VICTORIA WHITE: Offers of compensation and efforts to apportion blame not the answer

Emma Mhic Mhathúna. Picture: Domnick Walsh

I wish Harris and Varadkar would face the forest on fire behind them, a dysfunctional, two-tier health service, writes Victoria White

terminally ill mother of young children is a crime which cries out to heaven for vengeance.

That doesn’t necessarily mean there’s a criminal.

From the moment that Gabriel Scally’s recommendation in his Scoping Review that a statutory inquiry not be held, there have been howls of “white wash” from elements of the media and the opposition.

Only a statutory inquiry can name names, they say. But there may be no names to name and even if there are, naming them at a cost of perhaps €500m is not going to offer Irish women the most protection against cervical cancer going forward.

Although a Royal College of Obstetrics and Gynaecology-led review of the screening slides is still pending, Scally’s initial review sees no obvious cause for concern in the management of any of the laboratories currently used by CervicalCheck to process smear tests.

What Scally gives us, instead, is a lucid account of problems in one screening service which are redolent of what he calls “whole system failure” in our health service.

Scally is clear that “an injustice” was done to all those women — 161 in his report, and counting — who developed cervical cancer after an incorrect smear test about which they were not told.

The HSE’s policy and practice on disclosure were a mess.

In theory, disclosure was mandatory but there was provision for clinicians to make judgement calls about disclosing to certain patients and they were not required to justify those judgement calls to anyone.

The excellent practice, initiated by CervicalCheck, of auditing previous tests undergone by women who went on to develop cervical cancer, did not include clear guidance on disclosure.

Dr Gabriel Scally
Dr Gabriel Scally

Clinicians were to contact the affected patients, in line with best international practice. What was out of line with best practice was that one in five of them opted not to disclose.

Surely deep cultural issues are here exposed: the paternalistic nature of the medical establishment and poor training on wider aspects of patient care?

Scally makes the clear recommendation that open disclosure should be made law. That law should be on the drafting table by next week so cervical cancer sufferers can see a positive result from the entire CervicalCheck debacle.

Scally’s report underlines the psychological importance of respectful and open disclosure.

What the affected women have needed since this scandal broke is exactly what ill-used patients of all kinds need everywhere: to be told what happened and why; for someone who was involved to say they are sorry and mean it; and to be assured this won’t happen again to anyone else.

If this humane response were mandatory within the health service it would become automatic and far fewer legal claims would ensue.

The Taoiseach came out in the summer promising a scheme of redress for all the women whose cancer was not detected by Cervical Check “beyond normal error” and for all those women who were were not informed of previous false negative smear tests before they developed cervical cancer.

Leo Varadkar and Simon Harris
Leo Varadkar and Simon Harris

Aside from the difficulty of ascertaining what errors are “normal” and which are “abnormal”, I don’t believe this is the best way to proceed either for the affected women or for Irish women present and future.

As cervical cancer victim and mother of two Vicky Phelan said after being awarded €2.5m in damages by the High Court last Spring, “There are no winners here.” Money will not buy back the lives of the beautiful women who have been lost to this disease. In a properly working health system, it would not be the ingredient which buys affected women more time, either.

An award of €7.5m should not be necessary to educate and provide for Emma Nic Mhathúna’s five precious kids in a properly functioning welfare state.

The culture of compensation feeds the idea that horrendous diagnoses are crimes committed by named criminals. More falsely still, it feeds the idea that the wrong can be put right.

Worst of all, it divides sufferers into those who can name their criminal and those who can’t.

A Martian listening and watching Irish TV would form the consoling view, in recent days, that there is only one lovely mother who is terminally ill with cancer in this country and she is called Vicky Phelan.

There are thousands. There will be thousands more.

Are they, then, the mothers who have the “wrong” cancer? The mothers who don’t need childcare, transport, advanced medical treatment and — God forbid — care and education for their children if they don’t make it?

The worst scandal concerning Cervical Check is that free cervical screening was only introduced in this country in 2008, when such a scheme had been available in the neighbouring UK since 1988.

It is impossible to calculate how many Irish women lost their lives to cervical cancer while government after government dithered and dilly-dallied about introducing a free scheme. They are the women most wronged by our cervical screening system.

It will be not be an adequate result for Vicky Phelan and her fellow suffering women if Gabriel Scally’s piercing spotlight is deliberately angled by the Government to focus only on the detail of their particular cases.

StephenTeapand Vicky Phelan
Stephen Teap and Vicky Phelan

It is clear from his report that the use of the health service as a hot potato which can be put to use as a political football is far from limited to this case and has made system failures likely.

In particular, Scally makes the very serious finding that the dissolution of the HSE board, which to my mind was nothing more than a shamelessly populist election stunt badly performed by Fine Gael, increased the level of risk in the organisation.

Scally states baldly that the abolition of the board was a “major move away from the established norms of good governance of public bodies”.

He adds that “the net effect was to remove external, independent input into the running of the HSE at the highest level.” That this abolition was mindless vandalism is made clear when you consider that the Risk Committee which had been established had no board to which it could report.

Was it the dawning realisation that the board’s abolition would feature in relation to Cervical Check which led Varadkar and Harris to suddenly announce soon after Vicky Phelan won her award that they were going to appoint a new one?

I don’t know. But I do know I wish that Varadkar, Harris and their Government colleagues would stop trying to put out every fire with offers of compensation and efforts to apportion blame instead of facing the forest which is on fire behind them: a dysfunctional, two-tier health service which no-one in Ireland wants and an excellent cross-party Sláintecare reform plan which middle-aged adults like me believe they will never see.

More on this topic

Simon Harris accused of 'moving the goalposts' on CervicalCheck reviewSimon Harris accused of 'moving the goalposts' on CervicalCheck review

Cytopathologist apologises for smear test misinterpretation to woman who had hysterectomy Cytopathologist apologises for smear test misinterpretation to woman who had hysterectomy

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