Cancer scandal response heaping failure on failure
THE Government is making it up as it goes along when it comes to the CervicalCheck scandal – and inflicting huge damage on the nation’s cancer screening programmes in the process.
“We promised that because that’s what we wanted to happen,” said Health Minister Simon Harris on Thursday, explaining why a pledge that women caught up in the CervicalCheck controversy would not be forced into court rooms was broken.
It was a throwaway line that explains much of what has gone wrong. The Government, faced with a constant stream of bad press and mounting public anger in late April and early May, wanted to try to manage the mess. To change the narrative from ‘Government in crisis’ to ‘Government decisively taking action’.
So, they made promises. Lots of them. To the women affected, their families and the public. Without doing much, or indeed any, consultation with those charged with fulfilling those pledges on their behalf.
Dr Gabriel Scally, for instance, was tasked with undertaking a scoping review so wide-ranging and exhaustive that there was never any realistic prospect it would be completed by the Government’s arbitrary deadline of the end of June. Worse, the Government imposed this extremely tight timeframe without bothering to ensure that State bodies under its control would fully co-operate with Dr Scally and his team.
So, even as the Health Minister was assuring the public that the review would be completed on time, the HSE was stalling on sending important documents to Dr Scally – or sending documents in an unreadable and unsearchable format.
Mr Harris later dubbed the behaviour of the HSE “pathetic”, but as the minister overseeing that organisation, the buck stops with him and failures within the system he manages are his own failures.
Announcing a succession of reviews and reports, and letting other people deal with the logistics of trying to deliver on time, has been the hallmark of this crisis.
An independent review of smear tests, conducted by the Royal College of Obstetricians and Gynaecologists, was supposed to be completed by the end of May. It hasn’t even started yet.
In the immediate wake of the scandal, the Government promised every woman who wanted one a free repeat smear. It has now transpired the backlog caused by this increased level of screening – some 57,000 screens and counting – may mean many samples expire before they can be read.
Samples have to be read within six weeks or the screen must be repeated. The ‘Sunday Business Post’ reported at the weekend that the turnaround time has increased from four weeks to eight weeks, with GPs not getting results for up to 12 weeks.
Making hasty commitments, without ensuring there was either the time or the resources to deliver, gave the Government some brief respite from an incessant deluge of criticism. It gave it some breathing room.
But, in the long term, this is failure on top of failure. It only further erodes public confidence in the screening programme. And, in the Government’s ability to successfully manage the crisis, which is now leaking into other screening programmes including BreastCheck.
How is a woman, concerned enough to subject herself to an additional smear, supposed to have faith in a system which cannot even read the sample in time? How are labs coping with all of the additional workload?
Mr Harris has said the labs have “brought on additional staff, commenced overtime and tapped into their wider organisation for assistance” – whatever that latter part means.
Further, how much is all of this costing the State? As well as the Scally review and the independent review of smears, a public inquiry has been promised.
To date, two redress schemes have been mooted. One within a week of the scandal breaking, to compensate women for not being informed of the audit of their smear, and the other last week, when the Government finally conceded it was unable to stop labs defending cases where they didn’t think their staff had been negligent.
High Court judge Charles Meenan has now been given two months to try to come up with a system that will do justice for all of those involved, without the need for women to go to court. It will be a difficult job, because establishing negligence in a “non-adversarial” way, as Mr Harris says he wants to do, will be extremely difficult when perhaps hundreds of millions of euro are at stake.
Solicitor Cian O’Carroll, who represents Vicky Phelan and some of the other women involved, said last week that the cases that have thus far come to court are just the “tip of the iceberg”.
He has also stated that negligence was involved in the “vast, vast majority” of the cases of the 221 women affected – a claim that has been rejected by the Department of Health.
This, ultimately, is the heart of it, the question of negligence.
The truth is, we don’t know whether negligence was involved in all or even most of the cases.
The only way this question can be settled is with facts. Facts the Government won’t have until Dr Scally reports and the independent review of smears is completed.
At least then we will know if there was a higher level of negligence in the Irish screening programme than other comparable schemes. There will be expert independent opinion which either bolsters Mr O’Carroll’s position or that of the Department of Health.
The Government will finally know what it is dealing with. Is it grappling with a systemic failure within the screening programme or a level of false positives that is commensurate with other screening programmes across the world?
Because, to date, the Government, in promising to immediately settle cases and pursue the labs later, has made an effective admission of liability, impugning the reputation of the screening programme before there was any evidence that anything was wrong.
It has now, belatedly, tried to defend that programme – with Mr Harris, in an interview with RTÉ last week, constantly reiterating that screening was not diagnostic and cannot detect all cancers.
But, after more than three months in which the screening programme was traduced by both Government and Opposition TDs, many of whom have been equally irresponsible in their comments, it remains to be seen if it can recover from the damage.
Hasty commitments gave the Government some brief respite from an incessant deluge of criticism