Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)

Cervical cancer is the second most common cancer in women under 45 and the third most common cancer in women in Ireland. On average, almost 200 women in this State develop the disease every year. In contrast to most other cancers, this one affects mainly younger women, with 60% of cases occurring in women aged 50 or younger.

Faigheann 70 mná sna Fiche-Sé Chontae bás de thoradh ailse an mhuiníl gach bhliain. Léirigh suirbhé anuraidh nach bhfuil a fhois ag ach 29% de mná na hÉireann go bhfuil vacsaín ann chun déileáil leis an ailse seo. In ainneoin gurb é an dara ailse is coitianta i mná faoi 45 bliain d'aois, ní fios de triúr as gach ceathrar mná cad is cúis leis, nó na fáthanna taobh thiar de.

It needs to be known as widely as possible that this cancer can be prevented by means of a simple test, the cervical smear test. It is a scandal and a disgrace that successive Governments have failed to roll out a national testing programme and that only this year progress is being made in this regard.

On 24 February 2005, there was a unanimous call from the Irish Cancer Society and 24 other organisations, including trade unions, professional bodies and women's networks, for a State-wide pre-cancer screening programme. Comprehensive screening leading to early detection and treatment can and will dramatically reduce the incidence and development of cervical cancer and the resulting terrible death toll.

There is far too little information for women to highlight the fact that screening can be life-saving. That information and the associated screening need to be as widely available as possible. There must be quick progress in moving the screening programme beyond the current phase one in the mid-western HSE area. The promise is that the national cervical screening programme will be free to all women between 25 and 60 years of age. Screening will be provided every three years for women aged between 25 and 44, and every five years for women aged between 45 and 60, in line with best international practice. That is the commitment given by the Government to the women of this country and it must be kept.

It is very important that this long-promised national screening programme is not disrupted, as so much other patient care is being disrupted, by current HSE cutbacks. That would be a betrayal of the women of Ireland and their families, and it would condemn thousands of them to serious illness, which is preventable.

If the Government is only interested in bookkeeping, cutting this programme would make no economic sense as the cost of cancer treatment in the future, which could have been prevented or treated through early screening, will far outweigh the cost of the screening programme.

On 9 May, the National Cancer Screening Service, NCSS, announced a preferred bidder for the provision of laboratory testing services for the national cervical screening programme. This was described as an important milestone which, in the coming months, will enable the NCSS to launch the first quality-assured, population-based national cervical screening programme for women aged 25 to 60. However, major concerns have been raised about the use of laboratories outside this country for these tests. In particular, major concerns have been raised about the company named as the preferred bidder, Quest Diagnostics.

Quest has won the tender to analyse 300,000 Irish smear tests a year, but consultant pathologists from the Coombe Women's Hospital, St. James's Hospital and St. Luke's Hospital in Dublin, and University College Hospital in Galway stated that missed cases would arise because the diagnostic rate of pre-cancerous cells at Quest Diagnostics in the US is 30% less than that of Irish laboratories.

This concern has been echoed by the Irish Association for Clinical Cytology, IACC, which has expressed its disquiet at the decision to award the contract for cervical screening services to Quest, thereby excluding Irish laboratories. The IACC says this decision will have serious implications for the long-term quality of the cervical screening programme.

The association lists its main concerns as follows: quality in detection rates — from recently adjusted figures, excluding urgent smear policy, at least 30% of cases with pre-cancerous cells will go undetected based on the data from the previous outsourcing exercise by the NCSS to Quest Diagnostics; Irish laboratories' ability to tender for future work. the exclusion of the Irish cytology laboratories at this stage will result in the loss of cervical cytology as a discipline and laboratory service in this State — once lost, the re-establishment of this service will not be feasible due to the extensive training requirements and the loss of expertise and skill-mix that has taken years to develop here; and the creation of a monopoly. By contracting to one organisation the NCSS has tied itself to Quest Diagnostics without an alternative provider of services. If there is an issue with the provision of service down the line, there will be no domestic laboratories available to deliver such a service.

It also highlighted a reduction in mortality rates by 80%. Although this figure has been quoted as the potential reduction rate of mortality for cervical cancer, this can only be achieved in the setting of a population that has not been screened before and not in a relatively heavily screened population as in Ireland. We would be concerned that an increase in mortality and morbidity may result in Ireland by using a laboratory with low detection rates.

The Irish Association for Clinical Cytology states that Irish laboratories provide a quality screening service as evidenced by comparison of incidence and mortality rates to other European countries. Even without an organised national screening programme, this State compares favourably to the UK which has had an organised screening programme for more than 20 years.

There is significant concern that testing for this screening programme has been placed in the hands of a multinational giant that has been convicted of fraud in the US. Quest Diagnostics has paid out almost $40 million in fraud settlements over the past decade. It made major settlements in 1998, 2001 and 2004 after being investigated in connection with the billing of federal health care programmes for unnecessary tests. In 2004, Quest Diagnostics paid more than $11 million to settle a lawsuit that alleged the company billed Medicare, a federal health care programme, for certain blood tests that doctors had not specifically ordered. Janette Byrne of the Patients Together campaigning group, which is trying to improve the standard of patient care in Ireland, said: "We would definitely question why public money is being given to a company that has been investigated for acting fraudulently in another country."

It seems the Minister for Health and Children would rather listen to corporate executives in the private health business than to health experts and patients in Ireland. Not only are our health services being privatised, but jobs and services are being exported. Trained and trainee laboratory technicians in Ireland are being written off by this decision and many will have to emigrate to find work in the future.

Incidentally, another corporation, Fresenius, has been contracted by the HSE to carry out dialysis services. This corporation paid the biggest ever criminal and civil fraud fine to the US Government in 2000 — $0.5 billion. The Fresenius scam involved fraudulent and fictitious blood-testing claims, kickbacks to dialysis facilities in return for blood-testing contracts and fraudulent claims against State health insurers. This company, which will be based in Limerick, has been given a major role in the provision of dialysis in our health services in the mid-west and south east areas.

During questions on the issue of the cervical cancer screening programme last October, my colleague, Deputy Ó Caolain, asked the Minister if it was preferable that the testing labs should be here. The Minister replied: "Yes, ideally we must have our own laboratory facilities in Ireland." This does not seem to be the case now.

I have been contacted by a medical scientist, a constituent of mine, who has raised her concern at the outsourcing to Quest Diagnostics. She set out, in her letter to me yesterday, those concerns in the following terms: awarding this contract is handing a monopoly to a private company whose bottom line is profit not patients; the method of screening done by Quest Diagnostics is not up to the same standard as the public labs in Ireland — this means that more Irish women will die — and cytology labs in public hospitals will not be able to apply for the tender in two years' time as they will not be able to keep up their screening skills. These skills will be lost forever so it will not be possible to reintroduce the service in the future if anything goes wrong. The HSE has a sorry history with its privatisation agenda and she does not want to see it happening with laboratory services.

She concluded by stating: "As a woman and mother of two daughters I am horrified to think that the standards of screening cervical smears are going to be reduced unnecessarily and put us at risk." The Minister must listen to such expert voices — those involved in the service, those working in the service and the patients who have to use the service.

The warped mentality behind this decision is the same warped mentality that has forced the Coombe Women and Infants University Hospital to take the unnecessary step of discontinuing the cervical smear testing at that hospital. This was highlighted recently by my colleague, Councillor Ray McHugh, when his wife was told that the Coombe was suspending smear tests as a result of HSE cuts due to lack of staff. That is how illogical the approach of the Government and the HSE has been in terms of addressing the concerns of patients, cervical cancer and the screening programme it promised.

See this speech in context