CervicalCheck: How did such a huge communications failure occur?

Public trust in Ireland’s health service continues to be eroded, writes Dr Muiris Houston

Dr Tony Holohan during a press conference in Dubolin to address public concerns surrounding the  national cervical screening programme. Photograph: Gareth Chaney/Collins

Dr Tony Holohan during a press conference in Dubolin to address public concerns surrounding the national cervical screening programme. Photograph: Gareth Chaney/Collins

 

The invitation to the press conference looked promising: “Clinical Expert Panel to address public concerns surrounding Ireland’s national cervical screening programme.”

The headline speakers were Dr Tony Holohan, Chief Medical Officer, Department of Health and Dr Colm Henry, Chief Clinical Officer, Health Service Executive (HSE).

At last, the enormous public concern around the CervicalCheck scandal would be addressed comprehensively by doctors with inside knowledge of what had happened.

The women of Ireland, in particular, might now understand how a health service communications failure of such magnitude occurred.

The continuing haemorrhage that is the serious loss of public trust in the Republic’s health service might be staunched, if not stemmed.

However, it seems the main purpose of the exercise was to explain, in detail, how the elements of our cervical screening system are functioning well.

And we are grateful to Dr Holohan, Dr Henry and the other experts for this reassurance. But, while they acknowledged a communications failure had occurred, the issue they primarily addressed is not the one of most “public concern” to the thousands of women who have participated in CervicalCheck.

Kept informed

That issue, centrally and simply, is that patients were not kept informed about ongoing developments concerning their personal health. In an era of open disclosure, which the department and the HSE committed to publicly some years ago, excluding patients from personal health information makes absolutely no sense.

It’s as if the first page of ‘open disclosure 101’ had been torn from the training manual.

Alarm bells concerning duty of candour do not seem to have rung for Dr Henry, who confirmed he knew about women with cervical cancer not being told about past false smear test results since last August. He said he regretted not escalating the issue up the chain of command.

In the past, Dr Holohan advised Taoiseach and former minister for health Leo Varadkar, against a policy of mandatory open disclosure to patients. He confirmed there were policies and procedures in place in the Department of Health that fully supported open disclosure.

However, it must be said that, if duty of candour legislation had been introduced here, as it was in Britain in 2016, then professionals in the health service would have incorporated open disclosure into everyday practice.

Quite separate to legislation, the 2016 Medical Council ethics guide is crystal clear about a doctor’s ethical obligation to practice prompt open disclosure. “Patients and their families, where appropriate, are entitled to honest, open and prompt communication about adverse events that may have caused them harm,” it states.

Grossly inefficient

Communication failures surrounding CervicalCheck and other scandals illustrate how poorly information flows throughout the health system.

More than a week after Vicky Phelan brought the cervical cancer issue to public attention, a grossly inefficient HSE is still unable to provide definitive numbers, and in some cases, the names of women, caught up in the fiasco.

Much of the loss of public trust which has now come to a head is generated by the repeated failures by Department of Health and the HSE to get the basics of health service provision right. There’s little point in aspirational quality initiatives around “placing the patient at the centre of care” if the reality doesn’t become part of everyday practice.

There is a strong sense that the events of the last week have breached a line in the sand as far as the public is concerned. And so they should.

We are spending €15 billion a year on a health system that is disjointed and unbalanced.

The HSE is a failed entity. And it’s high time that civil servants in the Department of Health fronted up and got their hands dirty in response to our serious national health crisis.