Four years on from Dr Gabriel Scally’s report into the CervicalCheck controversy, the most effective reform he recommended has yet to be undertaken. The revelations of the failure to tell women with cervical cancer about an audit by the national screening programme, which showed how past smears might have provided different results, has not broken the dam and brought a flood of open disclosure in Irish healthcare, as he had hoped.
Producing the final progress report on whether the recommendations from his 2018 report have been implemented, the public health specialist expressed surprise and disappointment about how changes to ensure a more transparent relationship between doctors and patients – be it through stronger medical guidelines, a complaints procedure or effective legislation – have not been introduced. As it stands, there remains an over-reliance on the courts as a forum for solving problems arising in healthcare.
Dr Scally has set out his objectives simply: he wants the medical profession to be open and honest with patients and to communicate clearly where things go wrong, even when there are near misses. The recent death of cervical cancer campaigner Vicky Phelan, whose refusal to be silenced in a 2018 legal settlement exposed CervicalCheck’s failures, has highlighted the slow progress towards Dr Scally’s desired end-goal.
Following her death, the Taoiseach promised to get the Patient Safety Bill – more than three years in the making – passed before the end of the year, bringing in mandatory open disclosure, but even this falls short of what is needed. For the most part, the proposed legislation deals with disclosure by medics in cases where the patient has died. Dr Scally sees the legislation as a “first step” and hopes the range of errors covered will be increased. He described the Bill as “almost symptomatic of the problem” sitting there as an “island” in the “medical legal complex” which is plaguing progress.
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Given the work still required, it is hard to see how a full system of open disclosure, as envisaged by Dr Scally, can be fully legislated for within the Taoiseach’s timescale. Also worrying is the fact that the 221+ CervicalCheck campaign group, co-founded by Vicky Phelan, which is pushing for similar changes, is meeting strong opposition from some medical professionals who are refusing to treat women if they are members of the group.
This points to a deeper cultural problem that may also explain the reluctance of some clinicians to accept past failings in the screening programme. It should be noted that Dr Scally says in his final report that CervicalCheck is substantially better than it was in 2018, but it is not perfect. The remaining recommendations will undoubtedly improve the screening programme and should be embraced fully and without delay.