Richard Bruton
Question:8 Mr. R. Bruton asked the Minister for Health and Children when the roll-out of the national cervical screening programme promised for 2003 will be completed; and if he will make a statement on the matter. [6679/03]
Other Questions. - Cancer Screening Programme.
Phase one of the national cervical screening programme has been up and running in the Mid-Western Health Board since October 2000. Under the programme, cervical screening is offered to approximately 67,000 women in the 25 to 60 age group, free of charge, at five year intervals.
Under the national health strategy, a commitment has been given to the full extension of the programme to the rest of the country. The process of planning and organising the national programme is a major undertaking with significant logistical and resource implications that require careful consideration. Following discussions with my Department on the matter, the chief executive officers of the health boards, under the auspices of the Health Boards Executive, HeBE, have initiated an examination of the feasibility and implications of a roll-out of the national programme.
In this context, I am advised that the board of HeBE has established a sub-group, chaired by Dr. Sheelah Ryan, chief executive officer of the Western Health Board, to lead the initiative. The work being undertaken as part of the roll-out includes the planning and undertaking of an evaluation of phase one, policy development and the establishment of national governance arrangements. This work is informed by both the experiences gained from the phase one programme, the learning derived from other international programmes and current international best practice.
Regarding the evaluation of phase one, the approach being adopted by HeBE is an integrated evaluation and planning one. This will ensure that retrospective analysis is linked closely to establishing best practice and emerging international thinking on cervical screening that will inform the development of a high quality cervical screening model for Ireland. The evaluation dimensions will include: the overall approach to be taken by the national programme in the context of best practice elsewhere; quality assurance arrangements; standard operating procedures; governance arrangements; a women's charter; business model and organisational arrangements; programme screening policies; a population register; risk analysis and payment arrangements. Following a number of site visits and discussions with international experts, an evaluation team is being put together. It is expected that the evaluation of phase one will be completed by autumn 2003.
In regard to policy development, I am advised that the sub-group established by HeBE is preparing a series of policy proposals to be adopted by the programme. These policy proposals will address a wide range of issues including: the priority target groups to be reached by the programme, the most appropriate screening intervals, laboratory accreditation, the use of liquid based cytology, information systems, HPV immunisation and the development of population registers.
Additional information
In summary, the evaluation of phase one is a major part of the planning process for the national programme. HeBE has advised that it expects to have a draft roll-out plan prepared by the end of the year following the evaluation. Furthermore, governance structures for the full national programme are also being considered. A final decision on structures will be taken in the context of the evaluation report and roll-out plan. The question of the appointment of a director for the national programme is being considered by my Department.
I am perplexed because I understood that the national cervical screening programme which was rolled out was phase one of the entire roll-out which was to be completed this year. I now hear it is a pilot programme that is to be evaluated and given serious consideration and that another review group has been established.
Is this another broken promise? Can women believe the Minister is serious about rolling this out as a national programme when, in his constituency – he may not be aware of this – routine screening takes six months? It takes six months to have a test read. What plans, other than a review group, are in place to roll-out this scheme as promised?
Two issues are involved. One is the national screening programme and the other routine cervical smear programmes. This year and last year I provided additional funding, about €2.5 million, to enhance the laboratory and colposcopy services, and a further sum of €1.4 million was provided in 2003. This was to enable the employment of additional personnel, the purchase of new equipment and the introduction of new technology.
Regarding the issue of the Southern Health Board waiting lists and those of other health boards, I have a list of waiting lists from the various hospitals. Some are much better than others and are a matter of weeks. The waiting lists in the Southern Health Board are too long but the board has reached an arrangement with Belfast to try to speed that up.
We need to evaluate what has happened with phase one. Initial indicators suggested a poor response rate to the invitations issued under that phase. People sometimes have a simplistic view of what constitutes a screening programme. The national screening programme involves significant logistical operations. It is important we learn lessons from the operation of phase one.
It must be a priority in the interim to reduce significantly those waiting lists that have arisen for routine smear tests. Between 1997 and 2001, the number of tests processed increased from about 170,000 to 213,000. The number of screenings is increasing, and the figure for 2001 represents about a 25% increase over 1997. Demand for smear tests has obviously increased and that has clearly led to longer waiting times.
Without wishing to sound sarcastic, the Minister is extremely fortunate that there has been a low take-up rate. The system is unable to cope even with routine screenings. I realise these are separate from the national screening programme. However, if we do not have the capacity to deal with routine screenings, how can we possibly talk of a national screening programme?
If there is to be such a programme, and I presume the Minister set out with the intention of putting one in place, then we must bear in mind the example of the position in Monaghan regarding colposcopy treatments, which relate to suspect smears, the figures for which took me some time to obtain. Does the Minister know how long it takes to get one done when a woman has already had a smear test that is suspect? For those living in Cavan and Monaghan it now takes 12 months to have the next phase done. Apart from the fact that these are life-threatening illnesses, if the Minister wants to save money in the health service and get value for money he must get his act together on screening, early detection and early treatment outside hospitals.
I too would like to make the case for protecting the lives of the women. This is a screening programme that is very effective, good value for money and literally saves lives. The Minister will surely accept that he does not have to reinvent the wheel. International practice clearly shows that it is possible to have a programme that is effective, targeted and meeting the need. The Minister should be aware there are long delays in getting test results in areas other than the Southern Health Board area. A woman in County Donegal can wait up to six months for the results of a smear test. That is too long for anybody who has gone to the trouble of having the test done. If a woman is advised there is an issue or a doubt about the status of her health, it can take many weeks before she gets the result of a subsequent test. We must ensure we prevent the growth of cervical cancer and screening is one of the most effective tools.
While different hospitals have been mentioned, most urgent smear tests in St. Luke's Hospital are dealt with in two to three weeks. Routine smear tests can take up to 20 weeks. In St. James's Hospital, routine smear tests take seven weeks and urgent smear tests are reported in one week. In the National Maternity Hospital, it takes from one to three weeks to get results. In the Coombe Women's Hospital, routine smear tests take eight weeks and urgent smear tests take less than two weeks. In Beaumont Hospital, routine smear tests take seven to eight weeks and urgent smear tests take two weeks. In the Royal College of Surgeons, routine smear tests take nine to ten weeks and urgent smear tests take less than two weeks. In the Rotunda Hospital, routine smear tests take eight to nine weeks. At Our Lady of Lourdes Hospital it is two weeks and Sligo General Hospital—
What about Letterkenny?
And Cavan.
I want to indicate why we need the review. Some 15,000 invitational letters were sent in 2002. So far the response rate has been 20%.
That indicates something is wrong with the programme.
That underlines the need for a review. Before we start plunging forward we need to evaluate what is happening in this pilot, the phase one programme.
The Minister is right in some of what he says. However, doctors have difficulty in trying to switch from one laboratory to another. If I am waiting six months for the results from one laboratory and I ring another one to ask it to do my smear tests, it will refuse to take on any more people. That adds to the difficulty for GPs doing smear tests. I am not referring to the cervical screening programme, but simply to routine smear tests. It is difficult to get laboratories to take on tests from other doctors.
I accept the Deputy's point. We are making interim efforts to improve the lists. For example, the Belfast City Link Laboratory and the Antrim Hospital have been contracted to provide up to 250 smears per week on behalf of the Southern Health Board to deal with its long waiting lists. We provided additional funding last year and again this year to improve equipment at the laboratories to help get the results out. I understand the concerns of the Deputies and it will receive priority this year.