HSE chief defends decision to outsource analysis of smear tests

The head of the HSE Tony O'Brien has said he would not have gone on television to express a lack of confidence in the management of the cervical cancer screening programme as the Minister for Health Simon Harris did last week.

Mr O'Brien also said he had no knowledge of the case brought by Vicky Phelan, the mother of two from Co Limerick who was given incorrect cancer test results and is now terminally ill, until he read about it in the media.

He also strongly defended the decision to outsource the analysis of smear tests to laboratories in the United States, a move which the Government is coming under pressure to reverse.

Mr O'Brien argued that the HSE did not direct the legal strategy in cases brought against it for damages as this was a matter for the State Claims Agency. He said continuous suggestions that the HSE was "dragging people through the courts" was having a corrosive effect on the relationship between patients and the health system.

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Last Friday Mr Harris said he did not have confidence in the management of the Cervical Check programme, comments which came a day ahead of the departure of its clinical director Prof Gráinne Flannelly on Saturday night.

At a press conference on Monday Mr O’Brien said she was the strongest advocate in the country for a cervical cancer screening programme when such a service did not exist and had worked tirelessly to bring it into being.

He said whatever the circumstances of her resignation at the weekend, he would not wish for anyone to leave the room without understanding that she was an incredibly dedicated, skilled and highly respected clinician who had given the greater part of her career to ensuring the detection of 50,000 high- grade changes to cells in the cervix (under the screening programme) and that there was a good and effective treatment pathway for the women concerned.

Asked whether he had lost confidence in the management at the cervical screening programme, Mr O’Brien said: “I had concerns about what was emerging but I certainly would not have gone on the Six One News and expressed a lack of confidence, no.”

‘Not sufficient capacity’

On Monday, David Gibbons, the former chair of the cytology/histology group within the quality assurance committee of the National Cervical Screening Programme, said he had expressed fears about outsourcing the analysis of smear tests to the US 10 years ago. He said these were dismissed by Mr O'Brien at the time, when he was head of the State's national cancer screening service.

Mr O’Brien said he was slightly surprised by the remarks.

"In order to have the national cervical screening programme you had to be able to offer to those who took part an assurance they would receive their results from an independent, quality-assured lab in a timely way. At the time there was not sufficient capacity of that type in Ireland. "

He said the choice the country had in 2008 was not having a cervical screening programme at all or having many thousands of women going for opportunistic smears which they initiated themselves. He said these smears could be lying around for months or sometimes for more than a year in a laboratory without being looked at or possibly being read on someone’s kitchen table at home.

“Do I believe that a programme that has identified 50,000 cervical intraepithelial neoplasia (CIN) and produced a 7 per cent reduction in incidence was right? Yes I do.”

HSE’s legal strategy

Mr O'Brien said he only found out about the High Court case brought by Ms Phelan when he read about it on the RTÉ website. He said there were people in the HSE who ought, ideally, to have informed him but that this did not happen. He said he would not like to share the words that passed through his mind when he realised what he was reading about.

“It is little understood but needs to be understood that the HSE does not represent itself in any action brought seeking damages. Under legislation, the cases are defended by the State Claims Agency which has a statutory mandate to direct lawyers and to determine the nature of the defence. Obviously they rely on the relevant part of the HSE to obtain the necessary information regarding the case. The HSE does not instruct the legal strategy or inform the legal strategy or direct lawyers,” he said.

Ms Phelan settled a High Court action for €2.5 million against a US laboratory last week over a 2011 smear test which wrongly gave a negative result for cancer. She was diagnosed with cancer in 2014 and only told of the false negative in the smear test in September 2017.