For over a week and a half now, the health service has faced perhaps its biggest crisis with the cervical cancer controversy.

Women affected have been shocked, some key staff have resigned, or moved aside and the Government has been struggling to keep up with the pace of revelations.

We would know nothing of this without the bravery and strength of one remarkable woman, Vicky Phelan.

Her determination in the face of a desperate illness, not to settle her High Court case, by signing a confidentiality clause sought by the US laboratory, meant that the Irish people learned of the true scale of this health horror.

Since CervicalCheck began screening, over 1.8 million women have had a test under its service.

Screening is offered to women aged 25 years to 60 years every three years.

Cervical screening checks for changes in the neck of the womb using a smear test.

It's a simple procedure that takes minutes and is used to detect cell changes in the cervix.

Changes are common and cervical screening can pick up early cell changes, so they can be monitored or treated.

The earlier cell changes are found, the easier they are to treat.

Like most conditions, early detection and treatment can prevent cervical cancer.

There are two key elements to this controversy - the failure to tell women that their smear tests had been audited and what the results were and potentially missed cancers and delays in treatment.

We do not know everything at this stage, despite the fact that there have been so many revelations.

The amount of information that has been dragged out of the health service is almost mind-numbing and difficult to absorb.

At least 3,000 women who had a smear test in the past are affected in some way.

There is to be a statutory inquiry, but the form of that inquiry has yet to be decided.

There have been many calls for it to be in public.

There will be an independent review of all 3,000 cases by the Royal College of Obstetricians and Gynaecologists in Britain.

It is due to be concluded by the end of this month and there will be the hugely challenging task of informing each woman of the outcome.

Then there will also be a redress scheme, in cases where a woman's cancer was missed and should have been detected, beyond the normal error rate for such checks.

There will also be redress for women because of a breach of duty in not informing them that their case had been audited and they were never told the result.

CervicalCheck and individual treating doctors will have to account for their actions.

There are ethical and moral issues here of basic decency, telling patients as soon as possible of their clinical situation, so that the best treatment can be provided as soon as possible.


Read more:

What is the CervicalCheck controversy about?
Actions on cervical screening controversy
Woman speaks of delayed cervical cancer diagnosis


One of the most remarkable documents to emerge in this controversy was the 16 April briefing note written by a Department of Health official to Minister for Health Simon Harris.

It said that the Vicky Phelan case was not a patient safety incident but a reflection of the limitations of screening.

Yes, there are well-known limitations to screening and it may only pick up six out of every ten cases of abnormality in cells.

But the way the State Claims Agency took on Vicky Phelan, was very similar to the way the State took on the late Brigid McCole in 1994 when she was on her deathbed.

I covered the Hepatitis C scandal and it came to mind vividly again this week because of events.

In both the Brigid McCole and Vicky Phelan cases, the State was dealing with a terminally ill woman.

The agency has a duty to protect the taxpayer and lawyers will do as lawyers do.

So the issue here is political direction.

When does someone at the highest level shout stop, take the view that a human approach is needed, because the victim has been hurt through no fault of their own?

The other stark things to emerge from that infamous briefing note was that up to 2014, the audits of women's previous smears were used by CervicalCheck, for educational and training purposes only.

The Health Service Executive later decided that they should be passed on to treating doctors and those doctors got the reports in 2016, to be passed on to the women "as appropriate".

Well we know that the majority of the first group of 209 women were never told until this week and 17 had already died.

Given the clear ethical obligations on doctors to inform patients, it is likely that these matters will come before the Medical Council.

There have been many calls for the Director General of the HSE to quit.

He says he only learned of the Vicky Phelan case from RTÉ News last week.

Yet the briefing note for the Minister says the Department of Health and the HSE are in contact on drafting a press release on the affair.

So clearly people at some presumably high level in the HSE knew about this, but never told Tony O'Brien.

It is a big problem for the service that key matters were kept from the head of the HSE.

And what about the laboratories that do the testing?

Tony O'Brien believes that any investigation will find that the clinical standards of CervicalCheck are being met and that patients should not have concerns.

The task now facing a health service in crisis is a mammoth one.

This is probably its darkest hour.

It has to review 3,000 cases.

GPs must deal with potentially tens of thousands of repeat smear tests and consultations with women who want reassurance.

I have been covering health for 30 years, have dealt with many scandals and tragedies but I have never known a week similar to this.

The anxiety and upset, women and families affected must be feeling, is truly heartbreaking.

It's now 2018 - open disclosure was promised by governments and the HSE reminds us almost every day that the patient is at the centre of the health service.

In this controversy, the patient appears to have been the last to be considered.

Those responsible for this terrible mess, must come before an inquiry and be held accountable, ideally in public, given the need to reassure Irish people, that such events will never happen again.