Mr. Tony O'Brien:

I indicated last week that I would carry out a case management review, using the management of this case as a learning exercise. I have now directed the HSE's internal audit division to do that. There is a significant potential to improve the process. For example, if different parts of the organisation are involved in a case raised by a plaintiff and handled by the State Claims Agency, a discovery process is followed in different parts of the organisation and two or three parts of the discovery are joined up, but this is done by lawyers in the State Claims Agency and not people in the HSE. I want to put in place a process whereby the discovery is matched up by someone from within the HSE who will be better able to identify the danger signs, the warnings and the risk issues that might be apparent from discovery. In the current case, joining up the two lots of discovery would have made it possible for another part of the organisation to identify the risk around communication without anyone in the programme or anybody involved in it saying it internally. The externalising of the management of these cases, which has served other purposes usefully for the State, has led to a weakness in risk and management control inside the health service which we must now address. The internal audit case management review which I have instigated to look at the failures to escalate this case, and at the fact that the issues were not identified and addressed quickly, will provide a pathway to do that. This is not to criticise the State Claims Agency but to recognise that a lacuna has opened up in processes, which this case has really exposed.

Professor McKenna, who is providing clinical governance for the programme on an interim basis, indicated last week that he will be examining what enhancements can be made to the literature to promote a better understanding of the advantages, the risks, the disadvantages and what the screening programme cannot do. We are moving rapidly towards HPV testing as the primary mode of testing, which will transform the way we do cervical cancer testing in a hugely significant way and is the best way to improve the confidence people have in the programme, with or without the present circumstances.