Ms Tracey Conroy:

I thank the Chairman for the opportunity to meet the committee. I am joined by my colleagues, Ms Celeste O'Callaghan, principal officer; Dr. Ronan Glynn, deputy chief medial officer; and Mr. Stephen Brophy, principal officer in the Department.

I am pleased to have the opportunity to update the committee on the ongoing work to ensure a sustainable and effective national cervical screening programme and to address that have arisen since April 2018. The Department's priority focus is on implementing the recommendations of Dr. Scally's scoping inquiry, overseeing the completion of the independent clinical expert review led by the Royal College of Obstetricians and Gynaecologists and working with the HSE to ensure capacity issues are addressed and to implement the switch to HPV primary screening.

A further focus is on improving support for patient representation and putting in place an ex gratiascheme for the women and next-of-kin affected by non-disclosure of retrospective audit results, as well as the promised CervicalCheck tribunal.

Following his final report in September last year, Dr. Scally carried out a supplementary report which was published in June of this year. As the committee is aware, the supplementary report identified a number of issues including contractual compliance and the use of additional sites for the screening of slides without CervicalCheck's knowledge. Crucially, the report also stated that, on the basis of the information available to the inquiry, the use of these additional laboratories did not result in a reduction in the quality of the screening provided to Irish women and that there is no evidence to suggest deficiencies in screening quality in any laboratory. This is, obviously, very welcome reassurance from the perspective of women's health.

Notwithstanding the reassurance on screening quality provided by Dr. Scally's report, he identified a significant range of issues in the cervical screening programme that must be addressed. Dr. Scally's recommendations have been accepted in full by Government and an implementation plan was published in December, setting out more than 160 actions to be undertaken by all organisations involved. The Department has overseen progress in this regard and it has been steady, with more than half of these actions completed by the end of quarter two of this year.

The supplementary report of the scoping inquiry added two further recommendations and actions to address these are being incorporated in the overall implementation plan which will be published together with the quarter three report in October.

Smear test turnaround times have been a cause of significant concern for many women and there has been very good progress in recent weeks in this regard. In early May, MedLab ceased to accept new slides in order to focus on processing the backlog of smears in that lab. The HSE has now confirmed that, last month, MedLab completed in full the processing of its smear test backlog.

All smears are now being processed either by the Coombe or by Quest Diagnostics and turnaround times have significantly improved. Colleagues in the HSE will provide more detail on turnaround times and what women can expect over the coming weeks and months.

The introduction of the HPV test as the primary screening test was approved by the Minister in early 2018 and its introduction will be a significant milestone for the programme. Notwithstanding the challenges faced over the past year and more, the staff in the National Screening Service have continued to make strong progress across the various work streams required to effect this change.

The Minister recently approved the HSE’s draft project plan for the switch to HPV testing early next year. Funding has been made available in budget 2019 to support the necessary work.

Recognising that colposcopy clinics are experiencing pressures, additional funding is being provided this year both to address the immediate pressures and to improve resourcing as part of the introduction of the HPV primary screening test, which is expected to lead to increased referrals to colposcopy after the first year.

The review led by the Royal College of Obstetricians and Gynaecologists, RCOG, will provide each woman, or her next-of-kin, who consented to participate, with an independent report to provide them with assurance about the timing of their diagnosis and treatment. The Department has been engaging on an ongoing basis with the RCOG and the HSE over the past number of months on the operational aspects of the review and the process for communicating individual reports to women. The HSE will provide further detail on preparations in this regard at this meeting.

The RCOG will prepare an aggregate report for the Minister, which will include recommendations, where appropriate, on improving care for women. The RCOG wrote to the Minister on 6 September last advising that the aggregated report will be provided in October. It also advised that, based on the provisional findings of its review, the performance characteristics of the CervicalCheck screening programme that fall within the scope of the review appear to be broadly in line with the experience in the UK.

A further focus for the Department this year has been the introduction of legislation to establish the CervicalCheck Tribunal, which became law on 23 July. The Department is working on the practical arrangements to be put in place, and on the rules, processes and procedures required. Work is also progressing on the legislative provision for restoration of trust meetings.

In addition, an ex gratiascheme has been put in place for women or next-of-kin affected by the non-disclosure of retrospective audit results. Most recent figures are that 156 applications have been made with 152 assessments made. The scheme remains open.

There is wide recognition in the health sector that patients have an important role to play in the development of health policy and the reform of health services. It is essential that the patient voice be at the centre of the work under way to address the range of issues arising in relation to CervicalCheck. Both the CervicalCheck steering committee and the HSE oversight group include patient representatives.

Recognising the issues that have been highlighted by Dr. Scally and others in regard to payment for patient representatives, the Department has recently commenced work on the development of a policy for the selection and payment of patient representatives within the Department of Health and the HSE.

The Department has also provided funding to the 221+ CervicalCheck support group to enable it to support the 221 women and families involved in this issue. Most recently, the Department has agreed in principle to provide further funding to enable the 221+ group to offer support to additional women identified through the RCOG review as having discordant smear test results.

To conclude, I have set out some of the key areas of progress so far. The Department intends to continue a strong focus on the key priorities of implementation of the recommendations of Dr. Scally, the completion of the RCOG review and introduction of HPV primary screening, ensuring this lifesaving programme continues to deliver improvements in women’s health.