Simon Harris (Wicklow, Fine Gael) | Oireachtas source

Last week, I published the report of the scoping inquiry into the CervicalCheck programme and today I welcome the opportunity to speak about the issues at its very core. I want to acknowledge again on the record of this House the extraordinary contribution of Vicky Phelan as well as Stephen Teap and Lorraine Walsh and the other women and families impacted by the CervicalCheck audit.

Dr. Scally is clear that this crisis happened because of a failed attempt to disclose the results of a retrospective audit to women who had developed cervical cancer. There was significant public disquiet when it became clear that women themselves were not told about reviews of their own past screening history. The failure to disclose was absolutely wrong and I recognise the severe and real distress it caused to women and their families.

As is often the case with complex issues, some of the complexity was not fully reflected in the public discourse. I think it is fair to say there were people who believed women had not been told they had cancer - that assertion was made in this House - and people who believed that a diagnosis of cervical cancer in a woman who had been screened as negative was automatically negligence. Thanks to Dr Scally’s report, there is a greater understanding now of the complexities involved.

He has provided welcome reassurance on the quality of CervicalCheck laboratories. He has found no evidence of any cover-up - his words - and, most importantly, he has crystallised what this is about.

It is about women and their families who did not get the information they should have got and the devastating impact that it had on them. It is about unreservedly recognising that people have a right to their own medical information. It is about ensuring that our systems work and acknowledging that they completely did not work in this case. It is also about the impact of this disease at a human level and the need to do all we can to prevent it. Collectively, we should endeavour to effectively eradicate cervical cancer.

The report is the culmination of intensive work by Dr. Scally and his team done quickly and under intense scrutiny, for which I thank him sincerely. It is robust and comprehensive and it will help ensure that women can trust that our cervical screening programme is safe, effective and patient-centred.

I particularly want to extend my gratitude to the women and families who engaged with Dr. Scally. I do not underestimate how difficult this must have been. I thank them for their courage and commitment in ensuring that our cervical screening programme is improved. I was struck by a comment that was said to me many times by many of the women who had been impacted, namely, that the one thing they wanted to come out of this was a better screening programme, that lessons would be learned and that they were doing it for their daughters, granddaughters and sisters to make sure we have a screening programme that is robust and saves lives. Their generosity in how they engaged is something for which we should all be extremely grateful.

Dr. Scally's reports sets out the enormous impact this situation has had on those affected. Through my own interactions with them, I have gained some sense of the distress and pain that has been caused. He has made a number of key recommendations in regard to disclosure, which I intend to implement in full.

I intend as a priority to establish a new independent patient safety council that will, as its first take, carry out a detailed review of the existing policy on open disclosure. The resulting policy will have legislative underpinning and will operate right across the whole health service.

The establishment of a statutory duty of candour is a further key requirement. The patient safety Bill is scheduled to undergo pre-legislative scrutiny on 26 September and I ask Deputies on all sides of the House to prioritise the scrutiny of this vital legislation because it provides a legislative framework for a number of important patient safety issues, including mandatory open disclosure of serious patient safety incidents.

While these are key steps, disclosure is also about core values such as openness and honesty, and trust and confidence in doctors. This report presents a challenge to the medical profession but I believe the majority of doctors and the profession in general holds these values very dear in the care they provide. I also believe the dedication and commitment of the entire range of health professions, including doctors, is one of the key assets of our health service. I want to see constructive engagement on the part of the medical profession with these issues. There were failings on behalf of their profession and they must be addressed by them.

I want to be clear that the Government is committed to the continuation of the CervicalCheck programme, as well as BreastCheck and BowelScreen. We know that screening saves lives, and Dr. Scally has emphasised this. Crucially, he found no reason the existing contracts for the laboratory services should not continue until the new HPV regime is introduced. He is satisfied with the quality management processes in the laboratories, contrary to some information put on the record of this House by others in the past, and the report presents no evidence that the rates of discordant smear reporting or the performance of the programme fell below what is expected. He emphasises the very substantial contribution that CervicalCheck has made to women’s health over the ten years of the programme, and I know that has been acknowledged by Deputy Kelly and others in this House. A woman’s lifetime risk of developing cervical cancer has substantially reduced since the inception of the screening programme, from one in 96 in 2007, to a one in 135 in 2015.

Dr. Scally also considers that the work which has been carried out by staff in the programme to keep the screening service operating in the middle of what was a very intense controversy is worthy of recognition. I want to thank the staff for that as well.

I do not downplay in any way the very serious gaps that have been identified in the governance structures of our screening services, but I want to emphasise that Dr. Scally has stated in unequivocal terms that he had found no evidence of conspiracy, corruption or a cover-up - his words. This speaks to the integrity of our public and civil servants. Some of the things that were said in the heat of this controversy questioned the integrity of some of those public servants in leadership positions and, I think, after an independent report makes a finding on that, it is important we acknowledge the actual position on the record of this House, as outlined by the independent expert that we as an Oireachtas put in place to establish the facts.

The report examined the provision of briefing notes on screening audit and disclosure to my Department in 2016. These came into the public domain in May. I welcome the clarity provided - the inquiry considers that it would have been unreasonable to expect senior management in the HSE or, even more so, departmental officials to have intervened on foot of these notes. That is a finding of the inquiry. Subsequent problems were significantly associated with the failure to disclose, the report says, and it would have been difficult to predict this given the reassurance the briefing notes provided. As we have limited time, I will not quote from the report but they are there in the relevant sections.

Dr. Scally has based his findings on careful examination of contemporaneous records. He has had more than 12,800 records. I fully accept his conclusions in this regard and it clear that my officials and my Department acted entirely appropriately.

Dr. Scally has been clear that the problems he has uncovered are systematic and relevant to a whole system failure, and I believe a whole system failure requires a whole system response. I have already taken steps to re-establish a board for the HSE, appointing a chair designate yesterday. This provides a foundation for proper governance and accountability.

I intend to bring the Health Service Executive (Governance) Bill 2018, through the Houses of the Oireachtas during this session with a view to establishing the board this year. A priority issue for the new board will and must be the development and implementation of an effective performance management and accountability system in the HSE.

We are aware that screening alone is not enough to prevent all cervical cancers, but a well-organised screening programme, when combined with HPV vaccination for boys and girls, can bring us very close to eliminating this disease. That is the Government’s goal and that is the Oireachtas' goal. I do not intend to play party politics with this issue. It is supported by politicians from all political parties in this House. We now need to get on and do it. We have a vaccination that can save lives. It can prevent girls getting cancer and can prevent girls dying from cancer. We all need to support that unequivocally. I am very pleased that the House supported Deputy Kelly's motion to extend the HPV vaccination to boys. We need to extend the vaccination to boys once we receive the HIQA health technology assessment in the coming days. We should look to extend it next year.

I have given approval to a switch to HPV testing as the primary cervical screening test, and work is under way to progress this change. This is vital. We know that of 1,000 women who will be screened, 20 will have pre-cancerous cells. Screening today will pick up 15 of those 20 women but when we move to HPV testing it will pick up 18 of those 20. There will still be limitations to screening, but sadly there will always be limitations to screening. We can, however, have an even more accurate system and, along with a small number of other countries, Ireland can lead the way as we move to HPV testing.

I want to be very clear that the Government accepts in full all 50 recommendations in this report. I expect to return to Government in three months with a full implementation plan. In June I established the CervicalCheck steering committee, chaired by the Chief Medical Officer and the assistant secretary of acute care in my Department. Crucially, the committee includes representatives of the affected women and their families. I thank them for their generous and constructive contribution to that work. The committee meets weekly and we publish its minutes, its agendas and its weekly report on my Department's website. It will oversee and direct the implementation of all 50 recommendations, and my Department has established a working group to drive the work of those recommendations. I have written to each of the organisations mentioned in the report about preparations for implementation. Through the Chief Medical Officer, I have also commenced engagement with the leadership of the medical profession, which is very important. An initial meeting in this regard took place earlier today, and I intend to meet them shortly, along with the Medical Council.

The first step I wish to take, which I believe is the most appropriate, is to meet patients and their families, and I look forward to this happening next week. I will then engage with the Opposition on what needs further inquiry and what is the best modality in which to do that. I do not believe we should make knee-jerk decisions on this. I want to try to reach a consensus in this House, but most importantly with the patients also, on how best to move forward.

Dr. Scally has reached a view on a commission of investigation and we should consider that view and explore it together over the next number of weeks. The Government’s priority is equally with the women and families as well as with ensuring that our cervical screening programme is as good as it can be. Dr. Scally has given us the framework to fix the very many flaws he has identified. Our focus must now be on implementation. If we want to learn the lessons and if we want to fulfil Vicky Phelan's request that some good comes from this awful tragedy, we need to deliver on these recommendations. I look forward to working with each and every Member to make that a reality.

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