Dr. Stephanie O'Keeffe:

I believe there was a failure in closing out a very well-intended audit review of cancer cases notified to the programme in 2008. There was a failure in closing that out in the system, and I believe there was a failure in the detection of the risk by CervicalCheck and the national screening service. There was a failure in detecting the risk and there was absolutely a failure in its escalation because it is clear to me that there was correspondence in 2017. When I was head of the service, there was correspondence within the system-----