Scally report on cervical screening puts many previous reports to shame

After the launch on Wednesday of the Scally report and the round of media interviews that followed, Gabriel Scally had dinner in Dublin with Vicky Phelan and Stephen Teap. Phelan told him she thought she might owe him an apology. She reminded him of an incident early in the summer, soon after she had defied a gagging order and broken open the cervical screening scandal, and within weeks of Scally having been appointed by the Government to conduct his scoping inquiry.

Phelan, whose cervical cancer was diagnosed as terminal, had been on the train from Limerick to Dublin for treatment when she read a newspaper article about how Scally had said his report would take longer than had been anticipated.

“The slant of this piece was that the women were to blame for this delay,” she told me. “This was not true and I was hopping mad.” She rang Scally, who was due to meet women affected by the scandal the following week. She told him they would be furious too.

"I said you need to go on the radio – today. I went to hospital, had my treatment, made a call to an RTÉ producer, and then I got a taxi to Gabriel's office. I marched in and told him he was going on Drivetime. I picked up the phone, dialled the number and handed it to him." Scally did the interview.

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Phelan said he laughed when she recalled the story the other night. “I said I hoped he didn’t think I was too bolshie,” she said.

Far from it. Scally, like the rest of us, has been in awe of Phelan’s bolshie-ness, not to mention her political savvy, strategic brilliance, courage and sheer grit. He told her that no apology was required and that she had been right – the interview had put the record straight and, when he met the women, they had been receptive and open.

In the first paragraph of the letter to the Minister for Health, which prefaces his 170-page report, Scally pays tribute to the “extraordinary determination of Vicky Phelan not to be silenced”. In turn, she has this week praised his willingness to listen, and his ability to hear.

‘Treated disgracefully’

“No one had listened to the women before,” she said. “The first thing he said to us was that we had been treated disgracefully. He focused on us and on our experience. He respected us. The women are threaded through the report in such a way that no one reading it can forget what it is really about.”

The Scally report is a remarkable document. It puts many previous reports to shame and is a shining model for future efforts. Sadly, the redolence of “whole system failure” that he identifies suggests we have not seen the end of the scandals.

Scally brings a feminist sensibility to his task. His team is expert and gender balanced. The victims of the catastrophe are placed at the heart of the work, and presented as a pre-eminent source of vital information. They are given support in the process, enabled to participate. Scally repeatedly refers to knowing things “from the women and their families”. He endorses the comment that “many of the major controversies about maltreatment of patients or denial of reproductive rights in the Irish healthcare system have involved women being damaged”. There is a high degree of sensitivity. Some women came to meetings but not to make submissions. Scally notes that their participation as listeners was also a contribution.

The quotes woven through the document are in many cases shattering. The benefits and short-comings of health screening as opposed to diagnostic testing have been exposed. After all, young women died after agonising illnesses, when in some cases their medical treatment might have been altered if smear tests taken before their cancer diagnosis had been interpreted differently. Lives might have been saved. Others are coming to terms with the bleakness of a terminal prognosis, and many are undergoing gruelling treatment regimes knowing that they face uncertain outcomes. There is a great deal of pain and distress.

But it is worth noting that some of the comments are also about procedural and strategic matters – urging Scally to endorse the concept of audit reviews, demanding “processes, procedures and action”. And there are revelations of outrageous behaviour by clinicians in the aftermath of the scandal – epitomised by the consultant who told a woman who asked how she would be informed from then on: “Watch the news.”

Fight the system

Again and again in Ireland we have relied upon bolshie women who have already suffered grievous injustices to fight the system so that others will be spared. The choice of Scally to lead this review may turn out to be one of the best decisions this Government has made. He has laid bare how an injustice has been done and has said he does not believe “the currently available legal remedies are capable of resolving the deep hurt, anguish and resentment felt by many of the women and families”. That, he says, would require something “very different”.

Scally points the way, quoting the South African judge Albie Sachs who spoke of “infusing grace and compassion into the formal structure of the law”. That, says Scally, is what has been lacking, and it is what is now needed.