Dr. Tony Holohan:

I will address the first part of the Chairman's question. The RCOG review gives substantial insight and evidence into the answer to the question that the Chairman is asking. The limitations of screening was spoken about last night and there are many and varied reasons that explain the screening programme not identifying, failing to pick up on and, in about 30% of cases, failing to prevent cancers. The reasons for that can be very different, and the Chairman will be aware of this. They can be everything from the chain in terms of the issuing of call and recalls, and there could be errors there even before one gets to screening, the adequacy of the smear itself, the mounting on slides, and then ultimately, the cytology. We have heard a lot about the cytology all the way through to colposcopic diagnosis and so on.

It is true to say that where one sets the balance of risk and benefit ultimately determines the levels, broadly speaking, regarding false positives and false negatives. For most types of medical tests, not just screening, there is always a balance between the two. As Dr. Henry said, we can set the balance at a certain level which means we are over-diagnosing, we are over-treating, and exposing people to genuine harm, because over-treating means unnecessary drugs, unnecessary surgery, unnecessary time in hospital, exposure to infection and so on. All of those things have to be calibrated, and that constant calibration is an issue for all forms of medical test, but we have the best evidence that we have had in relation to the operation of our screening programme through what RCOG has done for us. On a dynamic basis, the programme would have to have its own quality assurance ranges into the future that continue to provide that assurance, but I will defer to colleagues who wish to supplement what I have said in relation to that.

On the specific issue of no-fault compensation, the committee will be aware that the Department is soon to receive the final report of Mr. Justice Meenan, who is giving consideration to the whole question of compensation. He was asked specifically how it might be applied in relation to vaccination. The point that the Chairman makes is a fair one. As part of the overall consideration of whatever recommendations Mr. Justice Meehan will make, it may form one of the considerations as to how that might operate, how that might facilitate the objectives of a population-based programme in the same way as it might in relation to something like immunisation.