HSE has passed point of reform, the only way to restore trust and accountability is to start over
ENOUGH is enough. Isn’t it time we did a PSNI on the Health Service Executive (HSE)? The more you learn about its top tier, the more you realise this monolith has an inherent resistance to reform – it should be disbanded and remodelled from scratch.
Public trust has collapsed and will not be regained easily. That’s because the HSE’s track record for transparency and accountability stands exposed as woeful; its culture is one of secrecy, obfuscation and denial.
After the cervical cancer scandal erupted, we were told this time it would be different. But cooperation continues to be limited. Obstacles to the truth are being erected still. Dying or seriously ill women are obliged to take the legal route just to access their own data.
Again and again, when mistakes are uncovered, the HSE looks apologetic and promises full compliance with investigations
– but its words and deeds don’t correspond. It says one thing and does another. Why should we expect anything different now?
So it is that between 80 and 90 ill or dying women are forced to go to the High Court to have their smear test slides released – information denied to them by the HSE, using legal protocols against people who have been wronged already. We can all agree that some mistakes are unintentional. But this is far from accidental, it smacks of policy. Unforgivable policy at that. And it’s happening in our name.
Alan Kelly, vice-chair of the Public Accounts Committee, describes it as “absolutely embarrassing and disgraceful”, not least because the women are entitled legally to the information. The TD has publicly questioned the HSE’s motives.
All sorts of delays leading to missed deadlines have been revealed. Dr Gabriel Scally’s scoping inquiry is being hindered because of documents redacted or kept back by the HSE, and he is unlikely to make his August deadline. If he does, a section of his report will be missing. The HSE has an obligation to provide him with the information he requires – but, reverting to type, it is throwing up barriers.
As for the external, independent assessment of 3,000 smear test slides which was meant to have reported by the end of May, it hasn’t even begun its work yet. Now it looks like lasting for six months, although we don’t even have a new start time for the review so the completion date is unknown.
What we do know is the cervical cancer scandal began in a grim way, and no improvement lies in sight. The number of women left in deliberate ignorance about their diagnosis has risen by a dozen, to 221 – probably not the final total.
So, to recap, women with cervical cancer have been blocked from accessing their own data by an arm of the State; more women are added to the misdiagnosis tally; report deadlines have been pushed back; and general progress is at a snail’s pace. Time appears to be unimportant.
Except to the women with terminal cancer. Emma Mhic Mhathúna was told a few days ago that the disease has spread to her brain, and she can expect seizures and loss of speech. She has coached her older children about what to do if they find her in the middle of a convulsion. To die at 37 when you have five beautiful reasons to live, including a child of two years who may not remember you, is a horrible fate – even more appalling because it was avoidable.
Her “death by negligence”, as she calls it herself, should be answered for – yet deadlines set to provide answers are written on sand. Isn’t it time someone was held to account?
On April 25, Vicky Phelan settled her case and refused to sign a gagging order – the first indication about something blighting hundreds and maybe thousands of citizens’ lives. She went public more than two months ago. There is little progress to report, however. Simon Harris says a huge body of work is involved and it’s important to get it right. Indeed, it is. But acting on a sense of urgency also matters.
These women deserve a government that’s strong and proactive in protecting their health and interests. We have heard plenty of strong and proactive sounding talk. But achievements are thin on the ground.
AT least the Health Minister has brought his Patient Safety Bill to Cabinet, designed to make open disclosure mandatory in the case of serious medical mistakes, both for hospitals and individual medics. The Cabinet approved it on Thursday, had it published and sent it to the Oireachtas Health Committee; discussion there will be followed by debate in the Dáil and Seanad. Cross-party support means open disclosure will be obligatory hopefully by the end of the year, unless a general election intervenes.
Despite the political will to achieve results, the HSE continues to get away with prevarication. Here we have an organisation paid for by the Exchequer and answerable to the Health Minister – but behaving as if accountable only to itself. It is intolerable.
The truth is we are rather poor at forcing politicians to live up to their promises. A week after a pledge is made, nobody remembers it. But here’s one undertaking to which we must hold the Health Minister: a Commission of Investigation into the cervical cancer scandal is meant to be set up in September. That’s a deadline which can’t waft away unmet. And what of its deliberations – will they be public or private? A need to restore confidence would suggest the former.
How quickly will it reach conclusions? How fast will they be acted on?
In the aftermath of Ms Phelan’s bombshell, the Taoiseach has said he is pursing four goals: care, truth, accountability and confidence. One hopes the care packages for the women are sufficient. But what of truth, confidence and, above, all accountability? Thanks to an utter lack of pace from the HSE, and its reliance on smokescreens and legal hurdles, those three goals are in danger of drifting. Women with a drastically curtailed life expectancy deserve better.
Elsewhere, other women have learned to doubt cervical cancer screening despite the crucial work carried out by the service, yet another negative repercussion from these cases.
To err is human. But the HSE has gone astray once too often, not by making mistakes but because of its failure to learn from them. A climate of distrust between the health body and the public has developed – the HSE has passed the point of reform.
Time to start over.
The HSE behaves as if accountable only to itself. It is intolerable