The Scally report recounts in vivid detail how women were treated appallingly, once again, by the health service, but it largely defuses a political nuclear bomb that had the megatonnage to destroy the Government.
When the scandal broke in the spring, the accusation levelled at the Government was that errors by the health service – of which ministers for health either were or should have been aware – resulted in women developing cancer when it should have been avoided. That incendiary suggestion has hung heavy over the screening programme in the months since the scandal was first revealed in the wake of Vicky Phelan’s court case.
If that was supported by an independent investigation, it would have plunged the health service into crisis and destroyed the Government. But the Scally report published on Wednesday does not bear out the wilder suppositions of a few months ago. Instead of a nuclear scandal, it's another example of how appallingly some women have been treated by a myopic politics, a callous bureaucracy and a sometimes arrogant medical establishment. But crucially, the shocking failures outlined by the Scally report were not in the actual screening process – indeed, Dr Gabriel Scally went to some lengths to defend the programme and to assure people that the laboratories where the tests are being assessed are operating to the highest standards.
Women and their families were certainly harmed by the non-disclosure of the results of the audit; but they didn't get cancer because of it
Rather the failures outlined in detail in the report related to how CervicalCheck was organised and run and – most pungently of all – how it communicated the results of the audit of the programme. Some of the descriptions of how women and their families were subsequently informed of the audit results beggar belief. They clearly caused great distress to people who had already been subjected to dreadful ordeals.
Screening process
These may be shocking; but they are of a significantly lesser degree than the discovery of a flawed screening process would have been. Women and their families were certainly harmed by the non-disclosure of the results of the audit; but they didn’t get cancer because of it.
As a consequence, the CervicalCheck scandal – which caused huge trepidation in the office of the Taoiseach (and former health minister) Leo Varadkar in the spring and for much of the summer – has significantly de-escalated in political terms in the last 24 hours. No screening process is 100 per cent foolproof, or anything like it. And the individual clinical reviews being conducted by the Royal College of Obstetricians and Gynaecologists (which won't be concluded for many months) may yet find that cancers which should have been spotted, weren't.
Whether they were sufficiently outside the realm of normal error to constitute actionable negligence is a question that can only been answered at that time, and in each case. But Scally’s vote of confidence in the laboratories currently used for screening suggest confidence that the error rate is likely to be within normal parameters. That is one of the most important findings of the report. It keeps the screening programme – which has saved hundreds of lives – alive. It clearly needs a profound overhaul in its organisation, culture, governance and supervision; but its basic function remains intact.
That is not to play down or diminish the significance of the findings about the behaviour of CervicalCheck corporately or doctors individually towards women affected by the disclosures. The report pulses with their barely restrained anger at how they were treated.
The injury was twofold – first the information about their smears was kept from them, and then, once the scandal broke, it was communicated to them in a way many found variously unsatisfactory, inappropriate, damaging, hurtful and offensive. Scally was able to faithfully convey the feelings of the women and their families because he went to considerable lengths to listen to them personally. It is very clear that in many cases, their doctors did not. But if the report points the finger in the general direction of bureaucrats and doctors, politicians cannot escape the responsibility for the rules under which they operate.
Among the many promises made by the Government on foot of the scandal has been the pledge to compel doctors by law to own up to their patients if mistakes have been made – mandatory open disclosure.
Mandatory disclosure
This Government blocked a proposal to introduce precisely this law less than a year ago. In fact, the provision for mandatory disclosure was in a Bill passed by the Seanad, but when it came to its final stage in the Dáil, the Government – with the co-operation of Fianna Fáil, which had backed the proposal in the Seanad – inserted a late amendment making disclosure voluntary. The last-minute wheeze came after intensive lobbying from the medical profession and pressure from its own officials.
What does it show us? That politicians are susceptible to pressure. Last year, it was medical and official lobbying; this year it was the bravery of Phelan and others that forced them to act. Scally has now given them a lengthy to-do list. Given the public passions stirred by the cervical scandal, they would be wise to follow it.