Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I have a good few questions so I will ask them quite quickly and in a row. I thank the witnesses for their submission. I also thank Dr. Gráinne Flannelly for her very informative letter on how the whole system works. It was very well thought-out and delivered. The page where Dr. Flannelly talked about 28 April 2018 is a very important piece concerning her advice to the Department not to proceed with offering a second test. In the letter, she wrote that laboratories would not have sufficient capacity, open access for repeat testing would be difficult to plan and deliver, colposcopy services would not have sufficient capacity and it would fundamentally undermine the screening programme. All of that was very prophetic because that is exactly what has happened where we have a backlog of 80,000 tests with a 33-week waiting period. The task facing the witnesses is enormous.

Was Dr. Flannelly a big loss to CervicalCheck? It seems to me that she must have been a big loss to the service given the struggle to recruit experts in this field. Do the witnesses think that, when this becomes increasingly exposed, there be a loss of confidence in the Department, regardless of whoever is responsible, be it the chief medical officer or the Minister or both, because Dr. Flannelly's advice to the Department was rejected, putting us into the position we are in now?

On CervicalCheck's record in sourcing laboratories to help get through this mess, has it looked to Northern Ireland? It has four laboratories which I believe have capacity. Will the witnesses address the result in Northern Ireland?

The witnesses mentioned challenges with CervicalCheck's other partner, having said that it has made progress with the Coombe and Quest. I assume that is MedLab. I do not want to take up the witnesses' entire day, but could they spell out what those challenges may be and the headline issues around those challenges?

In the section dealing with supports for women and their families, the submission reads that CervicalCheck supports them in the provision of access to their records and ensuring that they can get their slides where they are required for legal review. A total of 118 of 125 slides that have been requested have been dealt with, with an average waiting time of 27.5 days. This is under the headline of supporting families. Seven are still in progress. Are legal proceedings pending in those seven cases? Is a specific laboratory involved or are multiple laboratories involved?

Under the section on the independent review, the submission reads that in recent weeks the laboratories have commenced the transfer of slides. I am quite passionate about this because we were told last June that the Royal College of Obstetricians and Gynaecologists, RCOG, estimated that it would take six months to conclude. I understood that to mean to conclude its examination on the independent review, but it now looks like the witnesses are being told that it will take time to review the transfer of slides. Has it taken all this time just to get the slides transferred to the RCOG or is the review due to be completed? Did the 221 group of women ask to be removed from that review and dealt with separately? If so, why would they have done so?

With regard to requests I have repeatedly made for information on the laboratories from which the false negatives came, I was told repeatedly in parliamentary questions and at meetings like this by the Minister and his Department that this would be dealt with under the RCOG review and that until that review was conducted, I could not get that information. In a reply to a separate parliamentary question, I was told that an expert was being appointed to look at that and to get me that information. The information is still not forthcoming.

The decision ten years ago to outsource the service was a mortal sin because it has led to the deaths of women and the mess we are in with regard to CervicalCheck. This is what I am trying to get somebody to admit. What scares me now is that the only step forward we seem to be making with HPV testing is, again, to outsource it. That there are plans to continue the outsourcing of women's health is very worrying when we know that the decision to outsource testing ten years ago has led to a complete mess. I am delighted to hear that CervicalCheck is reinventing the Coombe as a public clinical service. That is the way to go because, at the time, university courses were shut down because of the decision to outsource and we lost the capacity to do our own screening in terms of clinical experts who can examine these things.

I am delighted to hear they will be reinstated. Does Mr. McCallion agree that outsourcing has been a disaster? Is he concerned that we are now being forced to outsource the HPV test?