Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

We earlier spoke about the counselling or information given to people when they went for a smear and the idea that when one's smear returned a clear result, everything was fine. According to the report, CervicalCheck organised the training of those responsible for imparting that information, so it is, surely, at fault for the poor training in that regard.

My main concern is that before any of this started I assumed that CervicalCheck checked the slides. I assumed there was a lab somewhere with people checking slides. We now know that doctors or nurses take smears in the community and labs abroad test some of the samples. Page 26 of the report details the organisational structure of CervicalCheck. If outside services were responsible for the testing and screening, the people whose roles are detailed on page 26 seem to have only been administering a service. As they only had one meeting in ten years and nobody was joined up, they do not seem to have had any proper role. The early part of the report twice refers to nobody being in charge. A concern of mine is that in January 2014 the NSS moved into the directorate of health and well-being. I cannot see any logical reason for that and such is not detailed in the report. Is there any reason for that move?

On the job description, although it is a funny anecdote it is very serious because even in the smallest business one is required to have a job description. It is very easy to ensure it is in place. I worked in the NHS. It is very easy to make sweeping statements that the NHS or the HSE is dysfunctional but this is a prime example of an arm of the organisation that is as bad as we could imagine.

On page 29 there is a reference to the recession. Is that the only excuse for incompetence that was offered to Dr. Scally? It seems like a fairly weak excuse.

On page 30 it states: “The QA Committee had a number of subgroups that concentrated on the development of standards for key functions in the screening process, such as cytopathology, primary care, histopathology, colposcopy and administration.” Is there a reason screening standards were not included in that or am I missing something?

The report states on page 32 that all was not well in the screening process. On what evidence is that comment based? Do we know anything about why CPL stopped screening in 2013? Is there any reason for that other than financial concerns?

The National Screening Service risk register report for October 2017 is quoted on page 35 as stating, "Clinical Audit process established and embedded in CervicalCheck by December 2017."The report then states: "This is also difficult to understand, as the audit process commenced many years previously." Discussion of the audit process began in 2009. It seems the relevant CervicalCheck staff were just making forms, creating standard operating procedures, having meetings and basically doing nothing.

Although he may not have wanted an answer to the question, Dr. Scally asked why there was an eight-year pilot and why it took so long to roll out the HPV vaccine. We were coming from a very primitive background in this country in terms of women’s health. If one looks at the media coverage of the roll-out of screening and the HPV vaccine, one will note comments by some religious organisations that one would not need a HPV vaccine if one led a pure and chaste life. That is the reason for the delay. There was huge pushback when the Minister for Health at the time, Ms Mary Harney, brought in cervical screening. Connections were made between a person's lifestyle and positive screening results. There was also significant pushback against HPV testing from what could be called interest groups or destructive people, which contributed to the low vaccination rate. The primitive attitude to women’s health held by some in Ireland is probably the answer to the question to which Dr. Scally may not have wanted an answer. We are now beginning to catch up in that regard, albeit far later than would be ideal.

I am very concerned that this arm of the HSE which employed all these people who were getting paid big money, judging by the wage bill, some of whom were eminently qualified rather than people who came in off the street, seems like such a basket case of an organisation that it could not even manage its data right.