Mary Harney (Dublin Mid West, Progressive Democrats)

I am very happy to have an opportunity to talk about the Government's cervical cancer screening programme. This debate was requested last week by the Opposition. I was delighted to agree to the facilitation of the debate.

This debate is about women and women who get cervical cancer in Ireland. On average, 75 women per year die in Ireland from cervical cancer. We know that from screening programmes, we can save up to 80% of those lives. So we could save 60 of the 75 women who currently die from cervical cancer. This debate must be about facts and data; it cannot be about innuendo, rumour or about somebody who came out the wrong end of a procurement process or about industrial relations issues. For many years there have been queries from Opposition Deputies and pleas for the roll-out the cervical screening programme. That is something to which the Government has been committed for quite some time.

Last year, we provided €5 million to the National Cancer Screening Service to prepare for the roll-out of a screening population-based cervical screening programme. This year, we provided €15 million towards the implementation of that programme. The intention is to begin the roll-out of that screening programme on a national basis during the summer. It is expected that between 240,000 and 300,000 women aged between 25 and 60 will qualify for screening. In the case of those aged 25 to 44, they will be called every three years and those aged 45 to 60 will be called every five years. That is being done on the basis of best international evidence available to us. The screening will be provided free of charge and this programme is the second one to be rolled out by the National Cancer Screening Service, the first being the breast cancer screening programme. Everybody in Ireland — particularly those who have used the service — and outside it who have examined our breast screening programme consider it is highly successful with a participation rate of almost 80%. By international standards, that is very high. The former Minister, Deputy Nora Owen, said of the service in this House that it was a model of health service delivery that she would recommend to anybody.

Therefore, I very much regret what I regard as the utterly irresponsible comments made by the Fine Gael spokesperson on health on the cervical screening programme. I do not say that lightly. The fact is that last week Deputy Reilly said that 2,000 women's lives would hang in the balance. I regard that as an utterly irresponsible statement made for no reason other than to scaremonger. Women have huge faith in the screening service and we want their faith in it to continue. If we lose 75 women a year as a result of cervical cancer, one would need to multiply that figure by 28 years to achieve the figure of approximately 2,000. All of us participating in this debate have a responsibility to adhere to facts and not to innuendo. I appeal to everybody in the House to make sure that in this and other debates on cancer screening we are not irresponsible and do not try to make political points that have the effect of damaging a service that has a significant reputation.

The National Cancer Screening Service is not part of the Health Service Executive, rather it is an independent service accountable to the Department of Health and Children and the Minister for Health and Children. It has its own independent board. The screening programme is now rolling out an integrated service where a system of call, recall, laboratory, colposcopy and follow up treatment will all be integrated and will all operate to best international practice.

The screening service had a two-stage tender process for the cytology service. It was open to all laboratories in Ireland and internationally to put forward an application in the context of the tender. The tender was clear. In order to meet the requirements, those who tendered had to fulfil three conditions. First, they had to be accredited by an independent accreditation body, meeting the international ISO standard. Second, they had to have a minimum throughput of 25,000 smears a year. Third, they had to be able to do a ten-day turnaround. Seven applications were made and I understand the number considered was reduced to about four. The successful bidder was Quest Diagnostics, which is the largest such facility in the world; last year, it dealt with 13 million smears. The tender was examined not by the Minister or any official from the Department of Health and Children, but by a group established by National Cancer Screening Service, which included doctors like Dr. O'Reilly, who has been running the service in the mid-west, and a doctor from Northern Ireland, who was charged with the responsibility for quality assurance there and who is also involved in the accreditation process in the UK. These are highly reputable people who were asked to examine the tenders. A total of 80% of the marks given related to quality and turnaround time and 20% of the marks given related to cost — that is the factual position.

In regard to data, we have had a number of examples of where rumour and innuendo were advanced here as fact. Two weeks ago on the Order of Business Deputy Reilly alleged that an official from the HSE had worked for this company and he wondered what the official's role was in regard to this tender. Subsequently, when questioned by a media source, Deputy Reilly said he was waiting to seek clarification, but he put forward in this House as a matter of fact that an official had worked for this company. That is not the case. Journalists went on a wild goose chase to find out who was this official. I appeal to people that when irresponsible statements, innuendo and rumour are advanced in this House as fact around something as important as a national screening programme that we would have the courage to withdraw those comments and not have the good name of individuals bandied around by journalists and in other places. It is grossly unfair, misleading and inaccurate. It is fiction and wrong.

Equally, Professor Miriam Wiley has had comments to make about data that was advanced in the Private Members' motion last week and I hope that will also be clarified. If we are not going to base the debates in this House on data, evidence and information, we will not have informed debates and we will not make the right decision.

In regard to company, or preferred bidder, awarded the contract, which has not been signed yet — obviously, there must be a cooling off period — the National Cancer Screening Service did not have to go to tender but chose to do so for reasons of transparency, fairness and equity to make sure it got the best quality assured service we would get. In line with the McGoogan report, which stated that laboratories that participate in this screening programme should be independently accredited, the screening service is living up to the advice domestically and to best international practice on this issue. The fact is that the company that won it is accredited independently. As I said, it is the largest such facility in the world and it does work for the National Health Service in the United Kingdom. I have never met anyone in the company and do not know anyone associated with it, but I understand it intends to put in place a laboratory facility in this country.

I said that 75 women in Ireland a year die from cervical cancer. International evidence shows, as has been demonstrably shown in the UK, that up to 80% of those deaths can be avoided. However, the screening is not a test or a diagnosis of cancer. What it detects are abnormalities that, if undetected and untreated, can lead to cancer. Some 800 women in Ireland in the last year for which we have data were found to have abnormalities. The purpose of a screening programme is early intervention to identify those abnormalities. In a lifetime, a woman can expect to be called to the screening programme up to 11 times to identify those abnormalities and, if detected, to intervene with treatment before cancer develops. We know such intervention is highly successful with a success rate of up to 80%. The women affected by cervical cancer tend to be young women with children and significant responsibilities. We also know that health promotion has a major role to play in the prevention of cervical cancer. The cessation of smoking has a huge contribution to make to its prevention. Sexual practices and the early onset of sexual activity contribute to the development of cervical cancer. A vaccine has now come on the market as a preventative measure. I asked the Health Information and Quality Authority to do a technology assessment of that vaccine. The authority brought its recommendation to my attention in recent weeks. This week, I received a recommendation from the National Cancer Screening Service for the vaccine. I will work on the advice given to me and a decision will be made this summer regarding the vaccine. Clearly, huge issues arise, not least that of parental consent because we are dealing with minors. Since the vaccine will have to be administered twice in a calendar year and since this will be done through a schools programme, we must begin when the academic year begins. It will not be possible to begin the programme in September 2008, as has been suggested. We do not have the necessary lead-in time to allow us to do that. What is important is that we make an early decision. The intention is that the decision be made this summer.

The National Cancer Screening Service has an enormous reputation, as a result of the success of BreastCheck. Our breast cancer screening service was the first in the world to go digital. That is something of which we should be very proud. It has a huge participation rate and has gained the enormous confidence of the women who use the service. Equally, I want to ensure that the cervical cancer screening programme has enormous confidence. Screening will be done at primary care level. It does not need to be done in acute hospitals. When women are contacted it is important they go for a smear test and continue to do so on a regular basis. Tests will be done every three years on women under 45 and every five years thereafter. As has happened in other countries, this programme has the capacity, in time, greatly to reduce the incidence of cervical cancer and, in particular, to reduce the death rate from that cancer by up to 80%. In everything we have done we have followed best international practice. We have independent accreditation and turn-around times of ten days.

With the opportunistic screening which was occurring, women were waiting more than nine months for test results. This is highly dangerous. This is why, in the past 18 months the HSE outsourced more than 40,000 smear samples so that we could get earlier results for the women who were awaiting them. It has been alleged in parliamentary questions that 12 errors were detected. No one could say there were 12 false readings without seeing the data. I understand that in one case out of 40,000 a high-grade lesion was discovered. This is not outside the scope of these matters. The smears which were outsourced were not the urgent ones. Urgent cases were examined domestically. A higher number of high-grade lesions would be picked up among urgent case than among a different population group.

Two cytotechnologists will read the smears. They will be doubly examined, which is appropriate.

It is important that this programme be rolled out quickly and I am satisfied that will happen over this summer. It is important that it is quality assured. It is particularly important that women get results within a four week period. Those standards meet best international practice in this area. The women of Ireland want the best possible service. The contract will be awarded for two years. This means that in the intervening period laboratories in Ireland can meet the independent standard required to provide a cytology service which is quality assured. No one would want to see us availing of services which are not quality assured. I have already explained that in awarding the contract, 80% of points were allotted for quality and turnaround time and 20% for price. As it happens, the price quoted by the successful applicant was one third of that quoted by many of the domestic laboratories. Laboratories in other jurisdictions offered better value for money that those which tendered in this jurisdiction.

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