Greatest systems failure in cancer care, healthcare is in political system

The question must be asked of Fianna Fáil how, after 61 years in charge of the health service, they did not leave us a single-tier public health care, writes Victoria White

Greatest systems failure in cancer care, healthcare is in political system

Let’s ask ex-HSE chief executive Tony O’Brien back to implement Sláintecare.

That might go some way towards showing that we have learned from the horrendous way we pilloried him during the CervicalCheck crisis.

It really doesn’t need to be said that the main victims of this crisis are the 221 women who have so far been found to have contracted cancer following misread smears.

The horror of their situation, which no words can describe, does not, however, cancel out the need for our politics and media to attempt fairness.

In the interview published in the Sunday Business Post last weekend, Tony O’Brien shone a harsh light through the blizzard of controversy which led to his resignation last May. He says he hopes “a sense of decorum and fairness will return to Irish political life and to the mainstream Irish media. If not, it bodes ill for the future of Irish democracy and society.”

He’s absolutely right. No-one is served by running the Public Accounts Committee (PAC) like a kangaroo court. The desperate efforts of rival politicians to be the most outraged was a horrifying spectacle which did the affected women no good at all.

ex-HSE chief executive Tony O’Brien
ex-HSE chief executive Tony O’Brien

Instead, Health Minister Simon Harris’s panicked offer of a free smear test to women within the testing age-range has meant a massive backlog which may delay cancer treatment for some women.

O’Brien said he found the politicians’ refusal to allow him to express compassion for the women particularly hard.

Leading the charge was Fine Gael TD Kate O’Connell, who produced a winning soundbyte when she took issue with O’Brien’s description of the controversy as a personal blow.

“I want to make very clear to you today that this is not about you,” she said. “You are the last person that this is about.”

This is a statement which portrays O’Brien as a something between a narcissist and a sociopath.

O’Connell was, however, out-gunned by Fianna Fáil’s Marc MacSharry, who told O’Brien: “You wouldn’t last 20 minutes in the private sector and you know it.”

O’Brien’s response was to the point.

“You are causing hysteria,” he said. “You are absolutely failing to accept the reality of population-based screening.”

Fine Gael TD Kate O’Connell
Fine Gael TD Kate O’Connell

The PAC was indeed acting here as “judge, jury, and executioner”, as O’Brien told the Post’s Susan Mitchell. If “accountability” were achieved by finding someone to hang, there would be no reason for an independent judiciary.

Similarly, there would be no need for employment law if victims and those who represent them were charged with firing people they feel have impacted on their welfare. What was RTÉ radio doing asking cervical cancer sufferer Vicky Phelan if she was satisfied now O’Brien had resigned?

What really gets my goat about MacSharry’s PAC attack on O’Brien, however, is his Trump-style implied criticism of public servants as mandarins who wouldn’t last in the elite sphere of private commerce. As a Fianna Fáil deputy, I would expect him to show as much or more respect for our public service as for our private sector. Let’s remember that MacSharry was elected for the party which built the health service, to a large extent, having been in power for 61 years since the foundation of the State.

Clearly, that service has had some huge successes, given our history of poverty. However, it is interesting that O’Brien credits Mary Harney as the most effective health minister with whom he worked, out of a batch, including Micheál Martin, James Relly, Leo Varadkar, and now “frightened boy” Simon Harris.

Mary Harney
Mary Harney

It was particularly in Cancer Control, and the establishment of a National Screening Service, that Harney was effective. In a short time, from 2004 on, we went from being among the worst of rich countries for cancer survival to being one of the best.

Harney was a Progressive Democrat but from the Fianna Fáil gene pool and working with Fianna Fáil governments. The party deserves credit for supporting her.

However, the question must be asked of Fianna Fáil and of MacSharry how it came about that, after 61 years in charge of the health service, including 14 consecutive years between 1997 and 2011, they did not leave us the single-tier public health care most of us want?

If Fianna Fáil had moved on health the way they moved on education, we might be coming in at No 2 in the UN’s league for health equality, as we are for educational equality. Instead, we are last out of 36 European countries surveyed last year for ease of access to healthcare and 21st overall for our health service.

The biggest scandal relating to missed cancer diagnosis in this country is the fact that people still die of cancer here because they are less well-off. And I’m not just talking about the lifestyle factors which tend to impact more on disadvantaged communities either. I’m talking about plain old delayed diagnosis. Research carried out by the Irish Cancer Society this year found that 40% of respondents would put off going to the doctor for financial reasons.

Meanwhile, 32% feared wasting the doctor’s time and 28% were put off because they knew they would have to wait for an appointment.

Harris’s response was to say he would tackle the €55-€60 charge for a doctor’s visit in the new GP contract. What he needs to do instead is restructure and adequately resource primary care.

GPs have been tasked with providing free care to the under-sixes and they cannot cope.

They became the whipping boys in the CervicalCheck controversy after the Gabriel Scally report had cleared the HSE of conducting a cover-up and pointed to no obvious divergence between the accuracy of our tests and those done internationally.

Emma Mhic Mhathúna
Emma Mhic Mhathúna

Only one in five of clinicians concerned had disclosed the information about the misread test in the cases of the known affected women.

There was, however, no legal imperative to do so, which would have given GPs cover in imparting disturbing information to sick women and their families. That legal imperative for mandatory open disclosure could only have been put in place by the politicians.

It is in the political system that the greatest “systems failure” in cancer care, and healthcare in general, really lies. It is the political system which must take the blame for the mishandling of CervicalCheck and avoidable deaths from cancer, not just of women such as Irene Teap and Emma Mhic Mhathúna, who died of cervical cancer following misread tests, but also of the many men and women who, like Susan Long in 2007, died because the public health service made them wait too long for a diagnosis.

Only the political system can change all this. That will never happen if it keeps “monstering” what it creates, from GPs, to the board and chief executive of the HSE, to the HSE itself, in a cheap bid to win favour from the electorate at the expense of the nation’s health.

More in this section

Puzzles logo

Puzzles hub

logo podcast

War of Independence Podcast

A special four-part series hosted by Mick Clifford

Available on

IE logo

Commemorating 100 years since the War of Independence

News Wrap

A lunchtime summary of content highlights on the Irish Examiner website. Delivered at 1pm each day.

Sign up

Some of the best bits from direct to your inbox every Monday.

Sign up
Execution Time: 0.235 s