LAST UPDATE | 3 Apr 2019
THE FORMER CLINICAL Director of CervicalCheck, Grainne Flannelly, is to tell the Oireachtas Health committee that she had warned Health Minister Simon Harris about the challenges in offering additional smear tests to women.
Among the advice Flannelly offered was that additional (or out-of-cycle smear tests) would be “difficult to plan for and difficult to deliver sufficient capacity to avoid longer waiting times for results”.
On 28 April, Harris offered women who had availed of the national screening programme an additional free smear test to ease their concerns in the wake of the CervicalCheck controversy.
Harris has been criticised for making this offer without allocating additional resources to healthcare services. The backlog, which reached a peak of 83,000 in January, has led to 1,000 women needing repeat smear tests due to their sample expiring.
Representatives of the HSE and CervicalCheck are due before the Oireachtas Joint Committee on Health from 9am today to give an update on the latest figures on the CervicalCheck programme and the implementation of the Scally report.
Flannelly is to tell the committee that at the end of April 2018, the head of screening at the National Screening Service Charles O’Hanlon informed Flannelly that the Department of Health had asked for their thoughts on offering out-of-cycle smears.
Flannelly said that she and O’Hanlon offered the following advice:
1. General Practitioners would not be able to be paid for this service as there was no mechanism for payment of out of programme tests
2. Laboratories would not have sufficient capacity – already laboratories had issues with recruitment and retention of cytologists
3. Colposcopy services will not have sufficient capacity, as capacity for new colposcopy was based on the number of women screened.
4. Most importantly, it would fundamentally undermine the screening programme.
In response to a parliamentary question from Fianna Fáil’s health spokesperson Stephen Donnelly, Harris said that he had not received advice prior to announcing the free smear tests:
Neither I nor my officials received advice that recommended against these tests in advance of the decision. Subsequent to the decision, on foot of telephone contact by the Department, the National Screening Service raised a number of concerns verbally.
“Following the announcement, the Screening Service set out concerns in an email to my Department, which related to uncertainty about costs, volume, impact on turnaround times, impact on perceptions of the programme’s accuracy, challenges with processing GP payments, and the potential difficulty in ceasing the arrangements in due course.”
Harris made the announcement on 28 April; Flannelly said the National Screening Service were first contacted on 28 April, and they responded on 29 April.
‘Save your own skin’
The issue was raised during Leaders’ Questions in the Dáil this afternoon. Fianna Fáil leader Micheál Martin said the government’s decision to offer repeat smear tests was wrong and done to “save their own skin and cover their own tracks”.
Martin said the decision “reeked of panic”, adding that the response of Harris and Leo Varadkar to the situation “lacks character”.
He told the Taoiseach the decision was made “to save your own skin because you panicked”.
Varadkar defended the move, saying the government was reacting to women’s genuine concerns and that a number of doctors, and members of the opposition, had called for repeat smear tests to be offered.
“The reality at the time was that there were a lot of women who were really concerned about the accuracy of smears,” he said, adding that Harris has already addressed the issue in the Dáil.
He said he expects the CervicalCheck backlog to improve in the coming weeks and months.
HSE apology and 33-week wait
The HSE is set to apologise for the “regrettable and unacceptable delays” women have been facing in receiving their smear test results, which have been partly caused by offering these extra smear tests, at the committee hearing today.
The HSE is to tell the committee that the maximum waiting time women now face before getting their smear test results is 33 weeks; that’s up from 2-4 weeks before May 2018. The average wait time is 15 weeks.
The HSE has said that while the delay is “undesirable”, that it poses a very low risk to women, as cervical cancer usually develops over a period of 10 to 15 years.
It did, however, add: “The HSE remains extremely conscious of women’s concerns regarding cervical screening over the past year and in particular women’s anxiety due to the delays in reporting on smear test results.
We are very sorry for these regrettable and unacceptable delays and remain committed to seeking solutions which will reduce women’s waiting times.
On the 28 March, there were around 79,500 tests waiting to be processed; that figure hasn’t changed much since January when there were 82,000 smear tests. Before the CervicalCheck controversy, the HSE says there was around 23,000 smear samples “in progress at any one time”.
Tackling the delay
The HSE has taken a number of measures to attempt to decrease the backlog: this includes prioritising certain samples, which includes smear tests from “high risk groups such as colposcopy”, and smears approaching the six-month storage limit, which are then tested for HPV before expiration for those tests.
The HSE has also made extensive efforts to source additional laboratory capacity, including in other countries.
Damien McCallion, the National Director of Screening Services at the HSE told the Committee today that of the number of women who availed of smear tests between May and December, a third are women who had not availed of the service and two thirds were women who had availed of the programme before.
Repeat smears
In an attempt to strengthen trust in the CervicalCheck programme, available for free to women aged from 25-60, Health Minister Simon Harris announced last year that women who had received a smear test could get a repeat done for free.
This offer was available between May and December last year; it has cost €9.6 million and today it was announced that the number of “early” smear tests was 57,810.
Concerns about the programme had been raised after 221 women who had been diagnosed with cervical cancer in the past 10 years were not told that their past smear tests had been audited, and was found later to have been interpreted incorrectly.
Since then, campaigners such as Vicky Phelan, Emma Mhic Mhathúna, Orla Church, and Stephen Teap, whose wife Irene died of cervical cancer, have all been fighting for improvement of the CervicalCheck programme, while also highlighting its importance in identifying abnormalities and its role in saving women’s lives.
Since then, changes have been made to the programme – in his February report, expert Dr Gabriel Scally said that he was “very encouraged by progress to date” in implementing the recommendations from his September report.
With reporting by Órla Ryan
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