Bríd Smith (Dublin South Central, People Before Profit Alliance) | Oireachtas source

It is more than ten months since this scandal broke but it has been the recent tragic deaths and the ongoing court battles which have kept it in public view. We have seen the new scandal involving the expired samples, the problems with one laboratory, ongoing problems with backlogs as a result of greater demand and women seeking reassurance of a second test. Side by side with these events, we are told that the Royal College of Obstetricians and Gynaecologists will produce a report in six months' time on the 221 cases at the centre of the scandal. Separately, we were told the HSE has now found an expert who is analysing and examining the false negative smears, what laboratories they came from and what grade of change was involved. I am told this report is weeks away. We await new reports from Dr. Scally.

In this blizzard of information and new twists it is easy to forget what lies at the heart of the scandal. I am sick of hearing the same mantra in every response from the Minister, the HSE and the self-professed experts on CervicalCheck, whether in the media or otherwise, that it is complex, that we do not understand the intricacies of testing, that it is not a diagnostic test, that every screening process has errors and that no process is 100% correct. The Minister's response and the response of many in the media and in scientific circles is laced with impatience and dismissal of our concerns and of any political implications that we may draw from this scandal. To be clear, I know screening is not a diagnostic check. I know there will be natural and unavoidable errors in screening. I know false negatives can mean really different things depending on the actual smear. I know that not all false negatives are negligent and that there are different grades of error in each individual test. I understand all of this as do other women. I also know something else. Since May 2018 I have asked in numerous different ways a simple question of the Minister and his Department. The Minister has the answer. From which laboratories did the recorded false negatives come and will the Minister provide a breakdown of how many laboratories per case contracted? I still have not got an answer. It has been ten months and counting. Instead, I get the same stock dismissive answer. It amounts to saying that I would not understand it, that I do not understand the figures and that those responsible will have to get an expert to analyse the figures and give me more information. I was told this by Mr. O'Brien when he was head of the HSE and by the Minister personally twice, as well as by the Taoiseach and the Minister for Public Expenditure and Reform. All of these people assured me that the answer would be forthcoming but I am still waiting.

It is interesting when I compare that question to a leaked report published in The Sunday Business Post. The report suggested there was an ability to do complex analysis of the patient status of the 221 women affected. This amounted to spinning the lie that they are really not so badly affected and that only 25% of them have active cancer. That sounds great until we think about these facts: 21 of them are already dead, 50 have active cancer diagnosis and many have a poor prognosis. I do not accept that it is impossible to get an answer to my question. If someone wants to spin it in certain ways, he or she will do so.

I believe that when we get to the core answer to the question of which laboratories these errors came from and what grade of errors were involved, we will find a disproportionate amount came from the private for-profit laboratories that operated to different standards from those in the public service. Alongside the barely-concealed and patronising attitude of commentators on the scandal, there is the immediate defence of the decision taken in 2008 to outsource to private for-profit laboratories the cervical screening process. The decision has been confirmed since by every Minister with responsibility for health, including Mary Harney, Senator James Reilly, Deputy Leo Varadkar and the current Minister, Deputy Simon Harris. This is compounded by the decision to outsource the HPV testing. We know for certain from the Scally report what happened when the outsourcing took place: not all US laboratories were ISO accredited at the time; the work practices were different and the workload was different in those laboratories; the criteria for awarding the contracts centred on the cost; and that one of the US laboratories subcontracted work out unbeknownst to the HSE.

We know that the decision to privatise meant that the capacity to conduct the screening in Ireland was lost and that cytologists trained in this country to our standards were lost to us. We know that university courses were lost and that laboratories were closed down for good.

Multinational companies always insist there must be evidence. Thus, it cannot be claimed that there was no problem. Why then did they settle in big numbers with the women with whom they settled in the courts? Multinational companies do not do this out of the goodness of their hearts. There had to be evidence that they were negligent. There had to be strong evidence that they were seriously negligent.

At some stage the truth will come out. What we have to realise is that at the heart of this lies the problem of outsourcing. We need to realise that at some stage we are going to have to return to a publically-funded and resourced screening programme in this State so that it can be controlled fully by the health services here.

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