The briefing memos for the HSE on the the cervical screening audits are striking in their omission of overt references to the need to inform the women concerned of the findings that affected them.
In hindsight, given the various comments from Ministers and health service officials on the HSE’s policy of open disclosure since 2013, this would seem remarkable.
The main emphasis would appear to have been to uphold public confidence in the benefits of the overall screening programme.
HSE director general Tony O'Brien argued strongly on Thursday that the CervicalCheck programme, while not infallible, had detected 50,000 high-grade abnormalities and had led to the avoidance of hundreds of incidents of cervical cancer and deaths.
This is a view shared generally across the health and medical communities.
However one of the briefing memos, a document dated March 2016, suggests that not only was a policy of open disclosure not being pursued, but that within the HSE at a senior level there were concerns as to the dangers of what could happen if it was followed.
“There is always the risk that in communicating individual case reports to clinicians of an individual patient reacting by contacting the media if they feel that screening did not diagnose my cancer.”
Go public
Perhaps more tellingly, the following line in the memo warns that effectively the more such letters were sent out to clinicians the greater the likelihood that someone would go public about their findings “if/when shared by their attending clinicians”.
Screening tests for cervical cancer, as doctors have repeatedly stressed, are not 100 per cent accurate and a negative result does not necessarily mean a woman will not go on to develop the condition in the future.
The memos show that the HSE was informing clinicians on the audit findings on their patients.
It was also drawing up a “reactive communications response” to any media story that emerged from the audits highlighting cases of women who had developed cancer despite undergoing screening and being given clear results.
The use of the phrase “if/when” the results were conveyed to patients, will also undoubtedly raise questions as to why this did not raise a red flag as to whether there was to be a blanket policy of disclosure.
Legal concerns
The memos for the first time also reveal that one of the cytology laboratories involved in the screening programme had expressed legal concerns about review findings being made known, although this issue seems to have been resolved in May 2016.
The official HSE position has been since the current controversy broke that there was no policy decision taken not to inform women of their audit results and that a row between doctors and CervicalCheck over who should tell them had delayed this process and should have been resolved earlier.
The memos do not show that this stance is untrue.
However, neither do the memos show that informing women of their audit findings was a central priority.
