DR GABRIEL SCALLY has suggested the emphasis on price in the procurement process for cervical screening tests became a more important factor than quality assurance.
In his recent supplementary report on the CervicalCheck scandal, Scally pointed out that the emphasis on quality assurance dropped from 25% in the 2008 tender process for laboratories to 15% in the 2012 tender.
Meanwhile, the weighting for the fee proposal increased from 20% in 2008 to 40% in 2012.
Scally, who led the CervicalCheck inquiry, appeared before the Oireachtas Health Committee today, along with consultant Dr Karin Denton and Shane McQuillan from Crowe, who both assisted him with his work.
“We did not come across in the documentation why they were subject to substantial reductions in weighting,”he said.
How can there be any other explanation other than price became a much more important factor in the whole process and that they were seeking to stimulate as much competition and drive down the price as possible? I can’t see how there could be any other explanation for it.
Sinn Féin TD Louise O’Reilly described the situation as “screening on the cheap”.
“Reducing the emphasis on quality and capacity and increasing the emphasis on price – so they were chasing down the costs, they weren’t keeping a close eye on quality”.
McQuillan told the committee that much of the documentation in relation to these procurement processes was incomplete or missing. He said the reduction to 15% would “tend to suggest that the service was being looked at more as a commodity than something that was quality driven”.
“It’s surprising that it would be down at that low level,” he said.
He said they have been engaging with the HSE to implement Dr Scally’s recommendations and there is a “much grater focus” now on the qualitative aspects.
“It’s fair to say they have learned the lessons.”
Lab visits
In relation to quality assurance visits to these laboratories initiated by CervicalCheck, Dr Denton said there “wasn’t really a definite, adequate programme or policy or specification for what the QA visits would entail.”
She also said that the laboratories they visited “didn’t include many of the places to which the work was actually being sent”.
In one instance, the team visited a laboratory in Austen, Texas. At the time this lab was sending around 40% of the work to a small facility in San Antonio set up solely for the purpose of servicing the CervicalCheck programme.
The quality assurance team did not visit this smaller laboratory.
Accreditation
In his recent report, Dr Scally had also expressed concern about a Medlab facility in Salford in the UK, which he said received accreditation retrospectively.
He told the committee that despite the fact that Medlab insists it was accredited by the Irish National Accreditation Board (INAB), the board had told Scally in the course of his inquiries that it was not aware of the lab’s existence.
Despite this, INAB later decided to add this lab to the accreditation list.
“We need an accreditation system people can rely on. I had expected another outcome, to tell you the truth.
“I had expected that INAB would tell me ‘we’ve never heard of this lab, we’ve never visited this lab, of course it’s not accredited’ and that’s not the answer I got back.”
Scally said the CervicalCheck programme stands up well internationally and that criticism was not about the programme but about how the controversy around the non-disclosure of audits to affected women was handled.
However he acknowledged he had been shocked by some of his findings in relation to how the programme was being managed.
“Have you ever seen the like of this?” Fine Gael TD Kate O’Connell asked him.
“I have never seen the likes of this in my long career, I really have not” he replied.
“Organisationally and structurally, I’ve never seen anything quite as wrong as this was from top to bottom.”
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