Ruth Coppinger (Dublin West, Solidarity) | Oireachtas source

Was any cost-benefit analysis done? There seems to have been a 35% increase in take-up either through that offer or through general heightened awareness if we look at the figures given. Did the Minister or the chief medical officer not realise that they would have to put extra resources in place when such an offer was made? What extra resources did the Minister put in place? Did he check with the laboratories? The fundamental question comes down to what control we have over the testing process. Did anyone check if the Minister asked Quest laboratory whether it recruited extra testers? It is striking that we even have to ask that question and that the Minister did not know. This boils down to the outsourcing and privatisation of cervical cancer testing. That is at the root of the problem, because we cannot question these laboratories.

6 o’clock

At least, for all its faults, we can get answers from the public health system. We know from the Scally report that we do not even know where many of the labs were doing their tests. Up to one third of tests were being outsourced and re-outsourced to places such as Honolulu, but Dr. Scally could not establish exactly where.

The Minister has stated there is a low clinical risk - he has been asked to tell us how low - after the samples were being tested outside of recommended timeframes. Will the Minister give the House more information on that? One would think that the length of time would matter in a cytology test and there is a huge difference between 100 days and ten days.

I do not feel the Minister has given answers on particular issues raised in the Scally report. Many problems seem to emanate from Quest Diagnostics. According to chapter 6 of the Scally report, Quest said that it had a false-negative reading rate of 3.19% whereas the Scally report identified the rate as being 17.6%. We still do not know what the difference is in the assessment. We assume it may be explained by labs in different countries with different testing and definitions of abnormality being used. The different processes of accreditation was a problem identified in the Scally report.

Cost is another issue. Why did it become an increasingly important consideration when contracts were being awarded to different labs? The Scally report notes that 20% of the proposal’s scoring was based on cost but it had doubled by 2012 to 40%. A bailout was under way, along with the austerity juggernaut. Costs had to be cut. Is the Minister seriously suggesting that when cost was made such a high criterion, it had no impact on those tests and their efficacy? By 2016 there were competitions where 80% could be the cost criterion. The profits of Quest Diagnostics have risen exponentially.

I will finish with a key question relating to HPV testing. The Government is fond of saying that we are cutting edge and we are one of the first countries to use the new test. Why not bring this back into public ownership and control as part of our public health system? There is no need for the number of cytologists and the upskilling of people, which was the excuse given in relation to smear tests.

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