Updated 9.10pm

A MEMO to HSE director general Tony O’Brien about the CervicalCheck audit warned there could be negative media coverage following the issuing of letters to doctors.

The July 2016 briefing note states that the CervicalCheck programme was prepared for such media coverage and “communications materials” had been drawn up to counter such a kickback against the organisation.

The note states that the outcomes of the audit process showed that while the majority of cancers were detected “as early as possible through cervical screening, not all cancers were prevented”.

It said it communications strategy would “ensure transparent, effective and robust communications processes are in place” so as to provide “clear information for the media and the public where appropriate on the CervicalCheck Clinical audit process and results”.

It also points out that “all international screening programmes will have encountered a media headline that ‘screening did not diagnose my cancer”.

In a statement this evening, the Department of Health said that this memo was not brought to the attention of Minister for Health Simon Harris.

The department said in a statement: “The Department is currently examining the records in relation to CervicalCheck.  A full discovery will be undertaken and all documents will be made available to the Scoping Inquiry to inform its considerations.

The HSE shared a number of documents in relation to the CervicalCheck clinical audit with the Department, including the memos made available to the PAC today.  However, nothing so far has been identified that changes our basic assertion that the fact of clinical audit being undertaken and arrangements being made to disclose to patients in this regard were positive features of CervicalCheck.

Similarly, Taoiseach Leo Varadkar wasn’t made aware of the memo. It is understood that his last remark on this specific matter to the Dáil remains the case.

He said on 1 May: “I was never informed of any patient safety concern or potential scandal relating to CervicalCheck and certainly not the outcome of any audit such as this. I have asked officials in the Department to check that for me in case my recollection was incorrect.”

With the intervention of Harris and Varadkar to say they weren’t aware of the memo, pressure increased on O’Brien to resign, which he has done this evening.

A Cabinet meeting scheduled to take place in Monaghan tomorrow has been cancelled, and will take place in Dublin instead. It is understood that Independent Minister Finian McGrath would have reiterated his call for O’Brien to go at Cabinet tomorrow.

Sinn Féin tabled a motion of no confidence in O’Brien that was due to be heard next week and, this evening, Fianna Fáil health spokesperson Stephen Donnelly said that his party would have backed the motion.

‘Alarm bells’

Appearing before the Public Accounts Committee (PAC) this morning, O’Brien insisted the message did not “ring alarm bells”.

O’Brien said the memo issued to him in July 2016 outlined a “communications protocol” in relation to the review of smear tests.

• You can view the memo here.

The CervicalCheck scandal came into the public eye last month when Vicky Phelan, who has received a terminal cervical cancer diagnosis, settled a High Court action against the HSE and Clinical Pathology Laboratories for €2.5 million over incorrect smear test results from 2011.

More information has continued to emerge about the controversy whereby women were told that they had normal smear test results in error. It has since emerged that more than 1,500 women who developed cervical cancer did not have their cases reviewed by CervicalCheck.

Informing treating clinicians

The memo states that in February 2016, CervicalCheck began telling treating doctors the outcome of the audit.

It states that some laboratories (that review the smear tests) raised concerns about CervicalCheck telling doctors about the audit outcomes and there had been legal correspondence sent. A meeting was set up to deal with the matter in May 2016 and the legal issue ceased.

Another memo – dated March 2016 – also sent to O’Brien outlines the legal concerns, and also raises the case of one patient diagnosed with cervical cancer who wished to have a meeting with CervicalCheck.

Under the heading ‘Next Steps’ the memo states that letters to patients should be paused.

‘No follow-up’

Criticism has been levelled at the HSE and CervicalCheck in recent days over the lack of follow-through in terms of ensuring doctors inform all affected patients that their smear test had been included in the audit process.

The memo shows O’Brien was briefed about the “communications protocol” which had been prepared for consulting clinicians.

The memo states that “the formal step of communicating cytology review findings arising from the clinical audit to the treating clinicians looking after individual women diagnosed with cervical cancer” had begun.

Letters

The note also informed the HSE boss about the number of letters that had been issued to GPs to date (86 in total up to July 2016) and indicated that a further 200 letters would be issued in the following months (July/August 2016).

The memo also highlighted a number of recommendations to the HSE boss, such as the aim of introducing HPV testing, which is yet to be introduced in Ireland (Health Minister Simon Harris said it will be introduced this year).

Notably, the memo also highlights the need to establish “formal links for statistical reporting with the National Cancer Registry Ireland (NCRI)”.

Yesterday the Oireachtas Health Committee was informed that CervicalCheck knew for many years that there were issues with the transfering of data from the NCRI.

Failure to reconcile CervicalCheck and NCR data meant the HSE initially told the health minister that 1,482 cases of cervical cancer had been diagnosed since its screening programme began in 2008. It later emerged it was closure to 3,000.

Labour’s Alan Kelly, who chaired today’s PAC meeting, said the memo showed that the communications strategy outlined in the briefing note was not executed.

He said this showed there was “no follow-up or accountability” by the HSE to ensure that clinicians had spoken to the women affected.

It called the memo a ”devastating document” because of the “tone and manner” in which it is written and highlighted the sort of communications strategy CervicalCheck was operating.

With reporting from Sean Murray