The most senior Government health adviser advised against a review of CervicalCheck the day after Vicky Phelan called for an investigation into the screening programme.
Instead, Tony Holohan, Department of Health chief medical officer (CMO), urged the health minister to opt for a report which Dr Holohan himself would prepare. He advised Simon Harris that the “appropriate way forward” was to “state that you have asked me to provide a report on the matter, including whether further actions or steps are required”.
He added: “I strongly advise that you do not commit to a review of CervicalCheck arising from the recent court case.”
His warning was issued the day after Ms Phelan stood on the steps of the High Court and said publicly that CervicalCheck had essentially failed her and she now had terminal cancer.
Her solicitor, Cian O’Carroll, also made public the discovery that other women had smears incorrectly read, and, like Ms Phelan, had not been told of an audit that discovered the errors.
Ms Phelan said at the time: “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.”
Dr Holohan warned the minister that to announce a review “could unnecessarily undermine public confidence in CervicalCheck” when there was “no evidence at this stage that there are quality or patient safety concerns with the CervicalCheck programme”.
The minister ignored Dr Holohan’s advice and announced a review that day.
Speaking to the Irish Examiner last night, Ms Phelan said Dr Holohan’s attempt to prevent a review did not surprise her.
“It doesn’t surprise me one bit,” she said.
“From my experience, the approach is to try and sweep things under the carpet. There was an attempt to gag me during the court case with a non-disclosure agreement and this is more of it.
“An internal review would not have got to the bottom of what happened at CervicalCheck. An external review was essential.”
In the Freedom of Information (FoI) correspondence, the minister said he had discussed the prospect of a review with Tony O’Brien, then director general of the HSE, who believed “it would be beneficial”.
Dr Holohan’s advice to the minister is contained in an email dated April 26, 2018, the day after mother-of-two Ms Phelan settled her case for €2.5m.
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 more than 200 other women who went on to develop cervical cancer had suffered a similar fate and had been kept in the dark about the same retrospective audit, which identified errors in previous smear results.
Mr Harris yesterday announced the establishment of an ex-gratia scheme, due to get up and running shortly, where the 221 women affected can seek compensation without going to court. Payment levels will be determined by an independent assessment panel.
Ms Phelan is credited by Gabriel Scally, the man who ultimately carried out a review of CervicalCheck, with bringing the crisis into the public domain through her refusal to be silenced.
The role of senior civil servants, including the Chief Medical Officer, is to advise the Minister on the appropriate course of action. For senior civil servants to decide on the most appropriate course of action in any circumstance, they need to establish all relevant facts and information before advising the Minister. Hence, the initial advice provided by the Chief Medical Officer to the Minister for Health on 26 April regarding the emerging issues relating to CervicalCheck was to allow a short time for him and his team to establish the facts. These facts would then be used to determine what if any, further investigation was required and what action should be taken. This is the same approach as the response to the tragic deaths of newborn babies at Portlaoise Hospital, revealed in January 2014, where a report was completed by the Chief Medical Officer in three weeks. This report was strongly critical of the patient safety practices in Portlaoise maternity services and it recommended, and led directly to, a large HIQA investigation.
The advice of the Chief Medical Officer to the Minister on 26 April to conduct an initial report preceded the decision to embark upon the Scally process. It is important to emphasise that it was the work of the Chief Medical Officer, other officials in the Department of Health, and the Serious Incident Management Team established at the direction of the Department which uncovered additional facts in response to which the Scally review was put in train.
Dr Scally’s report in September 2018 affirmed that there was no evidence that the rates of discordant smear reporting, or the performance of the programme, fell below what is expected in a cervical screening programme. Dr Scally’s report was clear that the crisis arose because of a failed attempt to disclose the results of a retrospective audit to women who had already developed cervical cancer. He found no evidence of a coverup by the Department.