Martina Devlin

Scally Report tells same old tale of individuals facing injustice if it suits the State’s purpose

TRAGEDY, scandal and widespread public anger – that’s what had to happen before lessons could be learned. Painful, personal testimony – that’s what had to be shared. Individuals dealing with terminal illness were obliged to show sheer grit, going to court and speaking up about it afterwards.

Fumbling in the greasy till can no longer be the default position. The State must place itself on the side of wronged citizens. It cannot allow its agents to engage in cover-ups to control reputational damage or adopt a lawyer-led approach to limit financial liability.

The State and its entities need to follow the example shown by the people at the heart of the cervical cancer outrage: show empathy for others. Their openness contrasts with the lack of transparency evident in State bodies involved, from CervicalCheck to the Health Service Executive to the Department of Health.

Beyond doubt, the HSE needs a radical overhaul. Fault lines are exposed in it by accounts in the Scally Report about how women with mistaken smear test results were treated.

We are indebted to decent individuals turned by circumstances into public advocates – they have shone light into dark corners. Yet what we learn isn’t new. The same theme can be identified in earlier cases, from the Brigid McCole blood contamination scandal to symphysiotomies to Magdalene laundries. It boils down to allowing individuals to experience injustice if it serves the State’s purpose.

Just five months ago, Vicky Phelan harnessed public anger when she stood outside the Four Courts and told her story.

The mother of two resisted pressure to sign a confidentiality agreement after the State and a US laboratory settled with her. She wanted us to know what was happening in our names, and was convinced others should not have to endure a similar experience. “It was just the right thing to do,” she said later.

Doing the right thing. It’s something to which most individuals probably aspire. Yet a pivotal organisation in the State – the HSE – views things differently. The Scally Report is a chilling inventory of how an organisation funded by public money saw fit to prioritise protection of the system above responsibility to the people it existed to serve.

Compassion for other humans has motivated Ms Phelan, Emma Mhic Mhathúna, Lorraine Walsh and other women affected. Similar fellow feeling was absent from many of the clinicians involved in – finally – giving information to patients, judging by Dr Gabriel Scally’s findings.

The women, along with Stephen Teap and Paul Reck who lost their wives to cervical cancer, had to speak to the people before the State was willing to be answerable. Accountability isn’t something it does readily. That has to change. It has been caught out by the persistence of the women and their families, and by public reaction to the cervical cancer scandal – by the momentum it has caused.

As for the HSE, risk management was taken to extremes with patients’ rights subordinated to the mammoth corporate. Heads have rolled there and within CervicalCheck. Perhaps too few – public mistrust towards the HSE has not abated. And what of Department of Health senior officials? Weren’t some of them complicit? They knew about the policy of denial.

CervicalCheck is an important service which has saved lives. Mistakes happen – no testing is 100pc accurate. But it’s how errors are dealt with that matters; the evidence here points to a need to strip down and reassemble the cervical screening programme.

CervicalCheck ignored the HSE’s own policy on disclosure, telling doctors they could be selective about passing on infor- mation to patients. Let’s not forget its June 2016 memo to consultants, shared with the Department of Health, suggesting that while open disclosure was good in principle, “there are limitations to its universal implantation”. Is it any wonder three in four clinicians chose silence?

However, there is a reason why doctors did not engage voluntarily. Fear of legal consequences deterred them. Doctors are burdened with enormous insurance premiums, a situation which must be considered anew – there has to be some way of factoring in errors without crippling law suits. But what cannot be roped in is concealment.

Some of the comments from women in the Scally Report refer to paternalism. It notes that “most of the doctors involved in the disclosure (or non-disclosure process) were male”, and this – in tandem with the way they felt treated – provoked concerns about “paternalism”.

‘Accountability isn’t something the State does readily. That must change. Let’s see the public interest put first. It’s never too late...’

Unfortunately, there is a great deal more than paternalism wrong with the HSE. The fault lines are persistent, pervasive and pernicious. Empathy has fled the system, as has its raison d’etre – to serve people. If it is acceptable to leave frail, elderly people on trolleys in A&E wards for days, why should we be surprised when clinicians begin seeing numbers instead of people?

Generous budget allocations for the HSE appear to have no impact on mounting waiting lists. Currently, more than 48,000 children are waiting for a doctor’s appointment or treatment.

No wonder people fret about high levels of bureaucracy.

From the ground up, excellent and committed staff work in the HSE. But it is constructed so that they serve the organisation first and patients second. Threats to the system are dealt with callously, judging by the cervical cancer cases.

The Scally Report is proof that the HSE must undergo a radical overhaul. A quick fix won’t work – a top-down cultural change is essential. The cervical cancer shambles wasn’t an isolated fault but the failure of its entire governance and supervision systems.

Something else has emerged from Scally. Women have noticed the pattern for some time and now more men see it, too. It’s the casual way women are treated – even in life and death situations.

Dr Peter Boylan says there have been too many instances in Irish healthcare where women have been let down, and he recommends ringfencing women’s healthcare budgets to separate them from hospital budgets.

The Scally Report also reveals that women were hurt by the hurried or insensitive way they were told about inaccurate smear results. Belated information was given in ways ranging from “unsatisfactory and inappropriate to damaging, hurtful and offensive”. At the launch of the review, Dr Scally described how one woman’s family was told “Nuns don’t get cervical cancer” – a reference to their chastity. “It’s verging on misogyny,” he observed.

The report contains 50 recommendations. The onus now is on Government to implement them. While I believe Simon Harris is doing his best, we also know that lobbying can affect outcomes – pressure was applied by medics and senior officials last year and Fine Gael watered down moves to introduce mandatory open disclosure, with Fianna Fáil abstaining.

Vested interests led to citizens being failed then – this time, let’s see the public interest put first. It’s never too late to do the right thing.