Oireachtas Joint and Select Committees

Wednesday, 9 May 2018

Joint Oireachtas Committee on Health

Quarterly Update on Health Issues: Discussion

9:00 am

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I am keen to make some quick points on CervicalCheck. Then I will move on to a question on non-registered consultants. Yesterday, a High Court judge described that situation as scandalous.

I wish address the issue of CervicalCheck first. I believe there is an opportunity to be proactive in identifying high-risk women. We have been speaking to general practitioners throughout the country. The point was made to us that the inverse care law may apply here. In other words, those most likely to contact the centre and go for further screening are not necessarily those most likely to need it. In one conversation relayed to me a general practitioner talked to women in his practice who he believed should have repeat screening. They said they were fine and that the GP should not worry about it. There is an opportunity to identify and target higher-risk women and proactively reach out to them. The idea is not simply to have a woman contact her GP and self-select or contact the helpline. We should be more proactive about it.

Will the Minister tighten up the guidelines for GPs? I have been contacted by several GPs. They say the information they have to date is insufficient. They have been told to use their clinical judgment. That is fine but I believe many of them are looking for a little more in terms of when it is appropriate or otherwise when it comes to different types of clinical advice.

I wish to address the preliminary investigation. I did not put this point in my submission to the Minister. I am suggesting something new. It relates to the fact that the investigation will be looking at the activities of the Department of Health and the Minister. My understanding is that it will include the period from when the Department knew about Vicky Phelan's case and sent the memorandum to the Minister and so forth. There is a clear conflict in reporting into the Minister or the Department on that basis. Will the Minister consider a reporting line into the Department of the Taoiseach? I appreciate that I should have raised the matter before the Minister brought it to Cabinet, but I will leave it with the Minister.

It would be useful to get a report on laboratory accuracy. There is considerable concern that the US laboratories may have been substandard and that the Irish laboratories were substandard. The HSE has released documentation. The HSE released it on Saturday but with insufficient explanation on the values. For example, if we use positive predictive value, it would appear that in two of the years the Irish-based laboratory was the least accurate. If we use the number of anomalies detected, it would appear the same laboratory was the most accurate. I am seeking expert advice on the matter myself but I believe a clarifying note from the Department or the HSE would be useful.

This is a political point for the Minister and for the Taoiseach as well. There is still considerable confusion as to the link between non-disclosure and clinical outcomes. I am talking to women who still believe that the issue of non-disclosure has led to women's deaths. My understanding from talking to consultants is that while that cannot be ruled out, in fact it is not the case.

When Storm Ophelia arrived, every time I turned on the television the Taoiseach was on the screen flanked by soldiers and rescue workers. He has not been out in the same way on this. This is a national emergency just like Storm Ophelia in terms of the level of fear and misunderstanding. Will the Minister talk to his boss and suggest that he show the same zeal for communicating with the public on this? Perhaps he does not believe it would be as good a photo opportunity to be standing beside the HSE officials at the moment. I am being somewhat tongue-in-cheek but there is a marked difference between how much he appeared on our television screens during Storm Ophelia and how we are seeing him on this issue.

Either the Minister can or cannot respond to any of these questions. I am making them as points so the Minister can feel free in that regard.

I want to ask the Minister on an issue described by a High Court judge yesterday as scandalous. There are well in excess of 100 doctors in Ireland working as consultants but who are not in fact consultants. It amounts to approximately one in 25 doctors in consultant posts in the country. On top of the CervicalCheck scandal, which has obviously shaken confidence, we have an issue described as scandalous by the courts. It seems a patient may not know whether the consultant he or she is seeing is in fact a registered consultant. What is the Minister's view on that? Does he believe it is acceptable? My understanding is that this has been going on for some time. We got evidence last week at committee that there is genuine clinical risk attached to this practice. What is the Minister's view on it? What, if anything, does the Minister intend to do to stop this practice?

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