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Home / New Zealand

Sickness defeats the spin doctors

19 Apr, 2001 04:18 AM6 mins to read

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Doubts remain whether the Health Ministry has learned the lesson of the cervical cancer screening inquiry, says FRANCESCA MOLD.

It was one of the most challenging public relations tests Ministry of Health officials had faced.

They were in the firing line for a shocking catalogue of mistakes going back a decade during the development of the cervical screening programme.

Because of those mistakes, women had undergone painful, dehumanising treatment for cancer, lost their ability to have children and some had died.

Yet from the moment the Gisborne cervical cancer inquiry report arrived at the ministry's offices in Wellington, the focus did not seem to be on seeking out those responsible and holding them to account.

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Instead, the ministry's main concern appeared to be how to present the report to the public in a way that would minimise the expected barrage of criticism and blunt the fury of a roomful of deeply wounded women.

The strategy was simple. A well-briefed team of officials flew to Gisborne on Tuesday armed with statements of apology and press releases listing the improvements made to the programme.

Throughout the public meeting, these officials carefully deflected tearful pleas to name those responsible by robotically repeating the mantras: "Things are much better now - we've learned our lesson - there's no need for heads to roll."

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But the ministry underestimated the fury of the women, who were not to be placated.

With good reason, they are the country's most sceptical health service "consumers." They have a complete distrust of the system and the people who work for it.

These women still believe they have been betrayed.

The ministry's apparent refusal to accept its responsibilities has merely added fuel to their desire to punish it by forcing the bureaucrats to hand over precious health dollars in compensation.

They also feel there is no justice in pathologist Dr Michael Bottrill's being disciplined by the medical fraternity, sued by the women he wronged and becoming a national symbol for incompetence, when the officials who allowed his bad practice to continue escape punishment.

The ministry slipped into damage control mode from the very beginning of the inquiry.

Its lawyers challenged every expert witness and staff took a defensive approach to giving evidence, carefully dodging criticism rather than risk opening their actions to public scrutiny.

Their attitude had visibly changed at Tuesday's public meeting, where they attempted to appear suitably chastened.

Unfortunately, that image was somewhat spoiled by the self-righteous attitude some ministry staff took in pointing out how mistaken those people were who predicted that the screening programme would be taken away from the ministry as a result of the inquiry.

It was this smug tone that has left women involved in the affair and advocates of screening programmes fearful that, despite the promises, nothing has changed at the ministry.

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They believe the attitude of "we know best," which has prevailed throughout the decade since the programme was first contemplated, is still alive.

It was this culture that landed the ministry in hot water in the first place. It consistently ignored advice from cancer experts who were driven by a desire to make the programme safe for women.

The ministry developed policies which it lacked the power to enforce. It paid taxpayers' dollars to laboratories which could not prove they had quality checks in place or even that they were skilled at reading cervical smears.

It made little attempt to do its own evaluation of the programme's success. Its measure of success was the number of women having smears - not whether screening was reducing cancer deaths.

Since the scandal erupted, there has been praise for the way staff from the Health Funding Authority responded. Many people in the field feel the programme has been in safe hands since public health specialist Dr Julia Peters took control.

She has made improvements at an impressive rate and is passionate about running a quality programme.

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But such is the climate of distrust that there is a suspicion that Dr Peters, who was swallowed up into the ministry when the HFA was dissolved, will become just another faceless bureaucrat indoctrinated into a culture of avoiding accountability.

The hope of cancer experts and the women was that the report would recommend the programme become part of an independent cancer control agency, staffed by people with a passion for fighting the disease.

The agency would look after breast and cervical screening, as well as implement a national strategy to control the disease in the future.

Instead, the ministry says it will implement a national cancer control strategy and run the national screening unit.

It has answered fears that the programme could become vulnerable when attention is diverted to another health crisis by promising to give those in charge more power and a distinct budget.

But critics point out that by leaving the programme in the ministry, it has become buried under layers of bureaucracy again. On paper, the clinical leader, Dr Peters, is answerable to a unit manager, directorate manager and the director-general. The chain of command is just as complicated as it was in the past.

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To a certain extent, the civil servants can escape blame for some of the problems experienced by the programme because it largely operates at the whim of Health Ministers who, with each new Government, have restructured the health system.

The programme has stuttered through a decade of health reforms, with responsibility for it passed from pillar to post so often that it almost got lost.

Ministers wanted the programme to look good for political gain, but did not appear to care too much about delving below the surface to see if it was actually working.

There has also been an eerie silence from political parties since the report was released.

That can be put down to the fact that both National and Labour have had a hand in the programme's failures and are reluctant to indulge in slinging mud that could so easily fly back in their faces.

In the end, neither the women nor those passionate about cancer prevention feel they can have confidence that an organisation which never wanted responsibility for the programme in the first place has suddenly developed an enthusiasm for it.

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They believe that no amount of assurances and statements of goodwill can substitute for setting up a specialist agency that cannot be touched by political whim or lost in a ministry with an abundance of other priorities.

Full report of the Inquiry

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