Scally scathing of ‘whole-system failure’ in cervical screening

System ‘doomed to fail’ due to ‘demonstrable’ governance deficit, report says

Dr Gabriel Scally has published a 200-page report into the CervicalCheck scandal. The report says the current policy and practice in relation to open disclosure in the health service was “deeply contradictory and unsatisfactory”. Video: Bryan O'Brien

 

Trust in doctors will be damaged “for years” over the failure to inform women about issues with their smear test results, a woman affected by the CervicalCheck controversy has said.

Lorraine Walsh, one of the 221 patients caught up in the debacle, made the comment after the publication of the findings of a scoping investigation by Dr Gabriel Scally, which she described as “very distressing”.

Dr Scally’s report concludes that “a whole-system failure” meant women who had been diagnosed with cancer were not told about subsequent audits which showed their past smear tests were incorrect.* 

He said the disclosure of the findings of the audits to the women concerned was handled badly and was responsible for much hurt and anger.

Male dominance

The report includes scathing criticism of the medical profession, with male dominance in the healthcare sector coming in for scrutiny as the affected women pointed out that most of the doctors behind the failures to disclose information to female patients were men.

“The point was made that many of the major controversies about maltreatment of patients or denial of reproductive rights in the Irish healthcare system have involved women being damaged,” says the report.

“Why does it always happen to women?” one woman said to the scoping inquiry. “I think there is a history of looking at women’s health services as being secondary,” said another.

“Women and women’s rights are not taken seriously,” was another comment made to Dr Scally.

A Northern Irish veteran of the British public health sector, Dr Scally said the screening system was “doomed to fail at some point” due to a “demonstrable deficit” of clear governance and reporting lines between CervicalCheck, the National Screening Service and Health Service Executive management.

The review says that a situation where an organisation “can be allowed to impede the speaking of truth to patients in relation to their healthcare is totally unacceptable”.

Crucial importance

However, Dr Scally says the continuation of cervical screening in the coming months was of crucial importance. “My scoping inquiry team has found no reason why the existing contracts for laboratory services should not continue until the new HPV regime is introduced.”

He also notes that he is satisfied with the quality management processes in the current laboratory sites used as part of the screening service.

Responding to the report, the HSE said it wished to reiterate its “deepest apology” to the women and families affected.

“We further accept that the manner in which women were told was inconsistent and in many instances ill-judged and poorly handled.”

Dr Scally said there was not a need for a further commission of investigation into the controversy, but Taoiseach Leo Varadkar said he would consult with the Opposition, those affected and patient representatives before making a decision. The Government has previously stated an intention to set up a follow-up commission.

Dr Scally paid tribute to the “extraordinary determination” of the terminally ill Limerick mother-of-two Vicky Phelan “not to be silenced” in reaching a court settlement which revealed the widespread non-disclosure issue.

Representatives of the affected women – and relatives of 18 women who have died – urged the Government to immediately implement Dr Scally’s 50 recommendations to improve the screening system.

Among these was a mandatory policy of open disclosure and a reconciliation process between doctors and patients.

“The only people who can properly say sorry are the people who were deeply involved in doing things that shouldn’t have been done,” Dr Scally notes.

* This article was amended on September 30th, 2018