Dr. Stephanie O'Keeffe:

The first thing to say about this, particularly in the interests of the women and the public who are terrified as a result of all this, is that the screening programme intended for the information to be disclosed. When this was first brought to my attention in February 2016, all of those briefings detailed that there was an accumulation of case reviews that had been completed. A decision was made the previous year to ensure that this information was given to women. A process was put in place to figure out the best way to do that. As Dr. McKenna mentioned and in relation to the Chair's question on who the best person to give this information was, they considered all those things. They looked at the open disclosure policy and the guidance for the disclosure of audit findings for cancer screening programmes to come up with a process that would support this. I have got emails from the screening programme stating that the programme has information on women's screening history that may be of benefit to her and we believe it should be disclosed.

The issue that they brought to my attention in February and March was the fact that they felt that some of the laboratories had queries once they found out that they were issuing letters to treating consultants so that the information could be given to patients. They were concerned, they escalated it to me and I supported them to resolve it so that those letters could continue to be given.

Deputy O'Reilly's questions on the interpretation in relation to the letters are very fair. The questions on whether the open disclosure policy was appropriate at the time are very fair, especially in hindsight, but they were looking at what the policies were in other jurisdictions on this type of disclosure in these circumstances. Their intent was that the information would go out.

In terms of Deputy O'Reilly's specific question on the letters, it is fair to say that these are templates. What that means is that every letter is individualised to the case, so when it says "if open disclosure is required" that is also a template letter for women who are getting the results of audit findings where there is no discordance between the cytology. Open disclosure would be required if there is a discordance. It is true that within the provisions here they have left space for clinical judgment. That needs to be reviewed and we need to look at it. In speaking to Professor Flannelly who was running the programme at that time and meeting individual women, and it can be seen in the first memo that she meets women, talks to people who are getting these results, and she is talking to consultants and so forth, my understanding was that there would be circumstances where it would not be advisable to tell a lady something like that, for example, if the person was close to passing away.

That absolutely has to be looked at, in terms of what kind of guidance can be given to clinicians in the context of wanting to be fully open and disclose this information, and some of the challenges there might be from a clinical perspective. It has to be reviewed in hindsight, but it is really important to say that those carrying out the programme, at all times, wanted the information to get into the hands of these women, and expected that it would.