Dáil debates

Tuesday, 29 May 2018

Other Questions

Cancer Screening Programmes

5:45 pm

Photo of Tommy BroughanTommy Broughan (Dublin Bay North, Independent)
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42. To ask the Minister for Health the status of the CervicalCheck test scandal; the number of women who have availed of the free follow-up smear tests; the laboratory being used to examine the results of the tests; the changes he plans to the programme and the regular audits of same; and if he will make a statement on the matter. [23145/18]

Photo of Tommy BroughanTommy Broughan (Dublin Bay North, Independent)
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On 11 May the Minister announced a package of services for anyone who wanted to avail of a new cervical smear test. How many women have availed of it? What is the Minister doing to ensure their tests and results will be delivered speedily and what laboratory is involved? We have all been astonished by the courage of Vicky Phelan and Emma Mhic Mhathúna, in particular, but there has been severe criticism recently that the package of measures is not being delivered speedily and that the Minister is not fulfilling the promises he made just a few weeks ago.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I assure the Deputy that rolling out the package of supports is a priority. Not only did we appoint a national lead within the HSE to co-ordinate it, but we have also instructed that lead to ensure public health nurses are assigned in each of the community healthcare organisations, CHOs, to liaise with the families. I do not want to hear of any woman or her family having to go to a meeting in Dublin or being dragged to meet the HSE. I want to see the infrastructure in place for a public health nurse to visit that woman or her next of kin in an appropriate setting for the family, for example, around the kitchen table in the family home. A number of such meetings have taken place and I am informed that a great deal of progress has been made. Without naming anyone in the Dáil, I have put some of the women affected in contact with the person co-ordinating this work nationally to ensure their feedback will go directly to the HSE. I will personally monitor the position closely.

As the Deputy knows, there was a significant downward trend in the incidence of invasive cervical cancer between 2010 and 2015 and we are seeing improvements in five-year survival rates. For that progress to continue, it is essential that women keep participating in cervical screening. Recent weeks have shaken confidence in many aspects of CervicalCheck, but participating in screening is vital if we are to continue to see a reduction in the incidence of invasive cervical cancer. It is welcome that so many women who have been adversely impacted jon or treated poorly by the health service have echoed that message.

As part of ensuring women can feel trust and confidence in the CervicalCheck programme and that it is well managed and quality assured, I have asked Dr. Gabriel Scally to carry out a scoping inquiry into all aspects of CervicalCheck. I expect him to report to me at the end of June. He is due to produce a progress report in the first week of June. Separately, there will be an international clinical expert review panel led by the Royal College of Obstetricians and Gynaecologists, as I believed it was important to involve external persons. It will review the screening history of all women who have developed cervical cancer and participated in the screening programme since it was established. This will provide independent clinical assurance for women about the timing of their diagnoses and any issue related to their treatments and outcomes.

Additional information not given on the floor of the House

On the number of free follow-up smear tests, the HSE has advised that this information is not available, given that there is always a time delay between when the smear test sample is taken by the smear taker and notification of the smear is received by CervicalCheck from the laboratories. Tests are examined in three laboratories, with approximately 50% of the testing done in Ireland and 50% abroad. All three laboratories meet quality assurance standards and are certified by the relevant national authorities. The clinical advice is that there is no evidence that the clinical and technical aspects of the programme have performed outside or below international standards or the quality guidelines set for the programme. However, smear tests can produce both false positive and false negative results. I have asked the HSE to introduce HPV testing as soon as possible as the primary screening method for the prevention of cervical cancer. The HPV test is a more accurate testing mechanism than liquid-based cytology, the current testing mechanism, and its use would result in fewer false negative results. Its introduction is in line with developments in cervical screening internationally.

Photo of Tommy BroughanTommy Broughan (Dublin Bay North, Independent)
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I welcome the Minister's commitment personally to monitor the delivery of the package he announced on 11 May, but he did not address my question about labsoratories-----

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Not yet.

Photo of Tommy BroughanTommy Broughan (Dublin Bay North, Independent)
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-----specifically MedLab Pathology and Clinical Pathology Laboratories, CPL, on the one hand, and the Coombe Hospital, on the other. To reassure people in seeking follow-up tests, will the Minister outline which laboratories will be used? At the weekend The Sunday Business Postreported that the minimum time for the study of each test was approximately six minutes under the protocol. It was not clear whether the protocol was being adhered to by the American laboratory. What is the position in that regard? The HSE would not offer a reply on it to the media.

Regarding the clinical audit and reviews, have there been contacts with all of the doctors who did not inform their patients of the false negative results?

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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At the request of many Deputies, the laboratories we use and their performance are specifically within Dr. Scally's terms of reference because I do not feel qualified nor, I respectfully suggest, is anyone in the House to make these adjudications.

All of the laboratories being used meet international standards and follow the quality guidelines set for the programme. The clinical advice is that there is no evidence that the clinical and technical aspects of the programme have performed outside or below international standards. That is what I am told now and what I believe based on what I am told. We need to allow Dr. Scally to make his adjudications. The laboratory at the centre of the Vicky Phelan case is not being used by CervicalCheck.

On the number of free follow-up smear tests, the HSE has advised that the information is currently not available, given that there is always a time delay between when the smear test sample is taken by the smear taker and the notification of the smear being received by CervicalCheck from the laboratories. I will ask the HSE to make that available to Deputy Broughan when it becomes available. Tests are examined in three laboratories, with approximately 50% of the testing done in Ireland and 50% done abroad. I assure women that all three laboratories meet quality assurance standards and are certified by the relevant national authorities.

5:55 pm

Photo of Tommy BroughanTommy Broughan (Dublin Bay North, Independent)
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I will continue the last point I mentioned about clinicians who have been involved in the 209 cases which led to this scandal. Has there been contact with all of those? What are the Minister's plans for mandatory reporting and the patient office? Does he intend to set that up as an independent agency? The Minister got a €685 million increase in the 2018 health budget. What kind of additional funding does he anticipate for 2019 to address some of the terrible issues that have come forward in this cervical smear check scandal?

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I have not negotiated my Estimates for 2019 with the Minister for Finance, and Public Expenditure and Reform, yet. The Government has made it clear in a number of decisions that whatever financial supports are required will be provided. The Taoiseach has made it clear here on the record of this House and the Government has given me assurances about the funding of the practical measures that we are putting in place. On mandatory reporting and mandatory open disclosure, I have received permission from the Government to progress the patient safety Bill. That will bring in mandatory open disclosure for serious reportable incidences. I have given an assurance that that will include issues relating to screening. I also want to move to HPV testing this year. I asked the HSE to introduce HPV testing as the primary screening method for the prevention of cervical cancer as soon as possible. The HPV test is a more accurate testing mechanism than liquid-based cytology which is the current testing mechanism and it would have fewer false negative results and its introduction is in line with developments in cervical screening internationally. It would place this country to the forefront. I hope, by accelerating that, that it could be something positive to come with regard to women's health and screening.