Gynaecology services ‘on back foot for long time’

Gynaecology services have been “on the back foot in Ireland” for a long time, with women, often elderly, left “sitting on waiting lists” with debilitating conditions such as prolapsed wombs, according to the first female chair of the Institute of Obstetricians and Gynaecologists.

Cliona Murphy, a consultant obstetrician/gynaecologist at the Coombe Women and Infants University Hospital and Tallaght Hospital, said consultants receive “piles of referral letters from GPs every week”, trying to access gynaecology services for their patients at a time when the outpatient waiting list figure is close to 30,000.

“We need to look at how services are structured,” said Dr Murphy.

“Gynaecology is seen as elective and you can have women with prolapsed wombs [where a pelvic organ bulges into the vagina], often elderly, sitting on waiting lists, dealing with a huge quality-of-life issue.

“You have post-menopausal women, who don’t tend to be vocal about their conditions, on a waiting list. I do strongly feel we need to be looking at this area.

"One of the problems is that we don’t have a centralised waiting list. If we did, we could see which hospitals within hospital groups had shorter waiting times.

"We also need to be more creative around models of care, we need to see can we be doing more in outpatients.”

Dr Murphy, who takes over the chain of office at the institute’s AGM from Dr Peter Boylan today, said she doesn’t wish to characterise the health service as being “anti-women”.

Nor does she believe the patriarchal attitudes towards women, revealed in the recent Scally report on CervicalCheck, are representative of all of her male colleagues in the area of obs/gynae.

“I would hate to think the comments [by women who took part in the Scally report] were reflective of the speciality as a whole. I know many of my colleagues are very woman-centred,” she said.

Dr Murphy said the institute will be “very supportive” of the expert panel review of CervicalCheck currently being conducted by the Royal College of Obstetrics and Gynaecology.

RCOG published the review protocol this week which outlines how it intends to examine 1,856 cases and to determine which cases of cervical cancer, that occurred since the establishment of CervicalCheck in 2008, could reasonably be attributable to errors in screening and reporting of cytology.

A determination will also be made as to whether such errors affected the treatment and outcome.

In cases of cervical cancer registered since the inception of CervicalCheck in 2008, all preceding slides taken within the CervicalCheck programme will be reviewed and read blind to the original report.

This is to avoid review bias, which can occur when the reviewer already knows the patient has developed cancer.

Dr Peter Boylan

The RCOG review is part of a broader investigation of problems within the national cervical cancer screening service where it emerged earlier this year that at least 221 women had received incorrect smear test results.

RCOG said a summary in standard format will be prepared for every woman who was in the review stating whether her cancer was considered preventable had cytological abnormalities not been missed.

“These summaries will be offered to each of the women, should she wish to receive it, and such information provided where relevant, within the context of ‘receiving bad news’ and provided by the woman’s practitioner in a sensitive and professional manner,” says the protocol.

Taoiseach Leo Varadkar said last May that the audit would take six months.

The timeline continues to be six months, but from what date remains unclear.

Dr Murphy said it is “better [for RCOG] to do it slowly and do it well rather than rushing it”.

Dr Murphy said there are a number of issues she intends to focus on during her three-year tenure as chair of the institute, including recruitment and retention of doctors and strengthening links with midwifery colleagues.

“I want to get rid of the silos that exist [between midwives and consultants]. We need a more collaborative approach,” she said.