Professor Sean Daly:

I submitted a briefing document which I presume people have had a chance to look at. The provision of medical scanning services in Ireland is unregulated. This creates a situation where Irish women may be exploited and even harmed by inadvertently trusting a medical investigation which is performed by individuals who are either unfit or untrained to perform this investigation. There are many aspects to this issue, and I will happily take questions on anything that members wish to discuss with me, there are three broad areas which I would like to briefly comment on.

I believe that the use of ultrasound in the practice of gynaecology is very important. It gives valuable information about the anatomy of the female pelvis. When a woman presents with symptoms suggestive of a gynaecological problem, she may be referred to a gynaecologist. Unfortunately, the waiting times are long for those appointments. More and more general practitioners are looking to investigate and manage these things themselves. That is very worthwhile, but if they are depending upon an ultrasound investigation the people performing that ultrasound should be regulated and there should be defined training. Unfortunately, ultrasound equipment, unlike radiological equipment, has now become very cheap, and any of us can buy an ultrasound machine and set ourselves up as an expert in any form of scanning one wishes to be an expert in. No one oversees that, and the ultimate consequence of that could be harm.

On infertility services, virtually all of them in Ireland are in the private sector. Within the private sector there is not the same regulation as there might be within the public sector. There is a professional body which oversees the practice of infertility treatments. Scanning is part of infertility services. If one is having scans one has to be confident that the person who is performing those investigations is trained to do so. In general, gynaecology provided and supervised by radiologists. These are trained doctors who have gone through formalised training schemes and are competent to sign off on the examinations. That is not to say that they perform all of the examinations, but there are images that one would expect to see. The gynaecology scan is really the only scan in obstetrics and gynaecology which is entirely reviewed and signed off on by a doctor. Outside of that the practice is disparate. There are a growing number of infertility services, and couples who required infertility services are really a very at-risk group. These people desperately want a baby and they will do virtually anything to get one. They will go to anyone who professes to be able to help them achieve that. Unfortunately, there is a wide variety of infertility services available in the country.

On the issue of pregnancy scanning, I will discuss two categories. Early pregnancy assessment, which is the assessment of pregnancies before 14 weeks, has provoked much discussion since 2010 about the incorrect diagnoses of miscarriages. An independent inquiry was set up which reported on the issue, and as a result of that the HSE made significant amounts of money available for training. Every unit in Ireland got a very good ultrasound machine, and people were identified to oversee that services. In general, that service runs reasonably well.

Obstetric scanning has been discussed here before. Dr. Peter Boylan and Professor Louise Kenny discussed it in some detail on 16 February. The reality is that in Ireland many women do not get a foetal anomaly scan. I believe that that is a tragedy and can result in tragic consequences for the baby, if it is born with a significant abnormality and born in the wrong place. There is huge geographical variation in terms of where women attend for care during pregnancy. If one is lucky enough to live in Dublin every woman, irrespective of her income, will have at least one anomaly scan. However, that is not the case throughout the rest of the country.

There is more information in my briefing document, but I am very happy to take questions.