Michael Harty (Clare, Independent) | Oireachtas source

A formal State apology is a solemn occasion. It is very important and very welcome. It is essential that this apology is made and I thank the Taoiseach for it. It is important not only to the group of 221, but to all women who have been affected by the cervical screening scandal; those who have had their anxiety and concerns raised and those who have waited months for delayed results. This is of course a controversy which has particularly affected women, but it has also affected their partners and families, particularly the families of those who have died as a result of cervical cancer.

However, several issues have been raised in this controversy. It is very important to state that CervicalCheck has been a successful screening programme. It has saved lives. There has been a 7% year-on-year reduction in the incidence of cervical cancer and 50,000 precancerous changes have been identified since the programme was introduced in 2008. In fact, it was introduced in the mid-west in 2001. That may be cold comfort to those who have suffered because of the deficiencies of cervical screening but it is very important to recognise that this screening programme has essentially been successful, albeit not in all cases. Dr. Gabriel Scally made 50 recommendations in his first report. He identified flaws in the system. Every screening system needs to be constantly reviewed. The flaws he identified included a need for more oversight of the scheme, particularly expert international oversight, as well as experienced expertise in public health, colposcopy and communications. Every scheme can be improved, and unfortunately it took legal action to bring the deficiencies in this scheme to the fore. There have been failures in management, organisation and communication. If Dr. Scally's recommendations are carried out, they will all be addressed. Of particular importance was the placement of patient advocates on various committees in order that the patient's voice could be heard. That is extremely important.

It is important that we welcome this. Unfortunately, we need to welcome those who have suffered from cervical screening to the Gallery today. We should recognise their persistence in pursuing this issue. We as politicians have let them down but we have also striven to repair the damage of this scandal. It is important that we continue to improve this screening programme.

It is important to say that this is not a diagnostic test but a screening test. There are flaws in all screening tests and all tests will fail to pick some people up. That does not mean the failure to pick them up is in any way negligent. It is just an inherent problem with the scheme. However there are some issues which need to be addressed. One of those is open disclosure. The withholding of information from any patient is wrong. We understand that. We are still waiting for the patient safety Bill to be brought before this House. It is extremely important that open disclosure is a part of the culture of our health service. It is the fundamental issue which underlies this scandal. The fact that an audit was introduced was extremely important. It was the correct action to take. Unfortunately, the closure of that audit loop was the failure of this cervical screening programme.

Dr. Gabriel Scally states it was "deeply contradictory and unsatisfactory" that the HSE had a policy of open disclosure but that policy was not implemented in this case. It is very important that when controversies like this arise, recourse to court should be the recourse of last resort. It should not be the recourse of first resort. Unfortunately, that is the case where people feel they can only go to the courts to get satisfaction. Open disclosure will satisfy many people in regard to wrongs they feel have been perpetrated against them by the health service.

There is another issue around absolute confidence. Cervical cytology is not a binary "Yes" or "No" question. It involves a matter of judgment about which it is difficult to be absolute. Screening cannot be absolute. In that context, a programme has built-in safeguards which will minimise missed cases but it cannot eliminate them completely. This is true of every screening programme. A missed case does not necessarily mean negligence was involved. It is extremely important that we move to a much more accurate test, that is, the HPV screening test. That will allow us to repatriate our screening to Ireland, where it should be. I am aware of no country in the world that outsources screening as we do. It is extremely important that HPV screening is introduced as rapidly as possible to allow us to look after our own screening. We will have much more control over the governance of such a scheme.

I am glad the Taoiseach mentioned the pressures that front-line staff in CervicalCheck were under. They were under severe pressure and are still under severe pressure in dealing with this fallout.

They have had to deal with the real and legitimate anxieties of women and been under extreme pressure to do so. It has affected their health. People have taken early retirement and left their jobs because they came under so much pressure over screening. The backlog in producing reports on smear tests arose from a political decision, whether right or wrong, to offer an out-of-cycle smear test as reassurance. It provided no reassurance and only increased women's anxieties. It should be highlighted that political decisions taken without recourse to thoughtful medical advice can have far-reaching consequences. It led to the anxiety over cervical cancer screening that has built up during the year.

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