Dr. Tony Holohan:

It is important to say that we still have substantial confidence in the performance of the programme for the reasons that Dr. McKenna has outlined - sufficient to enable us to give full reassurance that the programme operates to the highest quality assurance standard still. I know that much has been said on the issue of public confidence. I am not suggesting in any sense that the Deputy is taking us back in comparison, but it is worth pointing out that before the programme was established in 2008 - and this is a ballpark figure - we were doing somewhere in the region of 300,000 smears a year. We were sending the smear tests to small laboratories, where we were getting poor quality assurance, QA and we had no QA to tell us what the performance was. Some of the women being screened were being screened far too frequently and others were not being screened at all. We were having no impact on mortality. I can remember testimony by clinicians, particularly from those who came back to work in this country around that time about the late stage of presentation of young women with young children with cervical cancer. That situation has not changed completely, but it is changing substantially. We have had since 2010 a substantial reduction in the mortality associated with the programme and a range of other factors that allow us to say that people are being identified.

We heard earlier about the 50,000 or so women who have been identified with early stage changes that could be dealt with definitively. If we continue with the performance parameters that we are seeing with our programme, we can be confident that we will continue to drive down that mortality. When we supplement that with what we are doing in terms of HPV screening, which will start later year, we can be confident in the screening performance of that. We have substantial reason to continue to express high confidence as leaders in the health care system. All of our health care practitioners should be in a position to continue on the basis of the data that we have available to us. I can make available to the committee an article that was published in the European Journal of Cancer Careabout three years ago, based on a side by side comparison, questionnaire based. This analysis of cervical cancer screening programmes around Europe confirmed that we have one of the most organised, highest performing and most quality assured programmes anywhere in Europe. Many of the features we are talking about here today are exhibited by very few organised programmes. Many well-known countries, First World countries as it were, do not have that type of organised programmes. The basis for us to continue to reassure people that they can have confidence in the programme, confidence in the results of their tests on the basis of its performance remains. That has not been changed by any of the unfortunate experiences that some of the people of whom we have talked about have had.