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Cultural change needed to fulfil Vicky Phelan’s legacy



The late Vicky Phelan, who helped expose the cervical cancer screening scandal. Photo: Fergal Phillips

The late Vicky Phelan, who helped expose the cervical cancer screening scandal. Photo: Fergal Phillips

The late Vicky Phelan, who helped expose the cervical cancer screening scandal. Photo: Fergal Phillips

Much progress on the system, but not enough on the culture – that is the picture presented by Dr Gabriel Scally in his review of the implementation of the recommendations of his scoping inquiry into the cervical screening programme scandal.

He is discreet in his language, pinpointing problems and proposing solutions. Without any fudge, he makes it clear what he is saying without personalising or politicising the issue. 

In the wake of Vicky Phelan’s landmark court case, Dr Scally was called in to review the system. He did not mince his words. He found a litany of failings in the way CervicalCheck was run, particularly concerning oversight of quality assurance that was not fit for purpose. He said the deeply flawed screening programme was doomed to fail at some point – and it did. 

It is worth reflecting that his terms of reference were limited, but his scoping inquiry was produced quickly, identified the issues at hand succinctly and made firm recommendations.

Now Dr Scally is back reviewing for the final time what has been happening in the intervening years. He has given the renewed cervical check programme a clean bill of health, with most of the reorganisational overhaul complete. The lab work is now being conducted at one location in the US, with a new lab opening at Dublin’s Coombe Hospital, but it will take time before it can carry out all the work.

However, he also warned against putting all the eggs in one basket and stressed the need to remain vigilant for flaws in the system and to have back-ups in case of mistakes or external threats such as cyber attacks. 

The only test most women will need is for the HPV virus. A HPV test, which has a lower failure rate, is now applied to smear tests.

While the system is making substantial progress, the culture is not. The boxes on the recommendations are being ticked, but the fully fledged buy-in to a more transparent system is not there yet.

A strong element of the report says there has to be more of an acknowledgement of what went wrong in the past. 

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Dr Scally homes in on the need for all health professionals to be open and honest when a mistake is made. 

The concept of open disclosure is not as simple as is presented by some, including Health Minister Stephen Donnelly. A fear of litigation in an over-legalised system subdues the candour of medical professionals. The absence of a proper complaints system means an over-reliance on the courts to solve problems, which is long, arduous and costly. Being open and honest when a mistake is made is seen as an option, not an obligation.

Bricks and mortar, system changes and policy development are important, but a change in the attitude of those working in the system is vital for Ms Phelan’s legacy to truly be fulfilled.

There is now a screening process women can trust. Hearts and minds on the human side of those working for these women must also evolve.

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