Simon’s mad as hell... but can he root out the rot?

MAD as hell’. It’s not the choice of words we’ve come to expect from an Irish Government minister dealing with errors and failings in his own department. Promises of reviews and inquiries and investigations, yes, coded expressions of dissatisfaction with officials, for sure, glib excuses and qualified apologies, absolutely. But ‘mad as hell’?

That sounds surprisingly close to a normal human reaction to a shocking scandal, rather than a carefully scripted political response. But ‘mad as hell’ was how Minister for Health Simon Harris described himself as the worsening cervical screening debacle continued to unfold, this past week, at dripfeed pace.

Each day seemed to bring new figures for the women affected, for those still to be told that early alerts in their smears had been missed, for the margin of error within the US-based lab, for the cases pending and for the victims beyond help.

While the HSE’s handling of this wretched saga has been entirely in line with our expectations of the health authorities – to deny, to conceal, to pass the buck, to confuse – Minister Harris’s approach has been refreshingly reassuring. He could have played for time, last week, when he was asked if he had full confidence in CervicalCheck boss Gráinne Flannelly but instead he replied, ‘Truthfully, I can’t say I do.’

And he was echoing a frequent criticism of the health service, one you rarely hear acknowledged by Ministers for Health, when he added that ‘patients seem to get lost in the process’ which should have been focused on keeping them safe.

And his instincts served him well when he rang Vicky Phelan, the extraordinarily brave woman who single-handedly uncovered this scandal, to apologise for her ordeal. Whistleblowers haven’t always been able to rely on support and encouragement from on high when they’ve called out institutional failings in the past. If the top brasses picked up the phone in response to an emerging crisis, recent history suggests it was certainly not to applaud the person who exposed it.

Setting up a ‘scoping exercise’, rather than going straight down the ‘commission of inquiry’ route, suggests a conscientious minister who is more anxious to get answers than to forestall political criticism. And his decision to order a wider review of 1,500 cervical cancer sufferers not screened by CervicalCheck might well reveal many more who should also have been treated or diagnosed earlier. So far, then, so good for Minister Harris. Naturally, though, there’s a ‘but’ coming...

Notwithstanding his sure-footed progress to date, what will really define this minister’s handling of the crisis, and the true nature of his commitment to public health and safety, will be what Simon does next.

Will he appoint another Tony O’Brien to head up the HSE, perhaps picking one of his generals from within the Executive’s ranks, as the Minister for Justice did when Nóirín O’Sullivan was chosen to replace her close ally Martin Callinan? Or will he act upon the lessons of this scandal and the opportunity offered by O’Brien’s departure to make a truly radical change to the way we do health care in this country?

TONY O’Brien’s insistence that the first he learned of Vicky Phelan’s case was from the Six One News prompted widespread scepticism. But it wouldn’t be out of kilter with the dysfunction and cover-up culture that exists within the HSE. The Executive is the country’s biggest employer and covers a huge breadth of health-related and distinct divisions. Some years ago, its brief also included social work and child protection but that area was then hived off to Tusla, a separate organisation.

This may be the moment to consider breaking up the HSE, not into the regional divisions that existed under the old health boards, but rather into distinct clinically appropriate missions. It is certainly the moment to install a top tier of management with a solid commitment to transparency and candour. Covering up failings, denying errors, and dragging injured patients through the courts has not proved a very effective strategy over the past 30 years of our health service.

A ‘groupthink’ that seems to prioritise the reputation of the Executive over the welfare of its patients needs to be tackled by a fresh regime. A change in culture has to come from the top, and from a new management that simply will not tolerate staff who change notes, alter records, or advise doctors to keep quiet about awkward mistakes. These are the practices that have made the minister ‘mad as hell’, as they did the rest of us. Unlike the rest of us, though, he has a unique chance to turn that outrage into action.