Thursday, 5 May 2022
Nithe i dtosach suíonna - Commencement Matters
I thank the Minister of State for attending. He is great for coming in here and taking the heat but he is the Minister of State with responsibility for public health and well-being so my Commencement matter is relevant to his role as well as that of the Minister for Health.
I want to raise an issue that concerns cervical smear tests. There have been improvements thanks to great pioneers like Vicky Phelan and others but we have some way to go. Several women have contacted me to tell me that they have experienced a huge amount of stress caused by delays in getting results after they had an initial cervical smear test, and they experienced further delay, in cases where there were irregularities, in getting an appointment for a colposcopy procedure or have irregular cells removed and discover the final diagnosis.
A few women have told me that they had to wait over five months. As a woman who has had a cervical smear test and irregular cells were discovered, I know that as soon as one is told irregular cells have been found one automatically thinks cancer, and one continues to think like that until one is told that it is not cancer. So that is a stressful situation.
Every year in Ireland over 12,000 women are diagnosed as having irregular cells following a cervical smear test so that is 1,000 women a month or between 30 and 40 women every day. Therefore, every month 1,000 women must endure this stress until they get a final result. Targets have been set out but I could not find out whether we have reached them. It seems to me that most women still must wait between four and five months before getting the all-clear or find out that they need a further procedure or procedures.
In Ireland, the State provides a test, which is very good. Women should get tested every three years if aged between 25 and 29 years and every five years if aged between 30 and 65 years. There is a national screening programme where 295,000 women annually are screened, which is a much better target than in previous years. Unfortunately, I was unable to find up-to-date figures and cited the figures for 2020.
People still must wait. In some cases, the consultants have the results but if they go on holidays or take a break for a few weeks, which they are entitled to do, the test results sit on their desks and there is nobody in place to convey the test results. A few women have contacted me to tell me that they had waited for weeks and I made representations on their behalf so their results were taken off the desk of the consultant, who had gone on holidays, and brought to light so the women got their results. That is not my job. I should not have to help people to gain access to their medial results. It is the job of the HSE, clinicians and consultants to deliver results to women.
I do not know who is to blame for delays and it probably is not the fault of consultants. A woman told me that the reason for the delay in her case was that her consultant had the results but went on holidays. That poor woman was in bits because she thought she might have cancer and every single day she waited for her results. Partly due to me making inquiries she got her results quicker than she would have if she had not contacted me. Speeding up medical results is not our job as politicians. We make inquiries because we want to take care of constituents although the woman I mentioned was not even from County Clare. There is something radically wrong if people are left in a situation where they lose sleep because their results are on a desk because somebody has gone on holidays. That is not right.
I want to touch on targets and ask a couple of questions that the Minister of State might answer today or follow up. How can long waiting times for such a worrying diagnosis be justified? Let us think of the day-to-day worry that these women have experienced every step of the way. What is the procedure for continuing the CervicalCheck workload for consultants when they go on leave so that test results do not end up sitting on a desk? How many people await screening results? How many people await colposcopy results? Who conducts the tests for the State? Is it private companies? Who does the tests? Is the testing conducted inside or outside the State? If the State is paying can faster turnaround times be demanded?
The HSE and the Government have set target times as follows: the results of smear tests should be four weeks; an appointment for a colposcopy should be eight weeks, which is still a long time; and results for colposcopy should be four weeks. So the waiting time should not be five or six months. Have these targets been met? I ask because I could not find out that information. I look forward to the response of the Minister of State to this worrying issue that affects half of the population.
I thank the Senator for giving me the opportunity to update the House on this important matter on behalf of the Minister, Deputy Stephen Donnelly. Both the Minister and I are fully committed to supporting our population screening programmes which are a valuable part of our health service. I am pleased to say that the CervicalCheck programme is back screening at pre-COVID-19 levels. Furthermore, by the end of 2021, CervicalCheck had screened the same amount of people as in any other two-year period. I take this opportunity to acknowledge the effort made by the staff in CervicalCheck, primary care services and GPs along with the laboratory services in achieving this level of activity despite the difficulties they faced. This positive situation is also testament to the women across the country who took up their screening invitations and attended for this important test. Importantly, the focus of the resumption of cancer screening services includes the management of capacity across the whole of the screening pathway, which includes follow-up assessments and treatments.
In terms of colposcopy, it is important to acknowledge the effects that Covid-19, the May 2021 cyberattack on the HSE and the December 2021 cyberattack on the Coombe Women and Infants University Hospital had on these clinics. I am pleased that the latest data on colposcopy attendance, from March 2022, show that the majority of people are being seen within the programme's target timeframes. In terms of colposcopy attendance at University Hospital Limerick, the latest figures in March 2022 show that this applies here also, with 100% of urgent and high-grade referrals seen well within the set targets. There is ongoing work to continue to build capacity in the services to ensure that this remains the case, and further improve timeframes for low-grade referrals that are currently slightly outside national targets.
While it is understandable that waiting for any test results is a worrying time for anyone, it is important to emphasise the fact that colposcopy identifies abnormal cells and is not a cancer diagnosis in the first instance. In most cases, it takes between ten and 15 years for a human papillomavirus, or HPV, infection to cause abnormal cells to develop into cervical cancer. In addition, cervical cancer is a rare outcome of a HPV infection.
The Minister for Health and I want to ensure that we have world-class cancer screening programmes in which the people of Ireland can have confidence. This commitment was shown with the allocation of an additional €10 million in 2021 for cancer screening services in the HSE national service plan, and continues this year to progress with service developments. This investment represented a real dedication to improving cancer outcomes in Ireland through the early detection of disease.
The Government is committed to ensuring that Ireland has a robust cervical screening service, which will enable our progress towards the ultimate goal of eliminating cervical cancer. Importantly, CervicalCheck made the technical transition to HPV cervical screening in 2020. This means that Ireland has joined a small group of nations that employs best-in-class testing to screen their populations for cervical cancer. Ireland can look forward to a significant reduction in the incidence of cervical cancer cases over the next ten to 20 years.
The Senator mentioned that issues arise when consultants or whoever go on holidays. It is unacceptable that women must wait a little bit longer as that causes huge stress and strain.Within the HSE, with its clinical staff and consultants, there should be a system in place that would prevent these longer waiting times. If somebody goes on leave, there should be a mechanism in place. I will bring this matter back to the Minister.
The Senator raised many questions about leave, screening results and testing. If she sends me an email on those issues, I will to try to get an up-to-date answer as quickly as possible.
I thank the Minister of State for his response. He stated we were reaching the targets, yet I have evidence to show that, in the case of a woman who had an initial test in November and was told in December that she had abnormalities, it was not until last week, five months later and following my intervention, that she found out she will be okay. Despite what the Minister of State is being told, we are not meeting the targets.
There is no problem with getting the initial cervical smear done, thanks to brilliant CervicalCheck services and GPs around the country doing a great job. The first part is no problem but, unfortunately, while there is good uptake, all of those women must then wait on results. As I said, 12,000 women have a diagnosis of irregular cells every year. While most of those cases do not involve cancer, women cannot help but worry. When a woman is told she has irregular cells she cannot remove that knowledge or the worry about the possibility that these cells are cancerous.
As the Minister of State said, early intervention is key. It is very important that we give women the confidence to go ahead and start the experience. They are afraid to start in case they find out something negative and must wait in worry for six months. We need to build up confidence in cervical smear checks. I understand that we have had Covid and so on but it is now 2022. We need to make a conscious effort to let people know we are on our game and that this is being done properly and we are meeting our targets, so that people like me do not have to intervene on behalf of individuals to get test results off a desk because someone has gone on leave.
Senator Garvey has made some very interesting and valid points. I thank her for giving me the opportunity to update the House on this important matter on behalf of the Minister for Health, Deputy Stephen Donnelly. The Minister for Health and I are fully committed to supporting our population health screening services, which are a valuable part of our health service.
It is good to see that CervicalCheck screenings are back to pre-Covid levels. I acknowledge the effort being made by the staff at CervicalCheck, primary care services, GPs and laboratory services in achieving this level of activity, despite the difficulties they have faced. This positive situation is also testimony to the women across the country who took up their screening invitations and attended for this important test. Importantly, the focus of the resumption of cancer screening services includes the management of capacity across the whole of screening practice, which includes follow-up assessments and treatments.
The Senator has raised very difficult questions around this simple issue. If someone has a cervical check done, the results should be made available as quickly as possible and should not be on somebody's desk. If the Senator sends me details of the case, I will follow it up in the Department.