Peadar Tóibín (Meath West, Aontú)
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I am disappointed the Minister, Deputy Stephen Donnelly, is not here to answer these questions. I know he is busy but it is important that the Minister is in the Chamber.

Recently, Patricia Carrick, a mother of four from Oranmore in County Galway who is terminally ill, won her case in the High Court against the HSE and a laboratory. It was determined that a smear test done in 2016 was read in a manner that was neglectful. I believe Patricia's case may expose something deeply worrying, which is a major oversight in the previous Government's handling of the scandal when it broke in May 2018. I will try to explain this as best I can. When a woman is diagnosed with cervical cancer in this country CervicalCheck is notified of the diagnosis and conducts a review of the previous smear tests that woman had taken. In May 2018, it revealed that these audits between 2008 and 2018 had shown that out of 1,500 diagnoses reported to it in that timeframe, more than 200 of the tests had mistakes or missed readings. This is a mistake rate of 14%, which is a phenomenal figure.

In May 2018, the Government commissioned an independent review conducted by the Royal College of Obstetricians and Gynaecologists, RCOG. This review's finding differed significantly from the previous audits. It stated that out of a sample of 1,034 tests that it reviewed there was a 30% mistake rate. The terms of reference provided by the Government to RCOG are troubling in hindsight. The Government instructed RCOG to examine the slides of women who had since been diagnosed with cancer. RCOG did not examine all of the slides but only those women who had at the time been diagnosed with cancer.

Patricia Carrick, for example, had a smear test in 2016. She was given a clear result and carried on with her life. She had another test in 2018 and another in 2019, again with clear results. However, she was diagnosed with cancer a few months later. Given that she has won her case, we know the 2016 test was misread but when RCOG was carrying out its review, as instructed by the terms of reference provided by the Department, it skipped Patricia's slide because as of 2018 she had not been diagnosed with cancer. Her slide was left on the shelf and had not been examined.

The slides of all the women who have not yet been diagnosed with cancer have not been reviewed. This is startling. For people such as Patricia, who do not discovered their cancer until later or perhaps where the cancer has manifested itself since, sadly it seems that it is too late. Had the Government told RCOG to review all of the slides in 2018 then issues such as Patricia's would have been identified earlier and, perhaps, the prognosis could be different.

I am not raising this issue to speculate on what is a deep and difficult issue for the family, and our prayers and solidarity go out to the Carrick family. I am raising the issue because if RCOG states the samples it looked at had a 30% mistake rate then are we to assume that the slides and samples it did not look at of those women who had not been diagnosed with cancer at that time also have a 30% mistake rate? If this is true, even if it is a quarter of that figure it is startling information and it would necessitate a radical re-examination of the whole CervicalCheck scandal. I ask the Minister of State for a response.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy Tóibín for raising this issue and giving me the opportunity on behalf of the Minister to update the House on this very important matter. Patricia Carrick's story is indeed harrowing and I will raise many of the issues involved in it with the Minister.

A cancer diagnosed in the period of time after a negative screening test and before the next screening test is known as an interval cancer, which unfortunately are an inevitable occurrence in population-based screening programmes. Audit of interval cancer is a key quality assurance mechanism in assuring health authorities, patients and the public about the quality of cancer screening services. Audit processes were in place in CervicalCheck since 2010 as part of quality assurance measures. However, these were paused in 2018 following the issues which have been dealt with by the Scally report.

The scoping inquiry into the CervicalCheck screening programme led by Dr. Gabriel Scally made a number of recommendations, including that audit should continue to be an important component of cervical screening as this complies with all good clinical practice and that common, robust and externally validated approaches to the design, conduct, evaluation and oversight of audits should be developed across the screening services.

This recommendation was accepted by the Government, as were all of Dr. Scally's recommendations, and actions to implement these were set out in an implementation plan approved by Government and published on the website of the Department of Health. In line with the Scally recommendations, the HSE chief clinical officer commissioned a review of audit of interval cancer for all three cancer screening programmes, namely, BreastCheck, CervicalCheck and BowelScreen, with the aim of defining future audit processes and reviewing guidance for interval cancers in the national screening service based on international evidence and best practice.

Expert reference groups were set up comprising Irish and international experts and patient representatives and advocates. The expert reference groups' reports set out the future approach to managing reviews of interval cancers in CervicalCheck and our other two cancer screening services, BreastCheck and BowelScreen. The Minister, Deputy Stephen Donnelly, wishes to thank the groups for their work and acknowledges the contributions of the patient advocates and experts, including the Irish Cancer Society, and the doctors at home and abroad who were involved in these important reports.

10 o’clock

Implementation groups for CervicalCheck and other programmes will now be set up and the Minister expects an update on the progress in early 2021. The ongoing participation of patient representatives in the implementation groups will be the key to improving the patient experience, access to patient information and open communication. The CervicalCheck programme will contact any affected patients whose reviews were paused and keep them informed as implementation progresses.

The Minister wants audited cervical screening to recommence as soon as possible but it must be done in the correct and robust way that Dr. Scally recommends. Some work is required to ensure that will happen. The Minister supports the future direction of auditing within the national screening programme as set out in the expert reference group's reports and the Department of Health will work closely with the National Screening Service to ensure this happens in line with best practice and with patients at the centre.

I have two more general messages for the public, the first of which is that I strongly encourage anyone who has recently received an invitation for screening to follow up on it. Second, I remind the public that while screening is an important service to help identify those who may be at risk of certain cancers, anyone with concerns about symptoms they are experiencing should contact their GP.

Peadar Tóibín (Meath West, Aontú)
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I concur with the Minister of State that it is really important that people ensure they respond to invitations they receive in respect of cancer screening opportunities. It still breaks my heart that BreastCheck is not yet up and running in the State. It is incredible that a backlog of 200,000 women, according to the latest estimates, are on a waiting list for cancer screening.

The Minister of State mentioned interval cancer but I am not talking about an interval cancer. It is a pre-cancer that was missed. Patricia Carrick won her case. What the Minister of State mentioned, therefore, is not relevant. Two major studies of cancer screenings in the State have been carried out, separately showing a 14% mistake rate and a 30% mistake rate. Individuals who went through those screenings, some as late as last year, have gone to court and found out there was neglect in the reading of their cancer screenings. The Department of Health, when contacted by concerned women during the height of this scandal, emailed them back to say the issue was not one of concern because cervical cancer is known to take ten to 15 years to develop. This means there are likely to be women throughout the State who may feel they are perfectly healthy but, because of the rates of mistakes in those two samples, may not be. This is a significant fear and a big worry. The State has a responsibility to re-examine the slides of those women and check whether they are correct. At the very least, it should choose a sample of the slides to check whether they have the same mistake rate as the two samples that were taken previously.

This matter is very important and I ask the Minister of State to ensure he attends to it immediately.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I reiterate that the Minister supports the future direction within the national screening programme as set out in the expert reference group's reports. The Deputy outlined a few views, which I will relay to the Minister and the Department. The publication of these reports represents another important milestone in implementing the Scally report and the ongoing work to improve public confidence in our cancer screening services.

As we all know, screening saves lives and it is important that we have high-quality and sustainable screening services in Ireland. The Deputy appealed to people who have received a letter to turn up for the screening services. Sometimes, when people receive such a letter, we need to encourage them to appreciate its urgency. Implementing these reports will significantly improve our system to ensure we save as many lives as possible through screening in the future.

I again thank the Deputy for his views and the information he outlined, which I will relay to the Minister and the Department. We hope to have an answer for the Deputy in the coming days.