Editorial: Women let down by cervical report

There was little room for suspense or surprise when the findings of the inquiry into cervical cancer screening in Gisborne were released yesterday. The report duly pointed to deficiencies in the national screening programme and the work of Michael Bottrill, a pathologist with a dismissive attitude towards quality controls in his laboratory. That much was utterly predictable. Where the inquiry had really to earn its spurs was in its solution to the crisis of confidence which has inevitably affected the screening programme. Here, its grip was rather less secure.

The committee of inquiry has made 46 recommendations to the Government. Some represent obvious remedies to systemic failings, which included inadequate monitoring and fractured administration. Some have already been acted upon. Centrally, the inquiry wants a complete national evaluation of the cervical screening programme, with further independent reviews in six and 12 months. Such an evaluation by the Ministry of Health would clearly have discovered there was severe under-reporting in Gisborne. Equally logically, the committee calls for performance standards for laboratories and suggests that only appropriately trained practitioners should read smears.

The key question, however, is whether such measures will be enough to overcome women's lack of trust in the screening programme or whether the inquiry has placed too much emphasis on remedying the system and too little on the health of the individual patient. The programme will start to function effectively only if the confidence of women is recaptured.

Such has been the damage of the Gisborne scandal that relatively radical measures may be required. Perhaps, for example, there is a need for an inordinately high level of peer review of cervical cancer smear tests. This could go as far as individual slides being read by two practitioners. Such degree of scrutiny would be unusual - but so is the need for women to be able to rely on the programme.

That requirement has been reinforced by the inquiry's finding that the poor reporting in Gisborne might have happened also in other parts of the country. The systemic failures in the screening programme allow no other conclusion. Effectively, that means every woman has cause to wonder about her test results. And it also makes nonsense of Helen Clark's assumption that the history of the screening programme was "not that relevant now." Every woman's questions about the accuracy of her result means, again, that an uncommon remedy may be required.

Most reasonably, that might mean free tests - including free doctors' visits - being available to those women as of right.

The committee of inquiry's report does not concern itself with such detail. Its approach is more broadbrush. It does not consider, either, whether the programme would be more effective if placed under the control of a dedicated national cancer control agency. By implication, the programme will remain within the Ministry of Health. Most importantly, however, there is no precise prescription for restoring women's confidence.

Certainly, patients' concerns and rights are touched upon, as in the suggestion that the screening programme should have its own consumer complaints system. But the commission lets itself down there and also in recommending that the Medical Council should ensure that systems are in place to support the early reporting of errant practitioners.

Errant behaviour, such as that involving Christchurch GP Morgan Fahey or Northland gynaecologist Graham Parry, was, of course, the subject of a review released by Helen Cull, QC, little more than a week ago. That report was strongly critical of the medical profession's record in self-regulation and suggested a one-stop shop for patient complaints run by the Health and Disability Commissioner's office.

It is both odd and unfortunate that the Gisborne report should be so out of step with the Cull review, and that, despite the recent scandals, it should continue to set store by the Medical Council.

Perhaps more than anything else, that flaw betrays the inquiry's relative inattention to the needs of patients. Implanting correct procedures and professional standards are logical and commendable steps. In this instance, however, the breach of trust has been so severe that more is needed. A more direct response to the needs of the individual woman would have been welcome.