Tuesday 17 September 2019

We owe it to Vicky and Irene to make real and vital reforms

The health service failed cervical cancer victims. Now politicians and clinicians must deliver dramatic changes, writes Alan Kelly

MESSAGE: Vicky Phelan. Picture: RollingNews.ie
MESSAGE: Vicky Phelan. Picture: RollingNews.ie

Alan Kelly

I met Vicky Phelan for the first time last Wednesday. I felt like I already knew her. I shed tears during her deeply moving testimony to the Public Accounts Committee that evening. One of the strongest women I've ever met. Later, as I walked her to her taxi to get the 9pm train home to her loving family, I asked if I could hug her. It was a spontaneous thing, I hadn't planned it. She asked me to fight for her and I gave my word that I would.

The cervical cancer crisis that has engulfed our country is a stain on all of us who call ourselves politicians, no matter what stable we come from. Personally, I've gone way beyond the party political aspects of this issue. There'll be another day for that.

I participated in multiple Health and Public Accounts debates on this over the last three weeks. I've studied hundreds of pages of documents provided. I have to believe Leo Varadkar and Simon Harris when they say they didn't know anything about this.

Vicky and Stephen Teap, whose wife Irene died and who accompanied Vicky last Wednesday, want ''accountability'' and ''change'' in our health service. Accountability that is real and change that is permanent and we as a collective society must deliver this. There needs to be accountability and permanent change at clinician, HSE and political level for how this happened. They all failed them.

The clinicians have a duty of care to their patients. They also have a duty of candour. By failing to inform their patients about the audit results, whether they thought it was their role or not, they failed on both of these. The fact that they were discussing how to design a leaflet for six months while women were not being informed says everything.

The HSE has the responsibility of administrating our health service on behalf our citizens. In this instance, it failed catastrophically. There was a systemic management failure in the HSE with tragic consequences. Its senior management structures are designed to avoid accountability. On the audit, there was no probing during it or escalation when issues were identified.

The level of ''arse covering'' from its top team last week was shameful. Look at the list of people who didn't know about the issues with the audit until Vicky Phelan blew the lid off it; the CEO; Department, HSE Directorate; HSE Risk Committee, to name but a few layers.

John Connaghan, the new CEO, has a huge responsibility now. Allowing two of his Directorate team away on leave in the middle of the biggest health crisis in decades is insane. They'll hardly be able to help the Scally scoping enquiry from Spain or wherever they are. This is a ''live'' situation and he needs to make management changes immediately. Some will have to stand aside while the enquiry takes place. That is clear to everyone studying this and Stephen Teap has demanded it so it surely must be clear to Mr Connaghan.

At a political level, we all have to take responsibility for the dysfunctional nature of the Department of Health. Its officials still feel that after their briefing on the audit in 2016, that their response was a ''reasonable'' one. That says it all. The arms-length relationship with the HSE to avoid political accountability has come home to roost. There is little oversight of the HSE by the Department. It acts as a conduit for political concerns. The stupid decision to get rid of the HSE board is glaring now. Its blocking of mandatory open disclosure demonstrates its culture to the core.

I am in regular contact with Simon Harris on this issue. I don't want to be unfair to him. He's probably trying his best with health structures that are broken.

But let's get a few things clear. The parliamentary democratic institutions will continue to ask questions and look for accountability and any attempt to close that down cannot be tolerated. The Scally Scoping Enquiry will be published and then there will to be a Commission of Investigation into all of this, as I predicted as a lonely voice some weeks back.

Immediately, the most important issue is the women and families affected. They need to be given everything they require and shown compassion from us all. The package of supports must be fully delivered. All legal cases must be mediated and settled where the women or their families want that.

For the women of Ireland, we must resource the help lines and address concerns. For greater accuracy, we need to move to the HPV version of testing soon. Resources can't be an issue. A relatively quick examination of a random sample of smears over the last three years would help to allay concerns too.

We must maintain confidence in screening programmes, not just cervical check but also breast and bowel screening. They save thousands of lives. We must explain better that screening programmes are not diagnostic, though. The worrying situation where there isn't a sharing of patient information between the screening programmes and National Cancer Registry needs to be sorted immediately. Furthermore, the HPV vaccine for girls needs to be promoted and extended to boys.

Through the Scally enquiry, we are going to have to get real information on what statistically happened in the laboratories. As Vicky Phelan pointed out though, there is also a need to look at individual false negative results as there were potentially massive human errors in some cases. In future, I believe we have to conduct all this lab work for our own people on home soil as part of our national health service in a renewed screening programme. We need to also get to the financials of how these labs were paid by the State.

Legislatively, we need to make open disclosure mandatory across the health service with serious penalties embedded for any failures. A HSE board must be put back in place along with accountable regional management structures. Teflon-style management cannot be tolerated. Finally, we need to change how the State Claims Agency works when it comes to cases like those of the women affected. If we did all of these, it would go some way to getting ''accountability'' and ''change'' which is what Vicky and Stephen demanded last week.

Alan Kelly is a TD for Tipperary, Labour Spokesperson on Health and Vice Chair of the Public Accounts Committee

Sunday Independent

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