Dr. Stephanie O'Keeffe:

My understanding from the documentation and from the briefings I have received is that there had been engagement with the consulting clinicians on the audit process and its methodology. One of the documents the committee has talks about the process development, that they engage with the colposcopy forum, they engage with the programme colposcopy services and histology laboratories, the cytology lab providers, the quality improvement division and the State Claims Agency. The documentation and briefings I had suggested that was engagement with the consultants and clinicians. The October briefing I have, which is very important from my perspective in trying to look back at this and understand how this could have happened, makes it very clear that there was ongoing engagement with the consultants in supporting them with this process. They had developed a guidance note for them and Professor Gráinne Flannelly herself was directly engaging with consultants as they called up, as well as patients. That was my understanding at the time.

It was not brought to my attention that there were difficulties at that stage. I would have known that it was an evolving process. They would have said that this is very challenging and that all the international evidence suggests that this type of disclosure is very challenging. They would have said, while the treating clinicians were the most appropriate people to do it and that was well-established, it was not an easy thing to do. They would have described research studies which would have shown the types of fears around this type of thing. There were actively engaging with that. They stated in October that this would continue. As I mentioned already to Deputy Kelly, there was no escalation or no early risk detection communicated on that not happening in practice.