Dr. Colm Henry:

I want to emphasise the accuracy of interval cancers. They do not constitute errors per se. All screening programmes internationally have interval cancer rates because we are dealing with a healthy population and we are applying a relatively simple and quick test to identify some of that population who are at risk of going on to develop cancer in the case of cancer screening programmes. They are not diagnostic programmes. For example, in our breast screening programme, for every 1,000 people screened, there are two interval cancers. When one looks at interval cancers and breast screening programmes internationally, that breaks down to where nothing is seen, even in unblinded retrospective review, and in a small number of cases there will be something very clear in retrospective review. As I said earlier, programmes tend to measure interval cancer rates as a measure of the quality of a programme.

On the Chairman's question on an audit, the primary purposes of an audit are learning, education and improvement. These values are so strongly felt in many jurisdictions that the whole process of an audit is in itself protected to ensure that it can carry on unhindered so that people can learn, improve and further develop programmes.

The final question the Chairman put was on the Cross judgment and absolute confidence. At the time there was disquiet in the screening programmes and in many other disciplines, including primary care, applying a test of absolute confidence to clinical scenarios where judgement is being used, which, as the Chairman knows, is not necessarily absolute in all clinical scenarios. My understanding is that if that is gone, the State Claims Agency is appealing that judgment and that is proceeding in November. Beyond that I cannot say much at this stage.