Alarm bells sounded over cervical smear rechecks

In October 2008 the then minister for health, Mary Harney, found herself explaining in the Dáil questions how American laboratories had to be drafted in to deal with a backlog of smear tests that had built up across Irish hospitals.

At one point, it was reported that more than 30,000 women were affected.

The decision to outsource the tests led to criticism from the Well Woman Centre and the Medical Laboratory Scientists Association. They were worried about differences in how the tests might be read, and about what it would mean for the development of the Irish screening programme.

Almost a decade later, Tánaiste Simon Coveney found himself at the same Government bench apologising for a new backlog that had emerged. More than 80,000 women were being forced to wait 18 weeks for their results, he said.

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The reason was partly because of a decision made in the immediate aftermath of the CervicalCheck crisis, which had unfolded six months before.

The question was: could these delays have been avoided?

Thanks to the courage of Vicky Phelan, it emerged last April that 221 women who were diagnosed with cervical cancer were not informed of an audit that revised their earlier, negative smear tests.

In a bid to quell public anger and worry, Minister for Health Simon Harris announced via a tweet on April 28th that any woman who wanted a free out-of-cycle smear test could avail of one.

In the days after the announcement, politicians on the Oireachtas Committee on Health privately noted the muted language from senior HSE officials.

Exceptional reasons

At a committee on May 2nd, the clinical director of the national women and infants programme, Dr Peter McKenna, advised against the general out-of-cycle repeat smear test unless there were exceptional reasons.

“For the majority of people who have had negative reports, the message we would like to get out is to stick with the programme and attend for the next scheduled smear.”

Former director general of the HSE Tony O’Brien suggested that instead, the actual slides from previous smears could be re-examined if women wished.

The comments led some Opposition politicians to wonder if there had been advice given not to proceed with the plan, and if adequate planning had taken place. Mr Harris said no advice had been given to him or his officials not to go ahead with the plan before the decision was made.

Nevertheless, according to Fianna Fáil’s Stephen Donnelly, plenty of alarm bells were sounding afterwards.

He recently told the Dáil that on June 15th last year, “the chief executive officer of Sonic Healthcare, which runs the laboratory in Sandyford that deals with approximately half of the testing in the country, wrote to the Minister saying that urgent intervention was needed to cope with the increased demand after the announcement of the free rechecks”.

And in August 2018, GPs wrote to the National Screening Service, which was copied to the Minister and the Taoiseach.

They warned “that a chronic backlog in cervical cancer smear tests was putting the quality and accuracy of the checks at risk”. Another warning was given by a gynaecologist located in the midwest in October.

Not halted

And then on October 21st “the CervicalCheck project team wrote to the Minister asking him to end the offer of the free smear rechecks as it was putting pressure on the healthcare system”.

Despite the warnings, the plan was not halted.

Overall in 2018 some 90,000 extra women booked an appointment, putting serious pressure on the service. There are still about 80,000 women who are waiting up to 33 weeks for their results.

The political heat around the situation has been rising since the start of the year. The question was: could these delays have been avoided? The Minister correctly pointed out that when he announced the free out-of-cycle tests, the decision was welcomed by the Opposition.

But Sinn Féin’s health spokeswoman, Louise O’Reilly, says it was not up to the Opposition to ensure “the conversations take place to make sure the capacity is there”.

Until this week, that was the belief: that no such conversation had happened.

Last Tuesday night, former clinical director of CervicalCheck Gráinne Flannelly – who had stepped down from her role in the aftermath of the controversy – sent a document to the health committee.

She said that in the hours before the decision was announced on April 28th she warned that the labs did not have the capacity, and the proposal would undermine the screening programme.

Within hours, Harris was called on to correct the record of the Dáil. He has stood over his position.

Publish

It has also emerged that the National Screening Service sent an email to the department that same day.

The department has declined to publish this, but the health committee is likely to put in for an official request for it next week.

Perhaps the situation to date is best summed up by Taoiseach Leo Varadkar who said last month: “We were under enormous pressure from many quarters to act quickly.

“Everything we did was in good faith. Sometimes we acted perhaps from the heart rather than the head but this decision was made in good faith.”