Mr. Gerard O'Mahony:

During the outsourcing in 2007 and 2008 there were continual teleconferences. They were held either once or twice a week. They also continued after the laboratories had disappeared off the scene because multidisciplinary team, MDT, meetings had to take place between gynaecologists and the pathologists in the United States who had done the cytology and the smear. The difference at the time between the screening in the United States and here was in the volume of work we were doing. In Ireland initially, when we started screening, we were doing about 32 screens per day. That changed with the introduction in the early 1990s of the rapid review which was the safety net. We worked on the basis that we would continue with 32 smear screens. At that stage in the United States they were doing 100 a day. Many of them said they had moved to using liquid-based cytology, which we accept. However, we found it difficult. We were dealing with what could be regarded as the original pap smear. We were changing to using liquid-based cytology between 2007 and 2008. In that case, we were hoping we would be able to increase the numbers we would do on a daily basis. The Americans still continue with a figure of 100, but we had a full rapid review of all negatives. In America they were doing a review of 10% of all negatives. That was the difference between the two.

Was there a clinical need to outsource? I do not believe there was. The service provided here is exactly the same. In fact, I think there was a better quality service here. On the question of capacity, the idea behind outsourcing was to achieve a 28-day turnaround time. One of the statements identified five laboratories that had a turnaround time of 28 days, but the rest of us could not achieve it. The reason we could not do so was the most essential report on the cytology service, especially the cervical side of it, the negative report. We were consumed by making sure it was negative. It had to be negative and that took much time.

In 2007 and 2008, when working in a laboratory, I had four people in training. They were qualified at honours degree level and had trained in the United Kingdom in September 2006. They had come back to the laboratory where we double-screened their work. There was a follow-up week in the United Kingdom in July and August 2007. They made a pre-exam visit to the United Kingdom and in Ireland in December 2007. We carried out a full review and brought in an international person to deal with all members of staff in April 2008. In June 2008 they were certified to report on liquid-based cytology. It took 21 months after completing their degrees and experience in the laboratory to be able to report in the cytology lab. There was a long lead-in period. They were essential members of staff. If one of them got sick or decided to leave the job, we would have been back at square one in trying to get the expertise.