Dr. Gabriel Scally:

I thank the Senator for a fine set of questions. He asked about the Oireachtas and its potential role in this matter. I will link that with his final comment on finding people to blame. It is undoubtedly true that there is an appetite to find people to blame. In this situation, I do not know where one stops. Senator Dolan invited me to speak about the role of the Oireachtas and politicians in all of this. A reason we have this problem, as Dr. Denton has indicated, is that cervical screening is relatively recent in this country, having been in place for only the past ten years. It has been in place in the UK for 20 years and in a number of other European countries for much younger. I find it difficult to understand why it took an eight-year pilot before the programme was introduced. An eight-year pilot for a programme that has been well tried and tested elsewhere does not make sense to me. I have no idea why that occurred.

As the Senator will have gathered from the report, I am critical about the removal of the external governance of the HSE and that situation going on for so long. I am very pleased that it has been restored and with the appointment of the chair. A fine chairman has been chosen and I have confidence in that person. It is very unfortunate that certain things happened, for example, the decision to postpone the implementation of the HPV vaccination. I am very pleased that is in place now and that vaccination are on the way up. There was a decision to postpone its implementation.

As I have expressed already, I am a strong advocate - I hope there is no longer any argument about it - for the necessity of a statutory duty of candour being placed on individuals. The Oireachtas had the opportunity to do that and chose not to, for whatever reason. One can look at the entire system, from legislators all the way down to people on the ground, and find things that did not go well. I said I am hopeful that the culture will change. By nature, I am an optimist, but I come from Belfast where there is a saying that an optimist is someone who has not heard the bad news yet.

I hope there will not be bad news about these 50 recommendations. I hope they will be implemented and that the country will get the cervical screening service it deserves. I will certainly be doing what I can and what I am asked to do to help in that respect.

Regarding changing the culture, I have indicated in the report that certain provisions need to be put in place, including a national screening committee centre. On the Deputy's question on the future of other programmes, particularly in this modern age of genetics, I am quite confident other screening programmes will come forward. Ireland does not yet have a proper mechanism for looking at screening in a highly professional and consistent way, which is why I have recommended that a national screening committee be put in place. That would serve the country well in the future and would enable a rational approach to screening and oversight.

It will not have escaped the Deputy's attention that among my recommendations I made two regarding matters I have mentioned. I recommended there should be patient advocates on the board of the HSE. I also recommended that there should be patient advocates on the national screening committee, and I have made other similar recommendations in the report. I have been deeply impressed by the advocacy shown by some of the people affected, notably Vicky Phelan, who exposed much of it. I was also deeply impressed by some of the patient advocates involved in the Madden committee some time ago. I would encourage that approach to involving patient advocates at the highest level but with one caveat. I recall one day chairing a committee, on which we had included patient advocates, and as I looked around those attending it occurred to me that the only people who were not being paid to be there were the patient advocates. I am conscious that is unfair and exploitative.