Unless those who did the wrong thing are truly held responsible, this will just happen again

THE trauma and heartache of the individual stories of women and their families will stay long in our collective memory – long after the headlines and leaks of this week’s Scally scoping report into the cervical cancer debacle.

The report’s lengthy recommendations on how to rebuild the screening programme and instil international best practice are welcome, but recommendations from official reports do not always find their way into the real world; those who make them never have to worry about making them happen or how much the effort will cost.

What we will never know or understand is what really happened in the backrooms of responsibility for this programme with an annual cost of €24million. Gabriel Scally makes clear in his first page that the system was ‘doomed to fail at some point’ and that the problems uncovered are ‘redolent of a wholesystem failure’.

What was the chain of command and the flow of information that produced such an extraordinary series of thoughts and decisions that led to women being kept in the dark about their own health? How could they not have been told as soon as it was known that they had received the wrong result, that instead of being clear as they had been told, that their original smear tests had shown some abnormality which had been misreported? Were they not entitled to know – the smear test was their test, of their bodies, of their health and not just a statistic in an audit report.

Audits

Apparently not! Legal documents which emerged when the scandal first broke show that the HSE told the Department of Health privately that the ‘outcomes of clinical cancer audits were used by CervicalCheck for education and training purposes only’.

In other words, the HSE was ignoring the audit as a potential tool for enhanced accountability. When Vicky Phelan took on the US testing laboratory in the courts, she did not know that the HSE already knew – and had known for three years – that her original smear test had not been clear, as she had been told. They knew and did not tell her.

As a society, we all still fear cancer, even though more people survive it now than at any time since cancer records were established. Everyone knows one person – or more – who is ill with cancer or who have already died from some variation of its many manifestations.

Cervical cancer is serious. Across the world, it ranks as the second biggest cancer killer of women. The International Journal of Cancer notes that this form of cancer is more prevalent in poorer countries and in ‘hard to reach’ groups.

Yet Irish data shows it is also the second biggest killer here, even though this country is a wealthy one, with fewer socalled ‘hard to reach’ groups. It is a serious challenge, with more than 90 women dying every year; that’s close to two deaths each and every week. So, good screening matters and authorities know this and know that it saves lives. They must know, too, that they are being watched and included in data from across the world and Europe, data which continues to show Ireland is nowhere close to the top of the cancer survival rate table.

None of this appears to have urged on any real sense within the HSE that holding people to account for their actions will enhance performance – across the piece. The HSE is the bastion of health care for the country and if anything, its levels of accountability ought to be higher, sharper and more honed than in any other public sector organisation because actual lives are at stake. So far, there is no public evidence that anyone – high up or low down or in the middle – has been specifically held accountable for decisions made or avoided in this saga.

Cancer patients, more perhaps than in any other area, need to be able to trust the health service that professes to take care of them. They need to believe that everyone along the chain of command is rooting for them, wanting them to survive and to be healed – if it’s possible.

All the daffodils in the world and all the coffee mornings to raise money for cancer equipment and research fades to nothing if patients do not trust their own health service to take care of them. Gabriel Scally and his team were brought in from the UK to produce a scoping inquiry, to try to offer some prompt solutions to a mess which took some years to develop and involved lots of parties and the usual queue of self-styled stakeholders.

Government wanted quick concrete recommendations to help restore what the HSE itself referred to rather lightly as ‘a breach of trust’. Scally is a doctor, not a detective, albeit one with lengthy experience in the UK of public health policy. His task was not ‘whodunnit’ but more ‘neverdunnitagain’ – an analysis of errors to show how to put the Irish screening programme back on its feet and make it fit for purpose, with robust methodologies and examination systems.

Blinded

Scally was not asked to dig into the murkier and more difficult ‘accountability’ files; had he done so, he would still be buried knee deep in testimony and conflicting evidence. He had quite enough on his plate to try to plot a path through years of files and records, and thousands of documents, all the while trying to ensure respect for those women who had died or who are ill and equally trying not to be blinded by the glare of publicity.

Yet, Scally’s observations on the difficulty of getting hold of certain documents from relevant organisations and the fact that some documents were soft copy only and hard to read, is enough of a hint that the background story of accountability is just as important as the foreground story of better screening and better management of screening.

For the author of a document like this to concede that he himself felt ‘ashamed’ that these events had happened at all is quite startling, especially as Gabriel Scally was working in a different country when these events unfolded.

He can say this because he has seen the whites of the eyes of those who were involved and those who suffered. He knows where and when some of the most serious mistakes were made.

However, Dr Scally desperately wants the patient/doctor trust system, the basis of all good medicine, to be restored and he believes that it can be done if, what he describes as a ‘major cultural shift toward open disclosure’ can be encouraged. He wants to move on, not look back, hence his proposal to avoid a commission of inquiry

Such open discloure and real accountability cannot be pulled rabbit-like from the hat of goodwill and fine words, and this clear, well written and prompt report can’t make that happen either. Yes, implement Scally’s urgent and necessary recommendations – for the future of the healthcare system and for women’s lives. But individual and collective accountability cannot be allowed to slip under the radar while that happens. If they do, the outrage, shame and sorrow produced by today’s document will evaporate, as it has done in previous scandals. A commission of inquiry may not be the right tool, but the job still needs to be done.