag. The public knew something was up, and wanted, rightly, to know more.
The drip feed of information over the next few months, as the circle of women affected gradually widened, was one of the most damaging aspects of the whole debacle. The release of a series of memos, showing a strategy of containment and suppression when communicating with women regarding audits of their smear tests, was a particular low.
In the end, the report produced on foot of the review that Dr Holohan had resisted turned out to be a watershed moment in Irish healthcare.
Instead of the usual whitewash, we had a report unafraid to criticise. We heard, inter alia, that there were serious gaps in governance of CervicalCheck; that clinicians had failed to live up to a policy of open disclosure, and that there is a culture of paternalism in the health service.
The report, by Dr Gabriel Scally, gave Vicky Phelan a special mention. Because of her “extraordinary determination”, women had learned what CervicalCheck had hidden from them.
The report came with 50 recommendations, and the prospect of a fit-for-purpose screening programme is now very much on the cards.
Had there been no review, as argued by Dr Holohan, where would we be now?