Cancer Screening Programme: Statements.

Minister for Health and Children (Deputy Mary Harney)

I am very happy to have an opportunity to talk about the Government's cervical cancer screening programme. This debate was requested last week by the Opposition. I was delighted to agree to the facilitation of the debate.

This debate is about women and women who get cervical cancer in Ireland. On average, 75 women per year die in Ireland from cervical cancer. We know that from screening programmes, we can save up to 80% of those lives. So we could save 60 of the 75 women who currently die from cervical cancer. This debate must be about facts and data; it cannot be about innuendo, rumour or about somebody who came out the wrong end of a procurement process or about industrial relations issues. For many years there have been queries from Opposition Deputies and pleas for the roll-out the cervical screening programme. That is something to which the Government has been committed for quite some time.

Last year, we provided €5 million to the National Cancer Screening Service to prepare for the roll-out of a screening population-based cervical screening programme. This year, we provided €15 million towards the implementation of that programme. The intention is to begin the roll-out of that screening programme on a national basis during the summer. It is expected that between 240,000 and 300,000 women aged between 25 and 60 will qualify for screening. In the case of those aged 25 to 44, they will be called every three years and those aged 45 to 60 will be called every five years. That is being done on the basis of best international evidence available to us. The screening will be provided free of charge and this programme is the second one to be rolled out by the National Cancer Screening Service, the first being the breast cancer screening programme. Everybody in Ireland — particularly those who have used the service — and outside it who have examined our breast screening programme consider it is highly successful with a participation rate of almost 80%. By international standards, that is very high. The former Minister, Deputy Nora Owen, said of the service in this House that it was a model of health service delivery that she would recommend to anybody.

Therefore, I very much regret what I regard as the utterly irresponsible comments made by the Fine Gael spokesperson on health on the cervical screening programme. I do not say that lightly. The fact is that last week Deputy Reilly said that 2,000 women's lives would hang in the balance. I regard that as an utterly irresponsible statement made for no reason other than to scaremonger. Women have huge faith in the screening service and we want their faith in it to continue. If we lose 75 women a year as a result of cervical cancer, one would need to multiply that figure by 28 years to achieve the figure of approximately 2,000. All of us participating in this debate have a responsibility to adhere to facts and not to innuendo. I appeal to everybody in the House to make sure that in this and other debates on cancer screening we are not irresponsible and do not try to make political points that have the effect of damaging a service that has a significant reputation.

The National Cancer Screening Service is not part of the Health Service Executive, rather it is an independent service accountable to the Department of Health and Children and the Minister for Health and Children. It has its own independent board. The screening programme is now rolling out an integrated service where a system of call, recall, laboratory, colposcopy and follow up treatment will all be integrated and will all operate to best international practice.

The screening service had a two-stage tender process for the cytology service. It was open to all laboratories in Ireland and internationally to put forward an application in the context of the tender. The tender was clear. In order to meet the requirements, those who tendered had to fulfil three conditions. First, they had to be accredited by an independent accreditation body, meeting the international ISO standard. Second, they had to have a minimum throughput of 25,000 smears a year. Third, they had to be able to do a ten-day turnaround. Seven applications were made and I understand the number considered was reduced to about four. The successful bidder was Quest Diagnostics, which is the largest such facility in the world; last year, it dealt with 13 million smears. The tender was examined not by the Minister or any official from the Department of Health and Children, but by a group established by National Cancer Screening Service, which included doctors like Dr. O'Reilly, who has been running the service in the mid-west, and a doctor from Northern Ireland, who was charged with the responsibility for quality assurance there and who is also involved in the accreditation process in the UK. These are highly reputable people who were asked to examine the tenders. A total of 80% of the marks given related to quality and turnaround time and 20% of the marks given related to cost — that is the factual position.

In regard to data, we have had a number of examples of where rumour and innuendo were advanced here as fact. Two weeks ago on the Order of Business Deputy Reilly alleged that an official from the HSE had worked for this company and he wondered what the official's role was in regard to this tender. Subsequently, when questioned by a media source, Deputy Reilly said he was waiting to seek clarification, but he put forward in this House as a matter of fact that an official had worked for this company. That is not the case. Journalists went on a wild goose chase to find out who was this official. I appeal to people that when irresponsible statements, innuendo and rumour are advanced in this House as fact around something as important as a national screening programme that we would have the courage to withdraw those comments and not have the good name of individuals bandied around by journalists and in other places. It is grossly unfair, misleading and inaccurate. It is fiction and wrong.

Equally, Professor Miriam Wiley has had comments to make about data that was advanced in the Private Members' motion last week and I hope that will also be clarified. If we are not going to base the debates in this House on data, evidence and information, we will not have informed debates and we will not make the right decision.

In regard to company, or preferred bidder, awarded the contract, which has not been signed yet — obviously, there must be a cooling off period — the National Cancer Screening Service did not have to go to tender but chose to do so for reasons of transparency, fairness and equity to make sure it got the best quality assured service we would get. In line with the McGoogan report, which stated that laboratories that participate in this screening programme should be independently accredited, the screening service is living up to the advice domestically and to best international practice on this issue. The fact is that the company that won it is accredited independently. As I said, it is the largest such facility in the world and it does work for the National Health Service in the United Kingdom. I have never met anyone in the company and do not know anyone associated with it, but I understand it intends to put in place a laboratory facility in this country.

I said that 75 women in Ireland a year die from cervical cancer. International evidence shows, as has been demonstrably shown in the UK, that up to 80% of those deaths can be avoided. However, the screening is not a test or a diagnosis of cancer. What it detects are abnormalities that, if undetected and untreated, can lead to cancer. Some 800 women in Ireland in the last year for which we have data were found to have abnormalities. The purpose of a screening programme is early intervention to identify those abnormalities. In a lifetime, a woman can expect to be called to the screening programme up to 11 times to identify those abnormalities and, if detected, to intervene with treatment before cancer develops. We know such intervention is highly successful with a success rate of up to 80%. The women affected by cervical cancer tend to be young women with children and significant responsibilities. We also know that health promotion has a major role to play in the prevention of cervical cancer. The cessation of smoking has a huge contribution to make to its prevention. Sexual practices and the early onset of sexual activity contribute to the development of cervical cancer. A vaccine has now come on the market as a preventative measure. I asked the Health Information and Quality Authority to do a technology assessment of that vaccine. The authority brought its recommendation to my attention in recent weeks. This week, I received a recommendation from the National Cancer Screening Service for the vaccine. I will work on the advice given to me and a decision will be made this summer regarding the vaccine. Clearly, huge issues arise, not least that of parental consent because we are dealing with minors. Since the vaccine will have to be administered twice in a calendar year and since this will be done through a schools programme, we must begin when the academic year begins. It will not be possible to begin the programme in September 2008, as has been suggested. We do not have the necessary lead-in time to allow us to do that. What is important is that we make an early decision. The intention is that the decision be made this summer.

The National Cancer Screening Service has an enormous reputation, as a result of the success of BreastCheck. Our breast cancer screening service was the first in the world to go digital. That is something of which we should be very proud. It has a huge participation rate and has gained the enormous confidence of the women who use the service. Equally, I want to ensure that the cervical cancer screening programme has enormous confidence. Screening will be done at primary care level. It does not need to be done in acute hospitals. When women are contacted it is important they go for a smear test and continue to do so on a regular basis. Tests will be done every three years on women under 45 and every five years thereafter. As has happened in other countries, this programme has the capacity, in time, greatly to reduce the incidence of cervical cancer and, in particular, to reduce the death rate from that cancer by up to 80%. In everything we have done we have followed best international practice. We have independent accreditation and turn-around times of ten days.

With the opportunistic screening which was occurring, women were waiting more than nine months for test results. This is highly dangerous. This is why, in the past 18 months the HSE outsourced more than 40,000 smear samples so that we could get earlier results for the women who were awaiting them. It has been alleged in parliamentary questions that 12 errors were detected. No one could say there were 12 false readings without seeing the data. I understand that in one case out of 40,000 a high-grade lesion was discovered. This is not outside the scope of these matters. The smears which were outsourced were not the urgent ones. Urgent cases were examined domestically. A higher number of high-grade lesions would be picked up among urgent case than among a different population group.

Two cytotechnologists will read the smears. They will be doubly examined, which is appropriate.

It is important that this programme be rolled out quickly and I am satisfied that will happen over this summer. It is important that it is quality assured. It is particularly important that women get results within a four week period. Those standards meet best international practice in this area. The women of Ireland want the best possible service. The contract will be awarded for two years. This means that in the intervening period laboratories in Ireland can meet the independent standard required to provide a cytology service which is quality assured. No one would want to see us availing of services which are not quality assured. I have already explained that in awarding the contract, 80% of points were allotted for quality and turnaround time and 20% for price. As it happens, the price quoted by the successful applicant was one third of that quoted by many of the domestic laboratories. Laboratories in other jurisdictions offered better value for money that those which tendered in this jurisdiction.

Deputy James Reilly

I would like to share time with Deputy Deirdre Clune.

I must comment on something the Minister said. No one's good name or reputation was taken. No name was mentioned. Journalists came to me with the name but I would not do anyone the disservice of using his or her name in the House under privilege without absolute proof of a problem.

The Minister mentioned Professor Miriam Wiley and the ESRI. I have mentioned the issue of figures on a number of occasions. Accuracy is of the utmost importance when we are planning our health services. I wish to clarify comments I made and which some people have found confusing. My office was in touch with the ESRI by telephone and e-mail. I have expressed my opinion regarding the implications of that information. There is a difference between the figures given by Mayo General Hospital, which says 85 people were treated for breast cancer in 2007, and the ESRI figure of 37, as quoted by the Minister. That is too big a gap to be ignored. It must be examined. These data come from two sources: the National Cancer Registry and the hospitals. Inaccurate information is heading into the ESRI, which cannot be asked to stand over figures over which it has no control. The ESRI can stand over its analysis. I do not impugn its reputation and I understand that its work is very important. I have sought a meeting with Professor Miriam Wiley to clarify the information and to find out how the disparity arose.

I thank the Government for overruling the Minister for Health, who was not willing to concede this debate when I called for it two weeks ago.

Cervical cancer kills more than 70 women a year in this country and afflicts thousands of others. By initiating a cervical screening programme in conjunction with a cervical cancer vaccine we could make this horrible disease, which affects so many of our women particularly during their child bearing years, a thing of the past. I call on the Minister to introduce the vaccine without delay. By her own admission, this has been recommended to her by three different bodies. It is time to move things on. A combined vaccination and screening programme would eradicate up to 90% of cervical cancer cases.

Since my election to this House I have called on the Minister to introduce this programme and I warned on each occasion that I could not see how it could be achieved in the timeframe she promised, given that no preparation had been made between the HSE and the laboratories and particularly as so few of them had been accredited. Notwithstanding this, I understand several laboratories are now accredited, including Beaumont/Rotunda, RCSI, St. James's Hospital through its connection with Antrim and Altnagelvin Hospital, which has looked after the needs of Donegal, Sligo and Leitrim. St. Luke's is also mid-way through the process. While accreditation is important as it ensures the right facilities are in place, it is not a guarantee of outcome. That is, of itself it is not a guarantee of quality outcomes.

This call for action obviously fell on deaf ears as so many of the laboratories remained unaccredited at the start of 2008. Instead of addressing this issue and ensuring that our laboratories would be in a position to tender for and successfully provide cytology for our National Cervical Screening Service, the Minister struck out on a new route to outsource the entire smear reading service to another jurisdiction across the Atlantic. This rushed and ill-considered decision has serious consequences for our health service and for the health of our women and further begs the question as to why, when we seek out partners from the United States of America, we cannot find a company that has not been guilty of over-billing. Though technically not fraud in law, because they paid up before they were charged, nonetheless most people would consider this fraudulent behaviour. This was not a once-off action. It was found to be the case in 1998, again in 2001 and yet again in 2004. It was no small sum of money in total either. It was $40 million dollars. This is not the sort of partner one would seek out for a business venture, let alone a partner to provide an essential medical service where women's lives are at stake.

The Minister referred to the screening contract. I will read an extract from Council Directive 2004/18/EC:

Any economic operator may be excluded from participation in a contract where the economic operator has been guilty of grave professional misconduct proven by any means which the contracting authorities can demonstrate.

The sums of money paid for over-billing represent professional misconduct. These are not the sort of people we should be dealing with where women's lives are at stake.

There is, further, the issue of our loss of jobs. Over 100 highly skilled people will now be no longer employed and will either become de-skilled through lack of activity or will emigrate to continue to earn their livelihoods. This is a very odd situation when we have spent considerable time encouraging people to take up science. Furthermore if in two years, as I anticipate, we find we have made the wrong decision we will have to spend years rebuilding the service having given a foreign multinational a virtual monopoly on cervical cytology. This loss of cytology will further impact on the training of our pathologists for whom cytology is an integral part of training. They will no longer be able to sit the UK examination in pathology as they currently do unless they go there for training.

Most important, however, is the issue of reliability and the quality of testing. A study done by St. Luke's Hospital looking at the results of 14,500 smears read by Quest showed a 30% difference in the pick-up rate for high grade pre-invasive cancer of the cervix. Critics of the study from the NCSS have claimed it did not allow for urgent cases, but it did factor this in. Two other laboratories, Cork and the Royal College of Surgeons in Ireland, examined the figures for the Quest smears that went from their laboratories. They discovered that it was a 50% difference but they had not corrected for the urgent cases.

Accusations that the St. Luke's results are being over-simplistically analysed is absolutely outrageous and I refute it. An article published by St. Luke's in the Irish Medical Journal showed the expected rate of high grade pre-cancers is 1.9% and this is accepted internationally. In a comparative study by St. Luke’s this figure comes up again while the Quest figures were 1.2%. Quest, therefore, could be missing up to 30% of high grade pre-cancers of the cervix, placing Irish women at an unacceptable risk. These are statistics from medical professionals. I see no reason to disbelieve my fellow professionals.

The other deeply disconcerting aspect of this decision is that there will no longer be the ability of a multidisciplinary meeting to review the slides between the smear reader, the colposcopists and the gistopathologists who would give further advice. The result of this is a less safe service with some experts predicting 1,000 and another expert predicting up to 2,000 high grade pre-invasive carcinomas being missed annually. This may be acceptable if there is a system of annual smear tests, such as that in America. However, in Ireland it is intended to test every three to five years. We cannot afford that margin of error.

I understand the tender contract specified adherence to NHS UK guidelines which specifically state that no primary smear reader should spend more than four hours reading the smears. This in effect limits each reader to about 50 smears per day. It is my understanding that each smear reader in the Quest laboratories regularly reads 90 to 100 smears per day. How could they possibly have satisfied the tender document in this case?

The McGoogan report, on which this screening programme was initially designed, looked to a hub and spoke arrangement within the country. At no point did she mention outsourcing it, of which I am sure she would not approve. The current capacity in our laboratories is approximately 250,000 smears per annum. This would be well over 300,000 with the addition of two imagers, equipment which allows for automated pre-screening. They only cost approximately €125,000 per year to lease.

I ask the Minister not to ignore the McGoogan report or fragment our health service. Instead I ask her to support and resource our laboratories to achieve accreditation which could be in place by the autumn. She must invest in the imagers, thereby giving the women of Ireland the best quality service which is surely, what they deserve. Yet again the talk is of putting the patient first but the action says more about saving money. On this occasion, I beseech the Minister not to take the cheap option but to put the patient first.

An Ceann Comhairle

Before I call Deputy Deirdre Clune, I remind people in the Visitors Gallery that in the Parliament applause is simply not allowed. If it occurs again I will have to ask people to leave.

Deputy Deirdre Clune

The development of a national cervical cancer screening programme has been on the agenda for some time. It was promised in several programmes for Government in 1997 and 2002. Only in 2008 are we debating the implementation of a valuable programme that will save women's lives. Up to 75 women die from cervical cancer every year. It affects not just their families but their colleagues and friends. A screening programme such as this will save up to 80% of those lives. It is vital it is implemented as soon as possible.

The programme, however, has been dogged by controversy. In 2006, there were six-month waiting lists for smear tests. A large backlog developed and testing had to be outsourced, leading to a lack of confidence in the system. It is important that when developing the programme, women can have confidence in the system.

Deputy James Reilly gave figures from various medical professionals. The Coombe Women's Hospital, St. James's and University College Hospital Galway have also questioned the outsourcing of the programme to Quest Diagnostics and its ability to instil confidence in the screening programme. Dr. Conor O'Keane of the Royal College of Physicians of Ireland questioned the future of pathology services in the country if this testing is outsourced. It is important we maintain and develop expertise in this area. When the contract comes up for renewal in three years we should hope that local laboratories can tender for the service. It is also important if we want to attract young people into studying medical sciences.

The Minister referred to the breast screening programme being rolled out and I note the excellence of the service in Cork. The number of cases uncovered in the few short weeks that the service began in Cork highlighted the need for it. I compliment those involved in developing this important service.

Have GPs agreed to take the smear tests as part of the cervical cancer screening programme? They will be an important cog in the process and we must ensure there are no delays in the roll-out of the programme. I was glad the Minister spoke positively about the introduction of a cervical cancer vaccine programme. I accept it will be difficult and will involve parental consent. It is a necessary programme to which I hope the Minister will give the thumbs-up. I hope it is introduced as soon as possible.

Deputy Jan O’Sullivan

I wish to share time with Deputy Emmet Stagg.

I welcome this important debate which I have been requesting on the Order of Business over the past two weeks. I thank the Labour Party Whip, Deputy Emmet Stagg, for pursuing the matter at the Whips' meetings.

I assure the Minister that we are fully supportive of a good, accredited and safe programme of cancer screening, whether for cervical or breast screening or any other type of screening. However, I do not know whether it was intentional on the part of the Minister but there was an implication in her contribution that this screening was not available in this country and this is not true. We have accredited laboratories of a very high standard. The awarding of the contract to a company outside the country implies that the expertise is not available here and this needs to be clarified. I urge the Minister to provide this clarification in her response.

I welcome the fact that the Minister has said that while Quest Diagnostics is the preferred bidder, the contract has not yet been signed and there is some time. I urge the Minister to listen to what we are saying in the House today and to what is being said by other people who are very concerned about the decision to outsource the entire cytology screening programme. One source of this concern is the editorial in this week's Irish Medical News which expresses serious concern that the outsourcing of the entire service is not desirable.

The awarding of the entire contract for the Irish cervical screening programme to one bidder, Quest Diagnostics, a US-based private company, will result in the loss of jobs and skills which the Government cannot ignore. This is not just a matter for the national cancer screening service even though the Minister has said it is nothing to do with her or with her Department. However, its consequences are of national concern. I would suggest we are being penny wise but pound foolish and there are serious long-term consequences of this decision.

It is important to explain the context of the decision. The Irish cancer screening programme was first established as a pilot programme in the mid-west region where I live. The intention was that this programme would be evaluated after a period, that any necessary lessons would be learned and a national programme would be subsequently rolled out. Along with thousands of other women in the mid west, I benefited from this screening and I welcome the fact it will be available to women in the rest of the country. The Labour Party is fully supportive of the need for the highest standard in the quality of the screening methodology and the expertise of those who carry out the tests. There is absolute agreement on all sides of the House and throughout the country on this. What deeply concerns us is the awarding of the entire contract to one private non-Irish company, to the exclusion of all the Irish laboratories. This puts accountability at a further remove and this is not a good idea. Cytology will be separated from other aspects of patient care and this will not result in an integrated, patient-centred service which is vitally important.

A number of measures were identified during the pilot programme which would require to be implemented in order to roll out the programme to the rest of the country. These include the need to improve laboratory facilities, introduce quality assurance and accreditation and train extra staff to facilitate the full roll-out. There was close co-operation between the pilot phase screening programme and the cytology laboratories in Ireland. General practitioners and other providers of service took the smears and sent them to a number of laboratories around the country. The laboratories did the testing and also set about improving their facilities and their turnaround time. At least three, if not more, Irish laboratories are now fully accredited and others are in the final stages of achieving accreditation.

The other significant action taken to prepare for the roll-out was the establishment of a specific higher education course to train medical scientists to carry out the smears. This was one of the recommendations of the report by Dr. Euphemia McGoogan who carried out the evaluation of the pilot programme. This state-of-the-art course is in place and is training highly skilled graduates at DIT Kevin Street.

Deputy James Reilly

Hear, hear.

Deputy Jan O’Sullivan

It was set up at significant cost to the taxpayer with expensive equipment and expert academic staff. If all the testing is to be carried out by Quest Diagnostics, then all that effort and money will be down the drain. There will be no jobs for the students, there will be no cytology expertise in Ireland and there will be no backup if Quest does not seek to renew its contract or if anything goes wrong in the meantime.

We urgently need joined-up thinking in Government on this issue before it is too late. The Minister cannot close her mind to all that has gone before and hide behind the independence she has given to the national cancer screening service. Privatising and exporting the entire testing service has implications that are too serious to be decided purely within the narrow requirements of the national cancer screening service.

I do not have time to discuss the argument as to whether Quest's methodology is inferior to the Irish model although it has been claimed by those more expert than I that Irish screeners have double the specificity for picking up abnormalities compared to US screeners. I will not refer to the fraud charges that have been highlighted in the media. These may or may not be relevant, but the argument I am making stands up, irrespective of these factors.

If a rare species of animal, bird or insect was threatened with extinction from our country we would do everything we could to protect it and rightly so. We must be equally vigilant in protecting unique specialist skills which our people need for the future. I am not arguing that all of the testing must be carried out by Irish laboratories, rather that a significant amount should be. The tendering criteria stipulated that there must be a ten-day turnaround — to which the Minister referred — and that the prospective bidder must handle at least 25,000 samples per year. I understand there were Irish bidders that fulfilled these criteria. I have serious questions as to why such strict criteria were set particularly as the McGoogan report suggested four working weeks as an appropriate turnaround time. I ask the Minister to address this point in her reply. I take the point she said that 80% was for the turnaround and quality assurance but I question what part of this is the turnaround and why it decreased from four weeks to ten days. Was this in order to specifically exclude Irish laboratories? Is this decision the precursor of more privatisation of Irish laboratory services? This is another concern. Are other pathology jobs at risk?

Following on from the Minister's own co-location plans which will separate public and private patients on the campuses of many of our larger hospitals and which we in the Labour Party vehemently oppose, there has been more farming out of services to the private sector by the HSE and the national cancer screening programme. In my own constituency, kidney dialysis is to be provided by a multinational company. A sum of €15 million to €20 million has been paid to KPMG to administer the health repayment scheme. Even the letters to patients in the north east whose X-rays are being reviewed were sent by a private firm. It is difficult to believe there was any justification for contracting out that particular job. We are very concerned that this again represents more outsourcing, more privatisation and a failure to trust and invest in the Irish public health service.

I have no expectation that the Minister will share my concerns about the privatisation of cervical screening or of any other service. She is ideologically committed to privatisation. However, I do expect her partners in Government, Fianna Fáil and the Green Party, to be concerned about this continuous privatisation within the health service. I expect her and her Government colleagues to protect the jobs and essential skills needed for this country. I expect her to care about educating young people. Their expectations about pursuing a career in this country are being raised only to have the door shut in their faces.

I urge the Minister to intervene before this contract is signed. I welcome the fact she has said today that Quest Diagnostics is the preferred bidder but that there is some time still available. I urge her to consider all of the implications of this decision and also to consider the fact that we have the highest of standards and accredited laboratories in this country. We have trained workers who will lose their jobs and students are currently studying in DIT Kevin Street to work in cytology labs. We are in danger of losing these skills and in two years' time the skills will be gone. I urge the Minister to change her mind on this issue. I urge her to intervene to ensure that Irish laboratories are included in this contract as there is a national interest at stake.

Deputy Emmet Stagg

I wish to declare an interest. I worked in this area for 25 years as a medical scientist and I welcome colleagues, old and new, to the Visitors Gallery. They are being silenced, of course, by the Ceann Comhairle so they are mute today.

For 40 years, medical scientists have screened literally millions of cervical smears. Thousands of Irish women have had their lives saved because of this high quality service. The expertise was built up slowly over the years until it reached a level that is literally second to none in the world. We are now about to permanently wipe out that invaluable pool of expertise and sacrifice it on the altar of the Minister, Deputy Harney's privatisation agenda.

The comments of the Minister for Health and Children and the Tánaiste in the Dáil, and of Mr. Tony O'Brien of the National Cancer Screening Service, to the effect that Irish women have not had an accurate and quality cytology service in the past, is not only grossly insulting to the professional integrity of the medical scientists involved but also highly inaccurate and damaging, by any international standards.

Some 70 medical scientists in cytology laboratories now face an end to their careers. In addition, the country faces an end to sufficiency in cervical cancer screening and an absolute dependence on foreign private sector operators for a vital part of patient health. No other country in the world exports the health of its citizens in this way.

The quality of the outsourced work to the preferred bidder, Quest Diagnostics, has, on analysis, shown major discrepancies even on corrected figures. No amount of statistical fudging by the Minister or Tony O'Brien will improve Quest's low detection rate. If the screening programme is outsourced to Quest, the outcome for Irish women will be a decreased accuracy in the pick-up rate for high-grade smears, leading to an increase in cervical cancer and dire consequences for Irish women.

The Health Information and Quality Authority, HIQA, is the independent authority on all aspects of quality in the health service. Has it been asked to analyse the discrepancies in Quest's results and, if not, why not? Is HIQA happy with the outsourcing to Quest? Dr. Tracey Cooper, the CEO of HIQA, should be asked to report and comment on this matter. That is his job and it is what HIQA is there for.

The decision to outsource can only be explained by the political ideology of the Minister and the Government. This is another step in the privatisation of the health service towards a for-profit service, if one can afford it.

I served for 25 years as a medical technologist and, in addition, I served for ten years on the executive of the union representing that group. I want to issue a word of warning to the Minister. There are approximately 2,500 medical technologists and scientists in the country who are fully unionised and their unions have a mandate from their members for industrial action. If 70 of their members have their hard-won careers terminated by this crazy outsourcing and privatisation, it is highly unlikely that their union will stand idly by. They will have my full support in whatever action they take to protect the lives of women in Ireland, their careers and the knowledge base that we have built up here. I ask the Minister to consider this matter very seriously. It is seldom that such a debate is held in this House. The Government agreed to the Opposition's request for a debate because of the urgency and importance of the issue. Before a final decision is made on this matter, the Minister should seriously take on board the points that have been made in this debate by the Opposition, as well as the views of experts outside the House.

Deputy Aengus Ó Snodaigh

Cervical cancer is the second most common cancer in women under 45 and the third most common cancer in women in Ireland. On average, almost 200 women in this State develop the disease every year. In contrast to most other cancers, this one affects mainly younger women, with 60% of cases occurring in women aged 50 or younger.

Faigheann 70 mná sna Fiche-Sé Chontae bás de thoradh ailse an mhuiníl gach bhliain. Léirigh suirbhé anuraidh nach bhfuil a fhois ag ach 29% de mná na hÉireann go bhfuil vacsaín ann chun déileáil leis an ailse seo. In ainneoin gurb é an dara ailse is coitianta i mná faoi 45 bliain d'aois, ní fios de triúr as gach ceathrar mná cad is cúis leis, nó na fáthanna taobh thiar de.

It needs to be known as widely as possible that this cancer can be prevented by means of a simple test, the cervical smear test. It is a scandal and a disgrace that successive Governments have failed to roll out a national testing programme and that only this year progress is being made in this regard.

On 24 February 2005, there was a unanimous call from the Irish Cancer Society and 24 other organisations, including trade unions, professional bodies and women's networks, for a State-wide pre-cancer screening programme. Comprehensive screening leading to early detection and treatment can and will dramatically reduce the incidence and development of cervical cancer and the resulting terrible death toll.

There is far too little information for women to highlight the fact that screening can be life-saving. That information and the associated screening need to be as widely available as possible. There must be quick progress in moving the screening programme beyond the current phase one in the mid-western HSE area. The promise is that the national cervical screening programme will be free to all women between 25 and 60 years of age. Screening will be provided every three years for women aged between 25 and 44, and every five years for women aged between 45 and 60, in line with best international practice. That is the commitment given by the Government to the women of this country and it must be kept.

It is very important that this long-promised national screening programme is not disrupted, as so much other patient care is being disrupted, by current HSE cutbacks. That would be a betrayal of the women of Ireland and their families, and it would condemn thousands of them to serious illness, which is preventable.

If the Government is only interested in bookkeeping, cutting this programme would make no economic sense as the cost of cancer treatment in the future, which could have been prevented or treated through early screening, will far outweigh the cost of the screening programme.

On 9 May, the National Cancer Screening Service, NCSS, announced a preferred bidder for the provision of laboratory testing services for the national cervical screening programme. This was described as an important milestone which, in the coming months, will enable the NCSS to launch the first quality-assured, population-based national cervical screening programme for women aged 25 to 60. However, major concerns have been raised about the use of laboratories outside this country for these tests. In particular, major concerns have been raised about the company named as the preferred bidder, Quest Diagnostics.

Quest has won the tender to analyse 300,000 Irish smear tests a year, but consultant pathologists from the Coombe Women's Hospital, St. James's Hospital and St. Luke's Hospital in Dublin, and University College Hospital in Galway stated that missed cases would arise because the diagnostic rate of pre-cancerous cells at Quest Diagnostics in the US is 30% less than that of Irish laboratories.

This concern has been echoed by the Irish Association for Clinical Cytology, IACC, which has expressed its disquiet at the decision to award the contract for cervical screening services to Quest, thereby excluding Irish laboratories. The IACC says this decision will have serious implications for the long-term quality of the cervical screening programme.

The association lists its main concerns as follows: quality in detection rates — from recently adjusted figures, excluding urgent smear policy, at least 30% of cases with pre-cancerous cells will go undetected based on the data from the previous outsourcing exercise by the NCSS to Quest Diagnostics; Irish laboratories' ability to tender for future work. the exclusion of the Irish cytology laboratories at this stage will result in the loss of cervical cytology as a discipline and laboratory service in this State — once lost, the re-establishment of this service will not be feasible due to the extensive training requirements and the loss of expertise and skill-mix that has taken years to develop here; and the creation of a monopoly. By contracting to one organisation the NCSS has tied itself to Quest Diagnostics without an alternative provider of services. If there is an issue with the provision of service down the line, there will be no domestic laboratories available to deliver such a service.

It also highlighted a reduction in mortality rates by 80%. Although this figure has been quoted as the potential reduction rate of mortality for cervical cancer, this can only be achieved in the setting of a population that has not been screened before and not in a relatively heavily screened population as in Ireland. We would be concerned that an increase in mortality and morbidity may result in Ireland by using a laboratory with low detection rates.

The Irish Association for Clinical Cytology states that Irish laboratories provide a quality screening service as evidenced by comparison of incidence and mortality rates to other European countries. Even without an organised national screening programme, this State compares favourably to the UK which has had an organised screening programme for more than 20 years.

There is significant concern that testing for this screening programme has been placed in the hands of a multinational giant that has been convicted of fraud in the US. Quest Diagnostics has paid out almost $40 million in fraud settlements over the past decade. It made major settlements in 1998, 2001 and 2004 after being investigated in connection with the billing of federal health care programmes for unnecessary tests. In 2004, Quest Diagnostics paid more than $11 million to settle a lawsuit that alleged the company billed Medicare, a federal health care programme, for certain blood tests that doctors had not specifically ordered. Janette Byrne of the Patients Together campaigning group, which is trying to improve the standard of patient care in Ireland, said: "We would definitely question why public money is being given to a company that has been investigated for acting fraudulently in another country."

It seems the Minister for Health and Children would rather listen to corporate executives in the private health business than to health experts and patients in Ireland. Not only are our health services being privatised, but jobs and services are being exported. Trained and trainee laboratory technicians in Ireland are being written off by this decision and many will have to emigrate to find work in the future.

Incidentally, another corporation, Fresenius, has been contracted by the HSE to carry out dialysis services. This corporation paid the biggest ever criminal and civil fraud fine to the US Government in 2000 — $0.5 billion. The Fresenius scam involved fraudulent and fictitious blood-testing claims, kickbacks to dialysis facilities in return for blood-testing contracts and fraudulent claims against State health insurers. This company, which will be based in Limerick, has been given a major role in the provision of dialysis in our health services in the mid-west and south east areas.

During questions on the issue of the cervical cancer screening programme last October, my colleague, Deputy Ó Caolain, asked the Minister if it was preferable that the testing labs should be here. The Minister replied: "Yes, ideally we must have our own laboratory facilities in Ireland." This does not seem to be the case now.

I have been contacted by a medical scientist, a constituent of mine, who has raised her concern at the outsourcing to Quest Diagnostics. She set out, in her letter to me yesterday, those concerns in the following terms: awarding this contract is handing a monopoly to a private company whose bottom line is profit not patients; the method of screening done by Quest Diagnostics is not up to the same standard as the public labs in Ireland — this means that more Irish women will die — and cytology labs in public hospitals will not be able to apply for the tender in two years' time as they will not be able to keep up their screening skills. These skills will be lost forever so it will not be possible to reintroduce the service in the future if anything goes wrong. The HSE has a sorry history with its privatisation agenda and she does not want to see it happening with laboratory services.

She concluded by stating: "As a woman and mother of two daughters I am horrified to think that the standards of screening cervical smears are going to be reduced unnecessarily and put us at risk." The Minister must listen to such expert voices — those involved in the service, those working in the service and the patients who have to use the service.

The warped mentality behind this decision is the same warped mentality that has forced the Coombe Women and Infants University Hospital to take the unnecessary step of discontinuing the cervical smear testing at that hospital. This was highlighted recently by my colleague, Councillor Ray McHugh, when his wife was told that the Coombe was suspending smear tests as a result of HSE cuts due to lack of staff. That is how illogical the approach of the Government and the HSE has been in terms of addressing the concerns of patients, cervical cancer and the screening programme it promised.

Deputy Mary Alexandra White

I wish to share time with Deputy Mary O'Rourke.

I am pleased to speak here this morning. I believe the health system is slowly but surely reforming and the great challenges facing it are being addressed over time. The Green Party believes in equitable access to health services and recent achievements by the Government and the careful and co-ordinated approach by Professor Keane and the national cancer control programme, the encouraging signs of consultants accepting the contracts being offered by the Department of Health and Children and this latest development concerning the National Cancer Screening Service proposed contract for cervical cancer screening represent signs of reform and improvements in health care for the people of Ireland, particularly women. Many challenges remain, but everybody in this House must welcome the reform and improvements we are witnessing.

In recent weeks there has much coverage and criticism of the NCSS's announcement of a preferred bidder for the provision of laboratory testing services for the national cervical screening programme. Much of it has centred on concerns over jobs losses of laboratory workers involved in cervical cancer screening. Others have voiced complaints about the tendering process itself. I wish to make several points about the tendering process and the implications of any contract with Quest Diagnostics lest any undue concerns gain further credence here.

First, there is the issue of the procurement process and the speculation about the capacity criterion announced by the NCSS at the time of tendering. The procurement process was open to all laboratories in Ireland and internationally, public and private, in accordance with the usual EU procurement guidelines.

Each applicant was required to meet certain criteria, namely, currently screening a minimum of 25,000 cervical smear samples per annum at each proposed laboratory and the capacity and ability to process smears within a ten-day turnaround in order to facilitate the delivery of results to women within four weeks of their smear test. This requirement is reflected in European guidelines.

To ensure a quality assured service, the NCSS requires participating laboratories to currently screen a minimum of 25,000 cervical smear samples per annum at each proposed laboratory. It was an essential requirement to ensure the necessary level of expertise. Although the overall requirement for the programme is a target of 300,000 smears per annum, the procurement process was designed to allow for one or a number of tenderers if each met all tender criteria.

The second public concern worth addressing is that of a disparity in detection rates between those of Quest Diagnostics and Irish laboratories at the same time. The NCSS has highlighted that the analysis was not a comparative one of identical samples and that in the same analysis the performance of Quest Diagnostics matched that of an Irish accredited lab. Moreover, a high pick-up rate overlooks the fact that an individual laboratory could be overcalling abnormalities and subjecting women to needless anxiety, worry and investigation. A positive smear does not automatically mean a diagnosis of cancer. It means a requirement for further investigation.

Deputy James Reilly

It was published in the Irish Medical Journal.

Deputy Mary Alexandra White

The last point is the legitimate one regarding the loss of Irish jobs. On this, the Health Service Executive has accepted its responsibility to ensure medical laboratory scientists employed in cytology are redeployed in the health system.

It must be remembered the new contract the NCSS is set to sign will be good news for 1.1 million women who will receive test results within four weeks rather than waiting for six months in some cases. Each year, 180 women are diagnosed with cervical cancer and last year 73 women died from this form of cancer. We need to address delays of up to six months in smear test results. The NCSS has indicated that implementation of the national programme could reduce mortality rates from cervical cancer by up to 80%. The women of my constituency of Carlow-Kilkenny want a quick, efficient service and an end to the agonising delays spent waiting for test results.

Deputy Mary O’Rourke

I thank Deputy White for allowing me five minutes of her time, particularly as I was late in arranging to speak in this debate. I am pleased the Minister is present to speak about the cervical cancer screening service. One of the welcome features of her tenure has been her willingness, when important health matters surface, to engage in public debate in the Chamber by first laying out her stall, so to speak, before replying to questions raised by Deputies.

I do not propose to address specific issues related to cervical cancer but instead I propose to make a case on behalf of the women of Ireland who are coming late to a recognition of their needs in cancer specialties. As a result, there is impatience in the system in terms of the need to give women an opportunity to access a service, determine their needs and receive expert guidance and follow-up services. We have had many tears in the midlands and I have listened to and shared the many concerns expressed by women in the region. The best way to serve the people is to establish the best possible system for cancer services. The discussion on the centres of excellence should be considered definitively and concluded because there is nothing to debate. If one wants the very best for people, one does not opt for half measures or centres which may be good, one opts for the best.

The Minister, in speaking about the BreastCheck service, has given me licence to raise this issue. The roll-out of BreastCheck, a humane system which women understand, has been marvellous.

Deputy Jan O’Sullivan

Not everybody has access to the service.

Deputy Emmet Stagg

It has not been rolled out.

Acting Chairman (Deputy Johnny Brady)

Deputy Stagg was not interrupted and he should allow Deputy O'Rourke to continue without interruption.

Deputy Emmet Stagg

The BreastCheck service had not been rolled out.

Deputy Mary O’Rourke

Having heard the Deputy wax lyrical, I ask him to allow me to speak and observe the rules of democracy. I do not care how long it took to roll out the BreastCheck service, it is working satisfactorily.

Deputy Emmet Stagg

It has not been rolled out yet.

Acting Chairman

I ask the Deputy to allow Deputy O'Rourke to continue without interruption.

Deputy Mary O’Rourke

While I have experienced this type of carry-on many times, Deputy Stagg's interruptions are disgraceful. No one dared interrupt him whereas he believes he can interrupt me because I am a woman.

Deputy Emmet Stagg

I interrupted the Deputy because she is speaking rubbish.

Deputy Mary O’Rourke

In my time, I have heard a great deal of rubbish from that gentleman — he is full of it.

I have observed BreastCheck and it is a professional, finely tuned, wonderful service. May I ask the Minister, without interruption, the reason women aged 65 years and over are deemed to be invisible and denied access to the service? I cannot understand the reason for this. Many women have told me they are prevented from accessing the service because they are aged over 65 years. Professor Keane, whom I met recently, seems to be a very good man and he informed me of an aspiration to make the BreastCheck service available to women aged over 65 years. I want this aspiration to become a reality.

If BreastCheck is to be a professional, universal programme, one cannot argue in favour of excluding women of a certain age from using it because the incidence of breast cancer in this group is lower than in other groups. The incidence of breast cancer in women aged over 65 years is high and belies the statistics we often see. Everybody seems to be afraid to point this out. We do not need to erect a cordon sanitaire around women of this age, although I wish women in this group were immune from bullies and other obstructions life places before them. I plead with the Minister to ensure BreastCheck is made available to women aged 65 years and over. Cervical cancer screening services will be of great benefit to women.

Deputy Olwyn Enright

I wish to share time with Deputy Creighton.

I have listened to some interesting comments in this debate but it is wrong to suggest the women of Ireland were late in voicing their needs. They have been doing so for a considerable period but the Government has been late in meeting their needs. The issue of screening has been characterised by a remarkable lack of urgency in all cancer specialties, whether breast or cervical cancer or other cancers affecting men and women. While progress has been made in rolling out the BreastCheck programme, I understand the service is not universally available.

I concur with Deputy O'Rourke on the need to address the issue of women aged over 65 years. I note the Minister and her officials are nodding and hope progress will be made on this matter.

The purpose of today's statements is to discuss cervical cancer services. The roll-out of services in this area has been remarkably slow. We have heard accurate statistics on cervical cancer and Deputies largely agree on what is the current position in this area. Figures show between 170 and 240 new cases of cervical cancer are diagnosed and upwards of 73 women die from the condition annually. When Deputy Michael Noonan was Minister for Health one of the priorities in the national cancer strategy launched in 1996 was to establish a national screening service for cervical cancer. When one extrapolates from the figures I cited, one finds that the lives of approximately 900 women could have been saved if the service had been introduced 12 years ago. This is an important statistic, particularly given that the families of the women who died from this disease are probably still grieving.

While I welcome the Minister's commitment to roll out a national cervical cancer screening service, we have heard such commitments previously. I hope in this case it will be met. Since being elected to the House six years ago, I and other Deputies have repeatedly raised the need to provide cervical cancer screening. A service is not available to the majority of women in the constituency of Laois-Offaly, which I share with the Minister of State at the Department of Health and Children, Deputy John Moloney. I look forward to a nationwide service being rolled out without delay.

I ask the Minister to elaborate on whether a vaccine will be made available. Judging by her choice of language, it appears she will make a positive decision and provide the vaccine. I hope that is the case. The Minister will probably agree that vaccinating young people against cervical cancer will be difficult given the need for parental involvement. Notwithstanding this, it would be a worthwhile initiative and I hope progress will be made in this matter. The Minister mentioned that she has the HIQA report. When the vaccine was rolled out in the UK, the head of cancer research there said that it was an exciting step towards preventing cancer. Taken in conjunction with screening, it will be an exciting step here and I look forward to it happening.

I am not expert on pathology, but I have listened to the debate on the issue. The Minister for Health and Children was previously the Minister for Enterprise, Trade and Employment. In my own time as spokesperson on education, I became aware of the difficulty in building an ethos for research and science in Ireland. The service needs support from that basis. There are excellent accredited labs in Ireland. The Minister for Finance spoke about the decision in value for money terms. Nobody in Fine Gael will say that value for money is not important, but we must also look at long-term value, and not just value for money in one particular contract. Training people to be qualified pathologists, developing that service around the country but then effectively pulling the rug from under them has a long-term cost which weakens the value for money argument.

From both positive and negative publicity, women are very aware of breast cancer and the need for self-checking, screening and so on. People are a little bit less aware of the need for vigilance about cervical cancer. The All Ireland Cancer Foundation currently has a road show travelling around the country and a website, www.tellher.ie, which is a good idea. While I do not normally call for advertising campaigns as we waste money on a lot of them, if we can have an advertising campaign for Transport 21, then we can have a campaign to make people aware of the need for vigilance in this area and the need for screening.

Deputy Lucinda Creighton

I thank Deputy Reilly for giving me the opportunity to speak on this very important motion. I am again very disappointed to hear a Green Party Deputy speaking from a script clearly prepared by a civil servant and performing a U-turn on his party's position just over 12 months ago. We used to hear criticisms from the Green Party of the move toward promoting privatisation of the health service above patients, but the party now seems to have bought into this lock, stock and barrel. I do not know the price the party paid, but it is very disappointing to see that from its public representatives in the Dáil.

It is disappointing to think that we still do not have a national roll-out of cervical screening and the vaccine service. They are vital elements in the prevention of cancer in Ireland. There are more than 240 new cases of cervical cancer every year, with anywhere between 80 and 90 women dying from this illness annually. I am not sure that we have the right type of response from the Government benches. Evidence suggests that mortality rates can be cut by 80% with a national roll-out of proper screening. As a woman, I am very disappointed to see this has not happened yet.

The Fianna Fáil manifesto promised a national roll-out of cervical screening in 1997. Five years later, the two Government parties stated that they recognised the need to ensure that people in all parts of the country have reasonable access to cancer services, and that they would ensure this objective is achieved. That objective has clearly not been achieved. I sometimes feel sorry for the Minister, as I know that during the last general election, Fianna Fáil candidates in my own constituency blamed her for the problems in the health service. It is clearly an issue of collective responsibility, but Fianna Fáil always passes the buck and it is more than convenient to blame the Progressive Democrats Party for the problems in the health service, as opposed to taking collective Cabinet responsibility.

Significant concerns about Quest Diagnostics were clearly outlined by Deputies Reilly and Enright. The detection rate of pre-cancer cells is 30% lower than that of Irish laboratories, a statistic that has been supported by evidence and educated opinion in the Irish Medical Journal and elsewhere. That is a major concern and the Minister cannot afford to turn a blind eye to it. Of equal concern is the credibility and legitimacy of this private company. Serious question marks hang over the Government’s decision to award the contract to Quest Diagnostics. An article in the Irish Independent on May 15 stated that Quest Diagnostics paid out $40 million in fraud cases in 1998, 2001 and 2004. Irish women can hardly have trust and confidence in such a company. It is quite alarming that the Government parties have awarded such a vital contract to a company of such a dubious background.

There are legal consequences to all this, to which Deputy Reilly alluded. Council Directive 2004/18 EC clearly states that any economic operator may be excluded from participation in a public service contract where that economic operator has been guilty of grave professional misconduct, proven by any means which the contracting authorities can demonstrate. This particular contractor has admitted that it has been obliged to pay out $40 million in compensation for fraud, yet the Government is satisfied to award a public contract of national importance to this company. I find that bizarre and I would like the Minister to give an explanation to the House for it.

Deputy Michael D. Higgins

I listened with great care to the debate that has taken place. A number of fundamental issues arise. Some have been touched on in the last contribution. On the degree of accountability that will be present from the allocation of a contract, moving from a tender to a contract, in the case of State laboratories and the educational preparation of technical and medical personnel, there are elaborate measures of accountability in the public system in respect of professional practice, the duties of institutions and hospitals, and preparation and validation. These are the skills and accountable mechanisms in a public system.

The alternative that the Minister described is to move outside the jurisdiction to describe a tendering process where the accountability mechanisms are neither explicit nor under the control of the State. They are under the gaze of the courts in their own jurisdiction. It is only fair to say that the favoured tenderer is not alone in drawing one court decision after another, almost all of which are in the same vein and relate to excessive testing where it was unnecessary and where the federal and individual states are involved. They relate to overpricing and over-billing, and figures of €40 million have been mentioned. That is the accountability that is offered as the alternative to the public system.

The Minister mentions that after two years there will be a review and we will move on to a new condition of contract. In a later flourish she suggests that those who get the contract may have a laboratory in this country. One may ask if this is in anticipation of the two years or if it is on condition that the contract will be renewed after two years. These questions can be dealt with reasonably.

How will the capacity to have diversity in bidding at the end of two years be established if the professionals have been prepared and the equipment purchased but it cannot be seen by RTE cameras and the students who have been prepared have not been allowed to gather experience? If one wants security in any model of health, one wants it to be integrated where one can deliver accountability and give some certainty. It is like walking out of one's house and staring at a bungalow in the distance. What provision is there for continuity for these people and the capacity to prefer an alternative bid in two years' time that would be integrated with the Irish health system?

I refer to the procurement criteria. Everyone who spoke rightly emphasised what worries every woman, the natural anxiety about speed and accuracy of diagnosis. How were the volume and turnaround requirement established as criteria? The Minister suggests 80% relates to quality and turnaround. I contradict a point of the Minister, the suggestion that several different units within the Irish system could have combined to offer an alternative to the contract that is coming from abroad. That does not fit with the facts as I know them and I am perfectly happy to illustrate them.

There is a suggestion that 20% of the tender assessment was based on cost. The Minister differs from me politically. If cost is based on very large volumes with a lower level of quality and performance and a murky level of corporate ethics, does it not worry the Minister that just for the sake of the turnaround and to meet the volumes, she is willing to put at risk the existing and potential infrastructure that might provide a fine service over which she would have full accountability? She is saying that the corporate ethic of a bidder from abroad, over which she will not have the same level of accountability, is welcome in the short term. To contrast is to sacrifice good and careful planning at the cost of an immediate knee-jerk response.

There are those who say none of this matters but it does matter. Medicine all over the world has been damaged by people who suggest that what is important is a sickness industry rather than a health policy.

Deputy James Reilly

Why did the Minister not instruct the HSE to invest in the labs? When I met the NCSS yesterday, it made clear that its role was procurement and that laboratories were none of its business. That points the finger firmly at the Minister. It is objectionable that the NCSS would issue a statement impugning my consideration of women and delay this project, for which I have called for nine years. Having waited that length of time and having lost many lives as a consequence of the delays of the Government that has been in power all that time, the Minister will now rush in at the end and will, as many Members pointed out, cause the fragmentation of our public health service. I can only surmise this is a further part of the agenda to undermine the public health service, in addition to privatisation drives, co-located hospitals and other initiatives.

Why did the Minister not allow investment in the labs to proceed? Will the Minister confirm that Altnagelvin Hospital, which operates under the Western Health and Social Care Trust of Northern Ireland and covered the north west, is deeply unhappy with the way the tender was carried out and is threatening legal action?

Minister for Health and Children (Deputy Mary Harney)

The NCSS is independent of the HSE. It is a stand-alone body and reports to the Department and the Minister for Health and Children. I have confidence in the screening service and Deputies have attested to their experiences of BreastCheck, which is acknowledged domestically and internationally to have been rolled out in a most appropriate fashion. When I asked the NCSS to roll out a cervical screening programme I did not tell it how to do it. I have confidence in its capacity to make those decisions. As Minister for Health and Children, I make the policy and allow those with expertise to implement it at clinical level or at other levels.

Deputy Higgins asked why we decided on 25,000 as a minimum throughput and a ten day turnaround. We did so because these are the international standards. We will not have quality assurance and the women of Ireland will not have the best possible cervical screening standard unless we follow international best practice, as followed in the UK and several other countries that have introduced effective screening programmes and reduced mortality from cervical cancer by 80%. In our case we could reduce it by up to 60 women per year out of 75. I refer the Deputy to page 163 of the European Standard. I did not invent this, I provided the money and asked the experts to put a cervical screening programme into effect for women affected, aged between 25 and 60, as quickly as possible. Furthermore, there was a two-stage tender process that was robust and transparent. They did not have to go to tender.

Deputy James Reilly

I hesitate to interrupt but could the Minister answer the question rather than make a speech? We heard the Minister's speech.

Dáil Éireann debate - Thursday, 29 May 2008

Cancer Screening Programme: Statements.

Dáil Éireann debate -
Thursday, 29 May 2008