Michael Clifford on CervicalCheck: Why is nobody ever held to account?

There was one difference this time. On Saturday evening, just before Vicky Phelan related on RTÉ Television her heart-rending story, the director of the cervical screening programme resigned.

“I am sorry that recent events caused distress and worry to women,” Dr Gráinne Flannelly said in a statement. “I have decided to step aside to allow the programme to continue its important work.”

The resignation was very un-Irish, but a case could well be made that Dr Flannelly was thrown under the bus. Earlier in the day, Health Minister Simon Harris declared that he couldn’t express confidence in the programme.

Once that was said, Dr Flannelly had little option.

She could have toughed it out, but would undoubtedly have become the focus of most of the media and political ire over the days to follow. So she went quietly, and provided the minister with some political breathing space.

So the real difference this time was the willingness of a political figure to lay blame squarely at the door of somebody working in the public service. This could be viewed as a progressive move towards accountability, or a cynical attempt to kill a scandal and deflect all blame from serving politicians.

One way or the other, it won’t have gone un-noticed in the wider public service.

There has always existed a mutually beneficial tacit agreement between serving ministers and public servants that blame not be personally apportioned to a single person when scandal strikes.

Presumably, the agreement no longer holds. This should largely be regarded as a positive development, but one which is unlikely to leave politicians unscathed over the longer term.

Is Dr Flannelly the only figure to whom culpability should be ascribed for what Ms Phelan and up to 162 other women were subjected to?

How come the minister for health and director general of the HSE Tony O’Brien only heard of this enveloping scandal around the same time as the rest of us?

The answers to these and a host of other questions will only be answered at the conclusion of the promised statutory inquiry.

In examining the prospects of accountability, it is advisable to look at what exactly the issues are in the current scandal.

To that end, there appears to be two distinct areas. The first involves the screening programme. There were obviously misreadings in the screening that had a devastating effect on up to 162 women.

Was human error at fault? Could things have been done differently? Is the current system of outsourcing the screening the correct way to go?

As Tony O’Brien pointed out on RTÉ’s Today with Sean O’Rourke yesterday, screening is not diagnostic. There is inevitably going to be false negatives and false positives in the readings. The question is whether the level of these misreadings is in line with international best practice.

The HSE believes that to be the case. In a statement to the Irish Examiner yesterday in response to queries from Health Correspondent Catherine Shanahan, the HSE noted that CervicalCheck’s process “is in line with international practice and other European screening programmes, including Finland, Norway, Slovenia and some parts of the UK”.

The outsourcing of the screening is an issue that should be examined. The decision to do so was taken in 2008 when Mary Harney was health minister. The basis for it was that there was a major backlog that required addressing.

Then opposition spokesman James Reilly was opposed to outsourcing, but he didn’t attempt to reverse it when he became the minister. Was it the correct and most appropriate policy? Was patient focus the only consideration in doing so? An inquiry must ask these questions.

The other strand of the scandal is the failure to inform Vicky Phelan and all of the other women that a review was being undertaken of their tests and, even more unbelievably, the failure to inform them of the results of the review.

Ms Phelan revealed on the Ray Darcy Show on Saturday night that one of the first issues to arise when mediation was considered in her case was an insistence that she sign a confidentiality clause.

Putting such emphasis on confidentiality betrayed the overriding concern on behalf of the HSE. This must be kept under wraps. The full truth about the failure to contact so many women must not emerge. There must be no scandal, no blame, no accountability.

The position of the HSE demonstrated once more that the priority when things go wrong is to cover ass. Any concern for the patient, or client, or citizen, any urgency in fixing what is wrong, any proper perspective is relegated below the imperative to ensure that everybody can keep the head down and move past this inconvenience.

This attitude is not confined to the health sector, but endemic right across the public service.

It highlights the priority in the service to circle wagons and look after their own above all else. The public must get in line to be served by the public service, the requirements of and protection for staff coming before all else. Accountability is not part of the culture.

The body politic facilitates this culture and feeds off it. If public servants are not held accountable for operational culpability, how can politicians be brought to book for political culpability?

Notwithstanding the single high-profile resignation last week, that culture persists.

Vicky Phelan has done the State a major service, and done so in the most harrowing of circumstances.

Her first action in that regard was freighted with bravery. Living under the shadow of a terminal illness, and the threat that legal action might persist for years, she refused to stay quiet about what had been done to her.

The least she, and those whom she has come to represent, deserve is a change in the culture of impunity when it comes to accountability.