How to investigate why dozens of women received false smear tests and why they were not told about them – and how to conduct that investigation quickly and publicly – are the challenges facing the Government.
It is critical that the inquiry should be conducted in the full glare of the public spotlight given that Vicky Phelan, the terminally ill Limerick woman who exposed this scandal, brought to light the erroneous smear tests and their non-disclosure to patients because she refused to sign a gagging clause in a settlement with the US lab responsible. For Phelan, the motive was to be able to tell other women who may have been treated similarly.
Minister for Health Simon Harris pondered how "a bespoke investigation" into the failures of the CervicalCheck screening programme might work when he appeared before the Oireachtas health committee on Wednesday.
No one wants “to go down a big tribunal route that will go forever and ever with very sick women involved” he admitted, even though it might be a very public way of investigating the scandal.
Whereas a commission of investigation – the route the Government has chosen following an initial “scoping inquiry” – would be quicker, he suggested, they were generally not public. So this would not be in keeping with the spirit of why Phelan chose to tear down the shutters on CervicalCheck’s policy of closed disclosure.
“Is there a way of aligning the two?” asked Harris.
The Minister held open the possibility that a commission of investigation could hold public hearings so that people who want to give testimony in public can be facilitated. “There seems to be a viewpoint that it possibly can at the discretion of the chair,” he said.
Cancers being missed
The appointment of Dr Gabriel Scally, a veteran of the Northern Irish and English public health systems, as chairman of the initial scoping inquiry has bought the Government time to figure it out and to consult with the Opposition. Dr Scally, who will work with a women's health expert Dr Karin Denton, has until the end of June to produce a report with an update to be provided to the Minister in the first week of June.
Harris has said that the “most essential” aspect of the inquiry is that it deals with the concerns of Phelan and other affected women with cervical cancer (or their families if they have died).
Phelan's solicitor Cian O'Carroll has raised concerns that there may be an 'over-emphasis' in the terms of reference on why the women were not told about the false tests
So far, this seems to be strongly guiding Dr Scally in the first days of his work into this complicated controversy. He met Phelan for an hour yesterday morning at St Vincent’s Hospital in Dublin where she was receiving treatment for cervical cancer after speaking to her by phone the previous day.
The 10-point, 330-word terms of reference guiding the Scally inquiry are sufficiently comprehensive to allow him to establish some basic facts in the controversy when, just on Wednesday, it emerged that inaccurate information was still being provided by CervicalCheck even as the scandal broke.
Phelan’s solicitor Cian O’Carroll has raised concerns that there may be an “over-emphasis” in the terms of reference on why the women were not told about the false tests rather than on why cancers were being missed in testing and why an investigative team was not sent into the US labs to understand the pattern of misses.
The sheer volume of work involved in Scally’s seven-week inquiry may be a bigger challenge, particularly when the terms of reference dictate that he must engage directly with any affected women or their next of kin at a time when the HSE was still trying to contact all 209 women who received false smear test results.
Still, the scoping inquiry will be a start and, as Harris said yesterday, it will give the Government a few weeks before “getting into the commission of investigation space” to build on the work done by Dr Scally.
Getting that investigation right will be the harder part.