Catherine Connolly (Galway West, Independent) | Oireachtas source

Cervical cancer is the fourth most common cancer in women worldwide. This was mentioned in Dr. Gabriel Scally's report, which was published in September 2018. It goes on to say, "In Ireland in 2015 (the most recent year for which data is published), there were 241 cases of cervical cancer." It then goes on to talk about the importance of screening and of an effective screening service. We all know about that. I heard Deputy Bríd Smith speak earlier about being patronised with regard to screening. As women, we know how important screening is. That is not what this was about. Before I go into the body of what I am going to say, I will say that when I was on the Committee of Public Accounts, I remember what truly horrified me were the internal memos we eventually elicited. These showed that officials were more worried about publication and screaming headlines than about the failures that had taken place. That stays with me. I will not personalise the matter but the medical people from the Department of Health utterly failed to see the relevance of that for women. Indeed, Dr. Scally did not put much emphasis on it in his very welcome and methodical report. He certainly failed to see that the memos were more concerned with avoiding screaming headlines than with dealing with the issue.

We are here today to extend the time. None of us could disagree with doing so. What are we extending? We are extending the provisions of legislation that allows for women affected by this scandal to come forward and go to a tribunal while we know that nobody has come forward. When we look at the Bill digest, we read:

Although the Tribunal was established as an alternative to bringing a compensation claim to court, very few claims have been submitted to the Tribunal to date. No claims had been made to the Tribunal by 22 March 2021.

This should set alarm bells ringing for any government. There were no claims by March 2021, but the digest continues:

The Minister for Health stated on 30 June 2021 that 5 claims had been received. In contrast, 199 legal proceedings have been issued to date

I looked at why this was brought in. The Minister has quoted repeatedly from the Report on an Alternative System for Dealing with Claims Arising from CervicalCheck.

It is a very succinct report of 32 pages which comes down in favour of a tribunal. That is how the tribunal was set up. That report said many other things. The final chapter stated, "There is a clear urgency that this legislation be passed without delay", and it was duly passed. Many things were said about High Court hearings and the fact Mr. Justice Kevin Cross, the judge in charge of the personal injuries list, with the co-operation of the solicitors and barristers "has ensured that these cases have been dealt with in an efficient and timely way" and so on.

There was provision in the existing court system to deal efficiently with these cases but we went for a tribunal. I had serious reservations about that because language was being misused in relation to it not being adversarial. That was not true. It is a little less formal than a court setting but not less adversarial. The consent of all parties was needed. Surely, if the consent of all parties was got in court and liability was not an issue, it would proceed quickly in the courts system.

We set up the tribunal and nobody availed of it. Some women are availing of it now and I am glad they are, in the sense that that is the decision they have made for many reasons, including speed and illness. Within that Bill, we were to restore confidence but nothing has happened. Over two years later, the Minister tells us in his speech he will set up the process: "A facilitator of the meetings has recently been identified and preparatory work necessary to ...". We say we will restore confidence and bring in legislation. Two years later we have nothing and say again we will restore confidence. My confidence and trust are at an all-time low.

I have a very specific question before I go back to the general. When I sat on the Committee of Public Accounts, we were told by the head of the Department that the audit of cervical test results had stopped temporarily. Was that ever reinstated? If not, why not? That should be part of the Minister's speech today. It is an essential. That is how we learned - we did not, actually, but I will come to that. An audit was carried out and the women affected spoke out, starting with Vicky Phelan, who was extremely courageous and refused to sign a non-disclosure agreement. We learned then an audit had been carried out. We were told repeatedly it was for the purposes of learning, but we did not learn anything until Vicky Phelan had the courage not to sign the non-disclosure agreement and tell us. Then a lot of stuff came out.

Remember the number of women who have died in the meantime. Out of the 208 women whose results might have warranted a different action, 17 have died. A total of 162 women were not told their smears had been audited and that the audit found a different action should have been taken. I will not name out the women but we are deeply indebted to them and their families for their courage in persisting and bringing this matter to attention.

If we look at the speech given today, we get a clear indication of the mountain the women had to climb. I would have expected at this point a detailed speech on all the aspects of the tribunal, the various parts of the legislation I have mentioned, the audit and mandatory disclosure. We have a Bill sitting somewhere on disclosure. Scally had two reports and 52 recommendations. I quote from the digest but I have read the full Scally report, "In the Scally Report, a number of chapters dealt with open disclosure in the context of the HSE, the Medical Council and CervicalCheck." It goes on to refer to leaving a decision to disclose or not to disclose to "the unfettered judgement of the clinicians" as unacceptable and that is what happened. It refers to the "lack of a systematic evaluation of the implementation of the policy". On the following page, it says, quoting the Scally report:

When disclosure in the substantial majority of the cases eventually happened, [this is with the cervical smear cases] it was hurried and took place against a fevered media and political backdrop. The way in which women and families were treated was responsible for substantial hurt and anger.

I do not think we needed a scoping exercise from Dr. Scally to tell us that but at least it is down in black and white. The digest goes on to quote the Scally report:

A situation where an organisation can be allowed to impede the speaking of truth to patients in relation to their health care is totally unacceptable. Nor should it be acceptable for an organisation to give permission to health professionals, of whatever seniority, to withhold the truth from patients.

There are many other things I could quote from, including the Madden commission, going back to 2008, which set out the necessity for mandatory and open disclosure. It has not happened.

I ask for clarity on the audit. Why, if we want to restore trust, has that part of the Bill never been used? On the outsourcing of tests, what progress have we made? That was a fatal decision made by a Progressive Democrats-led Government. The Government inherited that but now it has the chance to change it. When we outsource something as essential as cervical smear tests, we are in serious trouble as a civilised society. What update has there been on that? Are we on the road to ending the privatisation of our laboratory services? It is extraordinary that the restoration of trust part of the tribunal legislation has never been used. Trust on every level has not been restored. The women are still fighting with the Government - I take back the word "fighting" - they are still struggling to get their voices heard and say this tribunal is not the most suitable mechanism. The High Court would do a more efficient job if it was adequately resourced to hear the cases. There is provision for private hearings and that could have been done.

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