Thursday, 26 September 2019
Department of Health
Cancer Screening Programmes
In May 2018, Government agreed to establish a Scoping Inquiry into the CervicalCheck screening programme. The Scoping Inquiry was led by Dr Gabriel Scally, under Terms of Reference which are published on the website of my Department.
The Scoping Inquiry produced a First, Final and Supplementary Report. In total these reports set out 58 recommendations for improvements in our screening programmes and wider health services. These reports are available on my Department's website.
The Final Report of the Scoping Inquiry, published in September 2018, is unequivocal in stating that the widespread non-disclosure of the results of historical screening audits was a substantial breach of trust for the women and families concerned. It caused significant distress and additional suffering to those affected. However, Dr Scally is clear that the Inquiry is satisfied with the quality management processes in the labs contracted by CervicalCheck. His reports present no evidence that the rates of discordant smear reporting or the performance of the programme fell below what is expected in a cervical screening programme. Crucially, he confirmed that he found no reason why the existing contracts for laboratory services should not continue until the new HPV regime is introduced. This provided welcome reassurance for women in Ireland, given the importance of screening for women’s health.
The Supplementary Report, published on 11 June 2019, addressed issues relating, broadly, to laboratories used for CervicalCheck screening, including the use of additional sites, laboratory accreditation schemes, and procurement and contracting of laboratory services by CervicalCheck. The Report identified issues in regard to contractual compliance, in particular the use of additional sites for screening of CervicalCheck sites without CervicalCheck’s knowledge; procurement, including a reduced focus on quality in procurement; and contracting. However, the Supplementary Report stated that, on the basis of the information available to the Inquiry, the use of additional laboratories did not in fact result in a reduction in the quality of the screening provided to Irish women and there is no evidence to suggest deficiencies in screening quality in any laboratory.
Dr Scally confirmed to me in July this year that the work of the Scoping Inquiry is concluded. Government has accepted all 58 of the recommendations that were set out in Dr Scally’s three reports into CervicalCheck. An implementation plan was approved by Government in December 2018 and work is ongoing in my Department, the HSE and the National Cancer Registry of Ireland on the range of actions within the Plan.
Dr Scally carried out a review of the implementation plan earlier this year, at my request, and he affirmed that the Implementation Plan is a comprehensive response to his report. He was clear that significant effort and resources are being committed to addressing the problems he identified and has acknowledged that substantial and important progress has been made to date in implementation of his recommendations. Quarterly reports against implementation are published on the website of my Department.
I have requested Dr Scally to undertake a further review of implementation of his recommendations, and this work is ongoing. Dr Scally has stated that he is confident that the recommendations which he has made are already facilitating the development of a cervical screening service that, in international terms, will be outstanding.
Also currently underway, following the Government decision in May 2018, is an Independent Clinical Expert Panel Review of cervical screening. This is being carried out by the Royal College of Obstetricians and Gynaecologists (RCOG), and will provide women with independent assurance about the timing of their diagnosis and treatment. Every woman who was diagnosed with cervical cancer since September 2008, whose cancer was registered with the National Cancer Registry of Ireland before 5 May 2018, and who had one or more tests under the CervicalCheck programme, was offered a review of her case.
As noted in a guidance document produced by Public Health England, "no matter how closely a review tries to reproduce the original screening conditions, the conditions of a review are different", and hence it is normally expected that any review such as this will have review results which disagree with their original review result (discordance). This is in line with international experience. For planning purposes, the HSE is estimating that up to 40% of participants may be identified by the RCOG Panel as having discordance.
Earlier this month the HSE sent a letter to all participants in the review to provide an update about the process, and to advise participants of when they may expect to receive their individual reports. This letter also provided women with options about how they may choose to receive their report. The feedback from participants has been positive, both in relation to the information pack and the options for receiving results. Women have started to receive their results and it is expected that the process will take a number of months to complete.
The Royal College will also prepare an aggregate report for the Minister, which will include recommendations, where appropriate, on improving care for women. The Royal College wrote to the Minister on the 6th of September last advising that, based on the provisional findings of its Review, the performance characteristics of the CervicalCheck Screening Programme that fall within the scope of the Review appear to be broadly in line with the experience in the UK.
Significant progress has been made in clearing the backlog of smear tests and reducing turnaround times. Medlab Pathology, which reported a backlog of 55,000 smear tests in May 2019, completed the processing of these tests in August this year, having ceased accepting new tests from 1 May. This marks a welcome milestone for the programme. All smear tests are now being read at two laboratories, the Coombe and Quest Diagnostics. As of 30 August, the HSE reported that average turnaround times for the Coombe and Quest were 4 weeks and 5 weeks respectively, and 96% of tests were being resulted within 7 weeks.
As the turnaround times for smear test results may fluctuate somewhat from week-to-week, I have asked the HSE to respond directly to the Deputy with the most up-to-date figures available.