Michael Harty (Clare, Independent) | Oireachtas source

I am sharing my time with Deputy Mattie McGrath. I thank the Minister for taking this debate. There are a number of issues regarding this report and the first and most important concerns open disclosure. Mandatory open disclosure will now be part of the patient safety Bill, which will come before the Committee on Health for pre-legislative scrutiny next Wednesday. That will be a very important meeting in terms of defining open disclosure.

Regarding CervicalCheck, and I am not in any way trying to explain what happened, there is a difference between organisational open disclosure and individual open disclosure. In terms of what happened in CervicalCheck, the lines of responsibility on disclosure were blurred. They should have been clarified and quickly identified. The failure to identify the lack of open disclosure in CervicalCheck was because there was no independent oversight of the scheme and there were no patient advocates on the structures of CervicalCheck who would have spotted that difficulty very early on, because when one openly discloses an incident, it is usually contemporaneous. Something happens and, within a few days, it has been identified that there has been a problem and one openly discloses. CervicalCheck, however, referred to historical events that had happened several years ago. It failed to identify the difficulties that would pose and who was to be the responsible person regarding disclosure. That has led to this failure.

The difficulty was in respect of disclosing to women but also the communication gaps that developed within CervicalCheck regarding where the lines of responsibility lay and the appalling shortcomings in the manner in which disclosure was eventually made when the scandal broke. It was rushed, ham-fisted, amateurish and did not reflect very well on the medical profession.

The second point is that Dr. Scally identified CervicalCheck as a dysfunctional organisation that lacked governance and accountability, that there was no clear responsibility among the various sectors in CervicalCheck and no clear job description. There was a lack of clarity in the way people should function within the system, in particular, how information was transmitted up and down the line. Dr. Scally identified a whole systems failure, and he was restrained in identifying particular individuals. If particular individuals are to be found wanting, I have no problem with that, but the blurring of lines in terms of the organisation, governance and accountability of CervicalCheck make that very difficult. There was nobody in charge. There was an absence of governance and poor oversight by the HSE.

There is an absolute urgency in reinstating the HSE board. I note that the Health Service Executive (Governance) Bill will also come before the Dáil very soon. It is absolutely essential that we have a reorganised, slimmed down, very clear governance structure within the HSE, not just in respect of its board but going right down through the organisation. It is a substantial part of the Sláintecare report that there has to be huge governance reform within the HSE. As we have spoken about that on many occasions I will not go into it again.

There is a necessity for no-fault compensation in respect of what happened. To have women go through the adversarial court system, as we have seen Vicky Phelan, Emma Mhic Mhathúna and others do, is not fair. We are talking about dealing with people who have offered themselves voluntarily, who are perfectly healthy when they go for screening, in the same way that when children present for vaccination they are perfectly healthy children. If they suffer an injury, whatever the case may be, there should be no-fault compensation. They should not have to go through the adversarial system. Mr. Justice Charles Meenan is to report on alternative methods. We have to look at how we deal with people who are injured by our health system. They should not have to go through the adversarial system. Gabriel Scally identifies that.

Another aspect of the report is data sharing. There was a breakdown in data sharing in that the National Cancer Registry and cervical screening service had different lists of people who had cervical cancer and they were not sharing that information with each other. Even the gathering of data was a problem in respect of CervicalCheck and the gathering of data is a big problem in the health service in general. We discussed that briefly at our health committee meeting this morning. Data is king. Without data, we cannot plan a health service. That was a deficiency within CervicalCheck.

I refer to a journalist who wrote about this during the week. He wrote that the shortcomings of CervicalCheck indicate a whole-of-system failure, a wider failure within the health service, where the welfare of patients got lost in the political and bureaucratic manoeuvres operating in a cocoon of detachment. That summarises what happened here. There was no outside vigilance on what was happening within cervical screening. People got locked into a bubble and were not thinking properly or putting the patient at the centre of the service. It is so important, whatever service we provide, that we put the patient at the centre. That is why it is important that we have two patient advocates on the HSE board. We should have two patient advocates on every board at local, regional and national level to make sure this does not happen again.

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