Elaine Loughlin: Without a change in attitudes, women will be left feeling like 'lepers'

Gabriel Scally's Cervical Check report speaks of an 'obstructive' and 'callous' system. And that's exactly it. If the attitudes underlying the State's services do not change, they will keep on making victims of patients, writes Elaine Loughlin

Gabriel Scally at the publication of his review of the implementation of recommendations of the scoping inquiry into the CervicalCheck screening programme, at Radisson Blu Royal Hotel, Dublin, yesterday. Pictures: Brian Lawless

“Culture eats strategy for breakfast,” was how Gabriel Scally put it when asked about a festering patriarchal mindset where ‘doctor knows best’.

While great strides have been made in women’s healthcare, changes which Vicky Phelan, Stephen Teap, Lorraine Walsh, and other campaigners can take much credit for, until we have a cultural shift in our healthcare system, patients will suffer. Changing culture isn’t easy. It takes time, effort, and commitment. 

As Dr Scally said: “You can’t turn it around in a year or two years.”

But without a compressive change in attitudes, women will still be left feeling like “lepers” because they speak up and join campaign groups like 221+.

Without a complete overhaul of approach, patients will never believe they are being treated as equals or as adults who have a right to be fully informed.

Co-founders of 221+, Lorraine Walsh and Stephen Teap, at today's publication of Gabriel Scally's Cervical Check report. Ms Walsh said medics' practices were asking survivors if they were members of the advocacy group: 'If they are, they’re told, unfortunately, they don’t have any spaces to take them on.' Picture: Cate McCurry/PA

Without a widespread acceptance that those who have been through the system have valid and important points to raise, those campaigning for better services, including members in the Cervical Check Steering Committee, will continue to be treated as tokens around the table, rather than full participants.

In paying tribute to the late Ms Phelan, Dr Scally stressed that the more than 50 recommendations he made in relation to Cervical Check must be implemented both in “letter and spirit”.

While some professionals and officials in our healthcare system have of course embraced change and created a supportive and welcoming environment for their patients, others will have to be dragged out of a comfortable existence which is intolerant of those who ask questions.

We are dealing with a system made up of people, which in the words of Dr Scally was at times “obstructive and callous” to women and their families who had been in some cases delivered the worst possible news.

How can the culture change if those within the system don’t fully accept the mistakes of the past? Again this was a point raised by Dr Scally in his report.

“It is, my view, entirely reprehensible to claim that in the past Cervical Check is as good as any other cervical screening programme in the world. 

If you can’t bring yourself to acknowledge past failings, why would anyone trust you today?

In the Dáil, Taoiseach Micheál Martin admitted that “cultural change is required as well in terms of absolute disclosure and candour”, adding that there has been “historic resistance” to enshrining this in legislation.

We are all human, mistakes happen, no screening service can ever pick up all cancers. We can never expect any screening programme to be perfect.

But in a just and supportive society, those in authority would want to let patients know when something goes wrong.

“What we do know from elsewhere is that if you do these things, if you tell people the truth, if you say sorry when something goes wrong, and if you tell them that you’re doing to clear up the problem to make sure it doesn’t happen to anyone else, in that case, it’s much less likely that people will seek litigation — much less likely,” Dr Scally said.

But instead of an open-minded approach to open disclosure, we must legislate to force those in our healthcare system to reveal the truth to those they treat.

Campaigners and opposition TDs have already cited serious limitations in a proposed law to introduce mandatory open disclosure and have called on the Government to amend and improve the legislation and pass it before the end of the year.

Box-ticking exercises don’t result in real change.