Dr. Stephanie O'Keeffe:

There are probably two things to say about that. I was reflecting on both the March memo and the October memo, at the end of page 2 of which it is stated to me that there is a legal case proceeding at that particular time and "In addition, four letters from legal representatives of women seeking copies of all medical records have been received." It is clear, by the way, across all these memos that CervicalCheck has always furnished women with their medical records whenever they have requested them. The memo goes on to say:

Two of these requests relate to women recently diagnosed, with the programme only having just initiated the cancer audit process in these cases. Two women have directly enquired informally about their diagnosis and have been informed of the cancer audit process and that any review findings will be communicated to their consultant doctors.

Therefore, to answer the initial part of the Deputy's question, it is clear that the clinical director of CervicalCheck did reach out and directly talk to women, so the answer there is not a zero.

To respond to the other part of the Deputy's question regarding the methodology that CervicalCheck chose at the time, it had these audit findings. It stated in February that these audit findings could provide information to women as to why their cancers were not prevented and information on the effectiveness and limitations of screening. In March they said to me that the gist of the situation is that the programme has information on the woman's screening history that may be of benefit to her and which they believe should be disclosed. In April, they said this represented six and a half years of screening and that the process which had been evolving then clearly underscored the need to offer women an opportunity to learn about the audit and to choose to know the result. The July information for healthcare professionals that all members have been furnished with says this. I know there are queries about the letters and I would love to be able to get to those questions, but the information note to healthcare professionals states:

Where the review outcome suggests that the abnormality was not detected on a cytology or histology test or that, under treatment, a colposcopy might have been a factor, at the appropriate time, please inform the woman that a cervical cancer audit process exists, that her history has been reviewed and that she can be informed of the outcome if she so wishes.

There are two things here. There is how CervicalCheck actually went about that process and whether it was the right process. The view at the time was that the consulting clinician was the person who was best placed to be able to give that information to the woman. We might have some questions about that and the processes and procedures CervicalCheck put around it. The abject failure here, which is the tragedy we are all observing and what we are hearing, is that it did not effectively happen in the end. Not all of the consultants heeded that particular advice - some of them did, but the vast majority did not - and told the woman that a review had been done of her case and gave her the opportunity, if she so wished, to learn about the outcomes of the review. That did not happen, and that is the awful thing we face right now because the reality is that cervical cancer is a reality in all our lives. No screening programme in the world can stop all cervical cancer cases from happening, and the awful thing is that if we continue with our screening programme, we will have more stories in time about women whose cancers were not prevented by cervical screening. That is a tragedy and a travesty. We can try to improve it with HPV testing, but it is a reality. The thing going forward is that what the CervicalCheck programme intended to happen needs to happen.