Mr. Damien McCallion:

I thank the Chairman for the invitation to attend this meeting. I am joined by Dr. Colm Henry, chief clinical officer in the HSE, Dr. Lorraine Doherty, clinical director for CervicalCheck, Ms Celine Fitzgerald, interim CEO for the national screening service and Dr. Peter McKenna, the clinical director for the women and infants programme. We continue to address and manage all issues that have arisen in the programme since April 2018. The briefing submitted in advance of the meeting to the committee updates it on these key areas of priority.

Our information line and client services unit continues to provide information to women and their families. We also support women and their families in the provision of access to their records and ensuring women get their slides from laboratories where required for legal review. The client services unit continues to support this process and we have provided healthcare records to 665 women and slides to 388 women, families or their representatives. We continue to support the 221+ group through our community liaison officers who support women and their families with the provision of the support packages following the Government decision of May 2018. We also work closely with the 221+ patient representatives across a wide range of areas and are very grateful for their guidance and input to the screening programmes. It is helping to make a real difference. We have just completed a patient and public inclusion plan for screening services. This was developed in conjunction with our patient representatives and was recently launched. We are very grateful to the three lead patient representatives who are part of the team. Some key actions within the plan include appointment of a full-time patient inclusion officer, extension of the screening patient panel, patients on key committees and a model for patient inclusion. We also have patient representatives on the HSE steering group for screening, Stephen Teap and Lorraine Walsh, and would like to acknowledge the work of Lorraine Walsh, who recently stepped down from the HSE steering group. Despite her own difficult illness, Lorraine has been an invaluable and supportive patient advocate and has been key in making the changes necessary to sustain cervical screening in this country. The HSE would like to formally thank her and wish her well in the future.

The HSE has contributed significantly to the development of an implementation plan in collaboration with other State agencies in response to the Scally scoping inquiry recommendations. An oversight group was established in the HSE with a senior manager appointed to support and ensure continued implementation of the Scally report. At the end of November, a total of 95 actions have been completed by the HSE from a total of 116 within the overall plan with the remainder in progress. Examples of progress to date include key appointments, governance improvements in the national screening service and CervicalCheck, an organisational review of risk management structures has been completed and a report setting out a revised approach to risk management across the organisation has been approved by the HSE board. A review of the HSE's healthcare record management policy is also due to conclude shortly.

One of Dr. Scally’s recommendations included setting out the future approach to interval cancer audit. The HSE established an oversight group for this project with expert groups. The expert groups are independently chaired and comprise patients, patient advocates, patient ethicists, screening clinicians and international experts. The expert groups have considered international best practice as part of the scope and the work continues to be progressed with a target to complete early in 2020. The recommendations of the RCOG aggregate report in relation to interval cancer audit will now be incorporated in this work. An interim revision of the HSE open disclosure policy was published in June 2019 and the HSE remains committed to ensuring the operation of open disclosure throughout the organisation by continuing to roll out its national training programme through the national open disclosure office. An open disclosure governance steering group chaired by the national director for quality improvement continues to provide the governance and the oversight to the operation of open disclosure throughout the HSE. The governance framework in the group will provide leadership for the evaluation of the audit of compliance with the policy.

All recommendations for procurement have now been implemented and the HSE also continues to work with medical training bodies in developing an open disclosure in communication skills training programme.

Turnaround times for the reporting of results are now running at an average of six weeks. We hope to sustain the turnaround times at this level going forward. This will ensure that women and their GPs get their results in a reasonable time period, which is one of the key performance indicators for the programme.

The key risk to enable cervical screening to continue in Ireland was the extension of the laboratory contracts. The HSE reached agreement with both the Coombe and Quest to enable continuity of the programme. The development of the national cervical screening laboratory was included in our recent HSE capital plan and will enable a better balance between public and private laboratory capacity provision. A project steering group and team are now in place with building and workforce plans developed. Additional support has been procured to enable the project to be accelerated as much as possible. The new laboratory is already at the planning stage. While we are planning for a rapid build programme, it will still take a number of years to implement, primarily due to the challenge of retaining and recruiting suitably qualified staff. This challenge cannot be underestimated in our environment.

Hospital colposcopy services remain under pressure with increased referrals and the requirement for increased consultation time. The HSE women and infants programme has recently completed an impact assessment on hospital colposcopy services that identified some immediate resource requirements. Funding was included in the 2019 national service plan and this was rolled out to the clinics to support additional service sessions, to increase capacity and improve waiting times. We continue to work with the hospital colposcopy clinics and a joint working group between the national women and infants programme, acute hospitals and CervicalCheck has been established to support this process.

The programme, after a long search, has just appointed a national colposcopy adviser. While we have secured support from our hospital colposcopy services on particular projects, this has been a significant gap over the last year.

We are continuing to implement our plan to introduce HPV primary screening. A project team has been in place since last year and there are seven work streams involved in the project. We remain committed to implementing HPV primary screening, with the target for implementation in the first quarter of 2020.

Since we last appeared before the committee, we have reduced some of the major risks to the project through the reduction in the backlog and securing laboratory providers who can provide the testing service. The implementation project, however, remains complex, with a number of risks which we continue to actively manage including IT system changes, laboratory preparedness and to ensure sufficient availability of colposcopy services to address future demand from HPV primary screening.

The introduction of the HPV vaccine for boys in September 2019 combined with the existing uptake of the HPV vaccine by girls will help reduce incidences of cervical cancer and other cancers. Evidence from elsewhere in the world shows that this combination of HPV vaccine and HPV primary screening will have the impact of eliminating cervical cancer over the next two to three decades and in the shorter term, ensuring that women present with earlier disease and are much less likely to progress to cancer.

While recruitment and retention of staff remains a challenge for our screening services, we have made significant progress. We have completed a review of the organisational design of the national screening service and one of the key actions was the appointment of a permanent CEO. The permanent CEO position within the national screening service has been advertised and an interim CEO for screening services is in place while we recruit a permanent CEO for the service.

In addition, we have appointed a permanent quality and risk manager for screening services and have filled additional new posts in quality and risk management. A deputy laboratory co-ordinator is now in place to strengthen the laboratory capacity in the programme.

We have recently appointed a CervicalCheck programme manager and are concluding the recruitment of a deputy CervicalCheck programme manager. A CervicalCheck colposcopy adviser has just been appointed and we are continuing to progress the recruitment of a CervicalCheck primary care adviser and colposcopy nurse, which will further strengthen the clinical input to the programme. We have also recruited a permanent director of public health for the screening service and continue to make efforts in recruiting public health specialists to support the work of the director. This will strengthen the public health input to the programme. Posts in communications and HR have also been advertised, in addition to a number of other programme support roles. We will ensure that the recruitment of all posts from the service workforce plan continues to be prioritised.

The HSE provided support to the independent international expert panel review undertaken by the Royal College of Obstetrics and Gynaecology, RCOG, which was established by the Minister for Health, following a Government decision for women who were diagnosed with cervical cancer. The HSE supported the consent process, established a national help desk, developed an eligible data set with the national cancer registry, implemented a client management system to support RCOG, co-ordinating the release of slides and medical records to RCOG and supported the provision of individual reports to women.

The HSE put a verification process in place to ensure that an anonymised report went to the correct woman for whom the HSE held her name and address. This was an administrative process to ensure that the right report went to the right woman. All women, or their next of kin, who wished to do so have now received their individual report. Throughout the process of communicating individual reports, the HSE’s focus has been on ensuring this is done as appropriately and sensitively as possible.

The aggregate report was published following the Government meeting of Tuesday, 3 December and provided further assurance about the quality of the cervical screening programme. It contained ten recommendations which are being incorporated into our existing overall implementation plan. The report’s key findings included that there was as expected a high proportion of very early screen detected cancer, which has saved many lives and concluded that the CervicalCheck programme was working effectively.

The review did find for a number of women a discordance with their original CervicalCheck results and RCOG set out the reasons for this in their aggregate report. We are conscious of how difficult it has been for many women and their families who were part of the review. The HSE will continue to provide meetings where required and an information line for those women and families who were part of the review. We will continue to provide this support for people impacted by the review.

Overall, the conclusion of the RCOG review is another milestone for the programme. It completes a major programme of operational support and provides welcome assurance about screening quality as we continue to stabilise and strengthen our screening services. I want to assure members that the HSE is absolutely focused on ensuring these important public health programmes continue to save lives. All possible resources are being directed at this challenge.