James Reilly (Dublin North, Fine Gael)

I would like to share time with Deputy Deirdre Clune.

I must comment on something the Minister said. No one's good name or reputation was taken. No name was mentioned. Journalists came to me with the name but I would not do anyone the disservice of using his or her name in the House under privilege without absolute proof of a problem.

The Minister mentioned Professor Miriam Wiley and the ESRI. I have mentioned the issue of figures on a number of occasions. Accuracy is of the utmost importance when we are planning our health services. I wish to clarify comments I made and which some people have found confusing. My office was in touch with the ESRI by telephone and e-mail. I have expressed my opinion regarding the implications of that information. There is a difference between the figures given by Mayo General Hospital, which says 85 people were treated for breast cancer in 2007, and the ESRI figure of 37, as quoted by the Minister. That is too big a gap to be ignored. It must be examined. These data come from two sources: the National Cancer Registry and the hospitals. Inaccurate information is heading into the ESRI, which cannot be asked to stand over figures over which it has no control. The ESRI can stand over its analysis. I do not impugn its reputation and I understand that its work is very important. I have sought a meeting with Professor Miriam Wiley to clarify the information and to find out how the disparity arose.

I thank the Government for overruling the Minister for Health, who was not willing to concede this debate when I called for it two weeks ago.

Cervical cancer kills more than 70 women a year in this country and afflicts thousands of others. By initiating a cervical screening programme in conjunction with a cervical cancer vaccine we could make this horrible disease, which affects so many of our women particularly during their child bearing years, a thing of the past. I call on the Minister to introduce the vaccine without delay. By her own admission, this has been recommended to her by three different bodies. It is time to move things on. A combined vaccination and screening programme would eradicate up to 90% of cervical cancer cases.

Since my election to this House I have called on the Minister to introduce this programme and I warned on each occasion that I could not see how it could be achieved in the timeframe she promised, given that no preparation had been made between the HSE and the laboratories and particularly as so few of them had been accredited. Notwithstanding this, I understand several laboratories are now accredited, including Beaumont/Rotunda, RCSI, St. James's Hospital through its connection with Antrim and Altnagelvin Hospital, which has looked after the needs of Donegal, Sligo and Leitrim. St. Luke's is also mid-way through the process. While accreditation is important as it ensures the right facilities are in place, it is not a guarantee of outcome. That is, of itself it is not a guarantee of quality outcomes.

This call for action obviously fell on deaf ears as so many of the laboratories remained unaccredited at the start of 2008. Instead of addressing this issue and ensuring that our laboratories would be in a position to tender for and successfully provide cytology for our National Cervical Screening Service, the Minister struck out on a new route to outsource the entire smear reading service to another jurisdiction across the Atlantic. This rushed and ill-considered decision has serious consequences for our health service and for the health of our women and further begs the question as to why, when we seek out partners from the United States of America, we cannot find a company that has not been guilty of over-billing. Though technically not fraud in law, because they paid up before they were charged, nonetheless most people would consider this fraudulent behaviour. This was not a once-off action. It was found to be the case in 1998, again in 2001 and yet again in 2004. It was no small sum of money in total either. It was $40 million dollars. This is not the sort of partner one would seek out for a business venture, let alone a partner to provide an essential medical service where women's lives are at stake.

The Minister referred to the screening contract. I will read an extract from Council Directive 2004/18/EC:

Any economic operator may be excluded from participation in a contract where the economic operator has been guilty of grave professional misconduct proven by any means which the contracting authorities can demonstrate.

The sums of money paid for over-billing represent professional misconduct. These are not the sort of people we should be dealing with where women's lives are at stake.

There is, further, the issue of our loss of jobs. Over 100 highly skilled people will now be no longer employed and will either become de-skilled through lack of activity or will emigrate to continue to earn their livelihoods. This is a very odd situation when we have spent considerable time encouraging people to take up science. Furthermore if in two years, as I anticipate, we find we have made the wrong decision we will have to spend years rebuilding the service having given a foreign multinational a virtual monopoly on cervical cytology. This loss of cytology will further impact on the training of our pathologists for whom cytology is an integral part of training. They will no longer be able to sit the UK examination in pathology as they currently do unless they go there for training.

Most important, however, is the issue of reliability and the quality of testing. A study done by St. Luke's Hospital looking at the results of 14,500 smears read by Quest showed a 30% difference in the pick-up rate for high grade pre-invasive cancer of the cervix. Critics of the study from the NCSS have claimed it did not allow for urgent cases, but it did factor this in. Two other laboratories, Cork and the Royal College of Surgeons in Ireland, examined the figures for the Quest smears that went from their laboratories. They discovered that it was a 50% difference but they had not corrected for the urgent cases.

Accusations that the St. Luke's results are being over-simplistically analysed is absolutely outrageous and I refute it. An article published by St. Luke's in the Irish Medical Journal showed the expected rate of high grade pre-cancers is 1.9% and this is accepted internationally. In a comparative study by St. Luke's this figure comes up again while the Quest figures were 1.2%. Quest, therefore, could be missing up to 30% of high grade pre-cancers of the cervix, placing Irish women at an unacceptable risk. These are statistics from medical professionals. I see no reason to disbelieve my fellow professionals.

The other deeply disconcerting aspect of this decision is that there will no longer be the ability of a multidisciplinary meeting to review the slides between the smear reader, the colposcopists and the gistopathologists who would give further advice. The result of this is a less safe service with some experts predicting 1,000 and another expert predicting up to 2,000 high grade pre-invasive carcinomas being missed annually. This may be acceptable if there is a system of annual smear tests, such as that in America. However, in Ireland it is intended to test every three to five years. We cannot afford that margin of error.

I understand the tender contract specified adherence to NHS UK guidelines which specifically state that no primary smear reader should spend more than four hours reading the smears. This in effect limits each reader to about 50 smears per day. It is my understanding that each smear reader in the Quest laboratories regularly reads 90 to 100 smears per day. How could they possibly have satisfied the tender document in this case?

The McGoogan report, on which this screening programme was initially designed, looked to a hub and spoke arrangement within the country. At no point did she mention outsourcing it, of which I am sure she would not approve. The current capacity in our laboratories is approximately 250,000 smears per annum. This would be well over 300,000 with the addition of two imagers, equipment which allows for automated pre-screening. They only cost approximately €125,000 per year to lease.

I ask the Minister not to ignore the McGoogan report or fragment our health service. Instead I ask her to support and resource our laboratories to achieve accreditation which could be in place by the autumn. She must invest in the imagers, thereby giving the women of Ireland the best quality service which is surely, what they deserve. Yet again the talk is of putting the patient first but the action says more about saving money. On this occasion, I beseech the Minister not to take the cheap option but to put the patient first.

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