Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I will go back to where the choke points in the process are and what we can do about them. As I understand it, and this is not a perfect understanding, there are essentially four steps. There is the capacity of general practitioners to meet women for a consultation and do the smear tests. There is then cytology, which involves looking at the cells on a screen and carrying out a HPV test afterwards if abnormalities are detected. I understand that if the test is clear, a clear test result will be sent back to the GP and the woman will meet her GP, or maybe the results are sent directly to the woman. If the test is not clear, colposcopy is then involved, which means the woman will see a consultant gynaecologist, a specialist in colposcopy, who will do an examination and take a biopsy. That biopsy will then go to a histopathologist who is a consultant doctor and a multidisciplinary team will take it on from there. I am sure there is much more complexity but the clinical specialties and capacity needed are general practice, cytology laboratories, colposcopy and histopathology. I am sure there is considerable specialty and complexity around that.

We know there are issues of capacity in general practice. Will the witnesses identify where the choke points are? This goes back to the six-month delay. Is it that women cannot get to see GPs quickly enough? Is it that the cytology laboratories are holding samples and cannot put them through quickly enough? Does the delay arise when abnormalities are detected and there is referral to a colposcopist?

Dr. McKenna noted, although not in relation to cervical cancer, that there are between 28,000 and 30,000 people awaiting a gynaecology outpatient appointment. Are growing colposcopist waiting lists one of the choke points causing the six-month backlog? Is part of the backlog that we do not have enough histopathologists and biopsies are being delayed? Will the witnesses give us a quick overview as to where the pinch points are in this process?