Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Medical Register Administration

Stephen Donnelly

Question:

42. Deputy Stephen S. Donnelly asked the Minister for Health if he will direct the HSE to mandate that patients are informed when their treating consultants are not on the specialist register, including the reason they are not on the specialist register; and if he will make a statement on the matter. [5519/19]

We were told last May that 149 doctors working in the HSE in consultant posts were not on the specialist consultant register, unbeknownst to patients. We were also told that while some of this was due to legacy administrative issues, some of it was because the doctors had not finished their consultant training. This represents a serious patient safety issue. Will the Minister issue an instruction to the HSE to the effect that any patient seeing a consultant who is not on the specialist register is informed of that and the reason for same?

I thank the Deputy for raising this important matter. In March 2008, the HSE amended the qualifications specified for consultant posts to require membership of the specialist division of the register of medical practitioners. The register is maintained by the Medical Council. Notwithstanding that policy position, the HSE has been obliged in certain circumstances to appoint doctors who are not on the specialist division to consultant posts to ensure service delivery. There are also limited circumstances where an experienced senior doctor not on the specialist register may cover for an absent consultant to ensure the provision of care.

Importantly, any doctor who occupies a consultant post, even if he or she is not on the specialist register, would still hold a medical licence and be on a division of the Medical Council's register. The doctor would, therefore, be fully qualified to practice medicine. A total of 161 consultants have been identified working in the public health services who are not on the specialist register. Nearly a third of these were appointed prior to the change in the HSE's requirements.

The HSE has established a group to examine posts that are filled by doctors who are not on the specialist register as well as the issues of recruitment and retention challenges. It is undertaking site visits and engaging with senior management at sites and with those not on the specialist division register who occupy consultant posts. Its report and recommendations are to be finalised and will be provided to my Department next month. Once received, officials in my Department will consider the HSE's findings and recommendations, in conjunction with legal advices on the matter.

One of the areas for consideration may be, as suggested by the Deputy, mandating that patients be informed when their "treating consultant" is not on the specialist register. However, this would have to be considered having regard to the legal position and the current guidance of the Medical Council on some of these matters. Once I receive the report next month, I will be happy to brief the Deputy on its contents. His suggestion on informing patients is an issue that will be considered at that point.

I thank the Minister for his reply. I am concerned by the lack of transparency for patients. Last May, our committee was told that the number of doctors working in consultant posts but not on the specialist register was 149. We were given assurances that the HSE would look into reducing that number. However, I received information in recent days saying that the number had increased to 161. Shockingly, my figures show that, in the midlands mental health service, 44% of doctors working in consultant posts are not on the specialist register. In South Tipperary General Hospital, that figure is 31%.

I am glad that a report is on the way to the Minister and I appreciate that some of the recommendations can wait for it, but does he agree that, regardless of what the report says, patients and their families have a right to know if the doctors they are seeing and who they have been told are consultants actually are consultants?

Instinctively I do, but I want to allow the HSE to complete this work. Given that it is imminent - it is due to be completed next month - I want to be guided by it. The HSE is pursuing a range of initiatives to improve the recruitment process and support those who are not on the specialist register to pursue registration. As the Deputy was good enough to acknowledge in his opening contribution, there may be people involved who are well entitled and have the qualifications to be on the register but have not applied to be so. For example, those appointed properly prior to 2008 could be dealt with by deeming provision to be part of the definition of "consultant". We can reduce the number and address some of these cases through that.

I do not want to be lost in the debate the fact that, notwithstanding recruitment and retention challenges, the number of consultants working in the health service increased by 125 in the 12 months to the end of December 2018 and by 540 in the past five years.

I am happy to revert to the Deputy when I receive the report.

I would like the Minister issue an instruction on three matters. First, it should be mandated that, if a patient is meeting a doctor whom he or she believes is a consultant and is in a consultant's post but who is not on the specialist register, he or she is told so and why. Second, every patient who believes that he or she has been seen, assessed or treated by such a doctor should be informed that the person is not a consultant. Third, I would like the Minister to instruct the HSE to conduct an analysis of this cohort to determine whether there is an unusual level of issues relating to patient safety, negligence and so forth. There may be serious patient safety issues concerning people being treated by doctors who are not consultants but whom they believe are consultants. I would like the Minister to take these suggestions under consideration.

I take seriously the Deputy's suggestions and I will reflect on them. However, the Medical Council is the regulator of our doctors. It is important for our citizens and patients to know that there is no suggestion - the Deputy Donnelly has not suggested it - that these doctors who are not on the specialist register are not fully qualified in medicine. This important point has been highlighted by the Medical Council.

I will make a decision on the issue of mandating the HSE to inform patients based on the report that I will receive on the project being undertaken, which is due to conclude next month.

At that time, I will also take an opportunity to engage with the Medical Council. The Joint Committee on Health might wish to engage with the HSE and the Medical Council as well to see how best we can square this circle.

Cancer Screening Programmes

Louise O'Reilly

Question:

43. Deputy Louise O'Reilly asked the Minister for Health when his attention was drawn to delays relating to smear tests under the CervicalCheck programme, which meant slides could not be read within the requisite timeframe; the steps he took to alleviate the backlog; the steps he took to relay the delays to those affected through the appropriate channels; and if he will make a statement on the matter. [5462/19]

As ever, my question is straightforward. I would be grateful if the Minister, in his reply, could concentrate on the measures taken to alleviate the backlog and the communication with those who were impacted because it came to my attention that a number of women found out that there was an issue via the media, which is not acceptable. The Minister might detail exactly what he was doing to ensure everybody knew as much as he knew.

I thank the Deputy for the question and the succinct way in which she put it. I interpret this question as her specifically referring to the issue that has arisen in respect of secondary HPV testing and she can tell me if she wishes me to talk more broadly.

I welcome the opportunity to clarify this matter in the House. Unfortunately, quite a bit of misinformation was put out, although not by the Deputy, for the sake of making political charges in recent weeks.

Where low grade changes are detected on a cervical smear test, a second so-called "triage test", which looks for the HPV virus, is carried out by laboratories. If HPV is found, women are recommended to attend for further testing. If HPV is not found, women are recommended to attend for routine screening again in three to five years. In the test used by the laboratory concerned, the manufacturer's recommendation is that the test for HPV should be carried out within 30 days of the sample having been given by a woman.

The current issue first came to light due to ongoing improvement work across the screening programme, including strengthening of its quality assurance processes, as recommended in Dr. Scally's report. The HSE was advised by Quest Diagnostics that there was a concern relating to secondary HPV testing within the recommended timeframe. The HSE convened an expert clinical team to establish the facts with the company and review the situation.

As I have stated previously, on 5 December I was informed by my Department that an issue had arisen and that the HSE was working to establish the facts and what action, if any, may be required, and received subsequent interim updates pending completion of the work of the expert clinical team and final confirmation of the position.

My priority, exactly as the Deputy suggested, was to seek to ensure that women were the first to be communicated with on this issue, and to learn the lessons of the past regarding CervicalCheck. I have heard patient advocates speak about this. Indeed, I met the members of 221 Plus group for a number of hours last week and they also wanted to hear the information first. It was always my priority, when all the facts were known, to make sure women hear directly or through their doctors. I am advised that Quest Diagnostics has now provided details of all the samples it knows to be affected, and that the vast majority of letters to women affected have now been issued by the HSE.

The HSE has advised that clinical research shows that HPV tests remain effective - this is important - when they are performed outside the recommended timeframe and that there is little risk of inaccuracy. In fact, it was defined as "exceedingly low risk" by the acting clinical director of the programme. Nevertheless, this is a precautionary measure. It is right and proper to do this.

I will come back in on other matters in a moment.

There were two separate delays. Women should have confidence. Screening saves lives. I have seen it at close quarters. I have great faith in this programme but all that has happened has knocked the confidence that women deserve to have in it.

I refer to a letter that was sent to the Minister by Dr. Maitiú Ó Tuathail in August 2018. It refers to the turnaround time for processing smears of up to 12 weeks being problematic. He also states that he would request that this delay in the processing of smear samples be addressed as a matter of urgency. He advises that his organisation's members will have to deal with women who have yet another repeat smear to face. That is where the confidence slips. It is where a woman keeps being told she must come back. Women deserve to have confidence in the programme. Could the Minister advise us exactly what was done on foot of receipt of that letter raising concerns because my understanding is no reply was received?

The Deputy is a strong advocate of the screening programme. When raising this issue, she always has been. However, a charge were made in this House by the leader of Fianna Fáil on an occasion when Members knew I was not here to respond. The charge was that I offered free repeat smear tests to women against official advice. That is false. That decision was made in conjunction with my officials, including the Chief Medical Officer, and it was supported by Opposition politicians, including those present, because women wanted that reassurance. Many women took up that opportunity to have reassurance. These were not the only women getting the reassurance. In addition, there were also new women, who had never availed of the programme, taking up screening which we all believe is good.

I accept that has caused a backlog, which cannot be easily fixed merely by resources. If it could, I guarantee it would be done. There is an issue in trying to identify more capacity in what is already a shortage of cytology. The HSE is due to complete a capacity report in the next couple of weeks on how we can look at addressing this and I will act on that immediately.

It is not true for Members to state in this House that the repeat smear test was offered against official advice. That was not the case. Of course, some doctors had views on this matter. Many others welcomed it. Many GPs also wanted to know what were they to do when women were coming to them looking for that reassurance and whether they were to charge them when they had done nothing wrong.

A serious issue was raised by a representative body in August 2018. It details delays that were happening and the fact that its members were having to deal with women who were yet to have another test. Neither I nor any member of my party made that charge and I am glad that the Minister made it clear. Not putting the necessary resources in place before that offer was made, respecting the fact that it was right to do, caused this delay and this backlog. Whatever about the advice the Minister received in June, which is a matter he needs to sort out with the person who said that as it was not me, I refer to the letter he received in August. He has detailed actions that took place from December. I want to know what was done in August when this letter was received because that is approximately the time the backlog started, according to my friends and family.

I repeat it is important that women have confidence in this service because it should be a good service.

First, it is not true for anyone to suggest that GPs or many medical bodies oppose this decision. For example, my Department negotiated the provision of the repeat free smear test with the Irish Medical Organisation. We agreed a fee with the organisation. We paid GPs to provide this test and the Deputy agrees with me on this. Had we not done that, we would have had a situation where women who could afford the repeat smear test would have got it and women who could not would not have been reassured. This was one of the top queries coming in to the CervicalCheck helpline, with women stating they did not want to wait for their next date to come around and they would like the reassurance. The Deputy is entirely correct. That led to a significant number of additional women taking that test, many of whom got reassurance. It also obviously added to a backlog.

Long before we received that letter, and consistently, the HSE had been working to try to identify more capacity. Its first priority was to ensure the continuation of the screening, which is not something we could take for granted. We came within hours of not having laboratories provide screening. Once that was done, the next focus was rightly on trying to find additional capacity. They are working hard on that. I hope they can make some progress on it. I expect to receive the capacity report shortly.

Drug Treatment Programmes

John Curran

Question:

44. Deputy John Curran asked the Minister for Health when the protocols on the methadone strategy were last reviewed; if he is satisfied that there are sufficient progression pathways for persons on the methadone programme to become drug free; and if he will make a statement on the matter. [5520/19]

When were the protocols regarding methadone treatment last reviewed? Is the Minister of State satisfied with the progression pathways available and are they are sufficient to ensure that those who want to progress from the methadone programme to become drug free can do so?

Methadone prescribing for opioid dependence is a key element of the harm reduction approach to opioid use set out in the national drugs strategy. Methadone is one of the medications used in opioid substitution treatment, along with Suboxone.

As of 30 November 2018, more than 10,000 people were in receipt of methadone maintenance treatment.

The HSE provides opioid substitution treatment in a number of treatment settings to meet the needs of individual drug users, including primary care, treatment centres and residential facilities.

Since 2016, an additional 350 treatment episodes have been provided in tier 4 residential centres at a cost of €2.15 million. Within the past year, the HSE has established services in south Tipperary, Wexford and Limerick, and a service in the midlands which was due to open, opened in December.

A review of the methadone treatment protocol was published in December 2010. Arising from the review, the HSE implemented an opioid treatment protocol to provide appropriate and timely substance treatment and rehabilitation services tailored to individual needs.

In 2016, the HSE published clinical guidelines for opioid substitution treatment. The guidelines are the first that specifically relate to opioid substitution treatment in HSE clinics and primary care settings.

Opioid substitution treatment supports patients to recover from drug dependence. HSE addiction services work within the national drugs rehabilitation framework to support progression pathways.

The framework ensures that individuals affected by drug misuse are offered a range of integrated options tailored to meet their needs and to create rehabilitation pathways.

Methadone treatment reflects the public health approach to drug and alcohol misuse set out in the national drugs strategy. Moreover, it is an important tool to reduce harm and to aid people to recover from drug use. I am committed to improving the availability of this treatment and to developing services to meet the needs of people on opioid substitution treatment.

I thank the Minister of State for her reply. I recognise that methadone has a significant role to play in harm reduction, be it in respect of health, criminal activity and so on, and I do not dispute that. My concern, and the purpose of the question, is that more than 10,000 people are currently on a methadone treatment programme, as she indicated. More than 6,000 have been on it for five years or more, while more than 4,000 are on methadone for ten years or more. Since 2016, between 70 and 80 teenagers have been on a treatment programme. I am concerned that some people seem to remain on a programme for a long time. There must be better outcomes. The Minister of State referred to a 2010 review. In 2019, it is time we reviewed it again, knowing that people are on this programme indefinitely. Are we suggesting to somebody who goes on such a programme when he or she is aged 17, 18 or 19 that he or she will still be on methadone treatment in ten or 15 years? There has to be a better outcome and the figures indicate that some people are on the programme way too long.

I agree with the Deputy in raising the issue here and in looking at how we can proceed at looking at another programme to identify the length of time people are on methadone. As he said, people are on methadone over a long period. Some of them have been on it for more than then ten years. For many, it is an opportunity to remain stable and to continue their lives and work. I know many of these people. There are limitations, however, in the opportunities for GPs in areas with regard to methadone services. A number of doctors are available for level 1 and level 2 GP services. There are, however, problems recruiting doctors for level 2 GP services for methadone treatment. We are succeeding around the State and with the funding made available through the HSE for services in primary and community care, I believe there will be an outcome into the future.

Suboxone use has also been established as a treatment in Ireland. To facilitate the increase in the use of Suboxone, €750,000 was allocated in each of the years 2017 and 2018, giving us a sum of €1.5 million for the full year costs. Suboxone is a new initiative in Ireland to help some people, while others will never be on Suboxone because that treatment does not suit them. We will continue to roll out the Suboxone treatment.

I agree with the Deputy that it is a while since the 2010 review of the treatment programme and that we may need to look at it again. People are, however, surviving on a daily basis, living out their lives, going to work and rearing families while they are on methadone. We cannot forget the fact that it is also available.

I do not suggest that one size fits all but I am concerned that more than 4,000 people are on a methadone programme for longer than ten years. When a person goes onto the programme, there needs to be personal plan for those who are suited to it to progress beyond a life on methadone. For some of those people it is a life on methadone.

I welcome the Minister of State's comments on Suboxone. Ireland, however, is a bit of an outlier in comparison with most European countries that have 20% or 30% of those on opioid substitution treatment, OST, using Suboxone. We have a very small cohort. This is not the same as in Europe. Suboxone has a lot of benefits. It is less addictive and easier to withdraw from, there is less chance of overdosing, and so on. The roll-out of Suboxone in Ireland for those who could benefit from it has been slow.

We often talk about the risks of taking somebody off methadone. There are risks also for people who remain on methadone. The drug-related death index shows there are some 700 drug-related deaths per annum, half of which are from poisonings. Approximately 20% of those who are poisoned have been in receipt of methadone. That means 1% of the population that receives methadone treatment per annum is dying. The treatment programme needs to be reviewed with personal progression plans being considered and the alternative Suboxone being made more widely available.

I agree with the Deputy that there is a small percentage of people on Suboxone, but we are heading in the right direction. We have had additional funding this year to roll it out further. We will do that. Under the new strategy it is very clear to me and my Department that we will have to evaluate some of the methadone treatment numbers to see what we can do in the future to help people to reduce the time they are on the programme. We need more GPs to come on board, especially in level 2 GP services, to help with chronic people coming into clinics. This can also be the first port of call for them. We are approaching the issue in the right way. We may differ in how quickly we can get through it but I agree there needs to be a review. It has been a long time since the methadone treatment services were reviewed in 2010. There are a lot of good services in the community, in pharmacies and GP practices, and they have made a significant difference to peoples' lives. I know we are not knocking it, but I do not believe we should constantly target those people who are making a major recovery because they have been on methadone, even for a short time.

Abortion Services Provision

Louise O'Reilly

Question:

45. Deputy Louise O'Reilly asked the Minister for Health the status of the provision of abortion services for women resident in Northern Ireland further to the enactment of the Health (Regulation of Termination of Pregnancy) Act 2018; when he will deliver on his commitment for free provision for these women; and if he will make a statement on the matter. [5463/19]

I have a straightforward question; I want to know the status of the provision of abortion services for women who are resident in the North of Ireland, further to the enactment of the Health (Regulation of Termination of Pregnancy) Act. When will the Minister for Health deliver on the commitment he gave for the free provision of access for these women?

I thank the Deputy for the question. I am very much aware of the concerns that women in Northern Ireland have regarding access to termination of pregnancy, which are similar to those faced by women in the Republic prior to the recent change in the law here as a result of the referendum. I hope that we arrive at a situation in the not too distant future where Northern Ireland makes its own decisions on this issue and moves in a direction where it can care for women in its health service. As long as that remains not to be the case I want to make sure we can offer care. I know that the Deputy and I share this view for women on the island of Ireland, regardless of whether a person lives North or South.

I believe it is welcome and it is progress that women who live in Northern Ireland can now access termination services in this jurisdiction. The Deputy will be aware, however, that under the Health Act 1970, eligibility for public health services is based on a person being ordinarily resident in the State. This is the bedrock on which our eligibility system for health services, and many other public services, is founded. The necessary provisions were made in the Health (Regulation of Termination of Pregnancy) Act 2018 to enable universal access for women living in the State to the services in question without charge. Women who live in Northern Ireland can access termination services in this jurisdiction - which is an important message to send out - but would, in effect, be doing so not in the universal and free way that women in the Republic of Ireland can.

To be very clear, I do not believe this is fair and I share the Deputy's wish to facilitate access without charge to termination of pregnancy services to women from Northern Ireland. Such a proposal, however, raises a number of legal and policy issues. I have had some initial discussion with the Attorney General about the matter. He has indicated that as a proposition along these lines appears not to have been considered before, it would require a fair bit of work. I, therefore, intend to undertake such an examination of the issues in conjunction with the Attorney General and other Government colleagues as necessary. We had a good meeting when Deputy O'Reilly brought civic society groups that are campaigning on this matter in Northern Ireland to Leinster House. I was pleased to have a chance to meet the Deputy and those groups. I would very much welcome the chance to do that again and to see, together and on a cross-party basis, how we can rectify this. My policy intention was clear; I want women in Northern Ireland to be able to access the services they can. To make sure they can access the services in a universal and free way is something I am currently trying to find a solution to. I remain absolutely committed to working to find one.

For some women the €450 they have to pay to access the service represents a prohibitively expensive barrier they cannot overcome. In 2017, just over 900 women from the North of Ireland travelled for an abortion. The figure is low and I venture that the financial commitment is not huge, but I do not dispute that it is a financial commitment. All of the circumstances that the Minister outlined in his reply were known to him when he made the commitment.

However, nothing has changed in the meantime. All of the circumstances were known. My colleague, Megan Fearon, MLA; Grainne Taggart of Amnesty International, the Alliance for Choice and other groups are working hard to do what they can for women in the North. However, I put it to the Minister that it was he who made the commitment and that it is up to him to deliver on it. I would welcome an opportunity to meet him again to discuss the matter. As I have said before, I assure him that he will have my party's support in bringing this about, but for many, €450 does not represent access but a barrier.

Yes and for many others, it facilitates access. It means that people can access services on the island of Ireland without having to travel to another island and stay overnight in the United Kingdom or experience high air fares and so on. It means being able to visit a GP in the Republic at an early stage of pregnancy to access services at primary care level. However, the Deputy should not take this to suggest I think it is satisfactory. My commitment was given in good faith. My commitment that women would be able to access the service has been acted on. The commitment on which I want to deliver, however, is that they can access it freely, like women living in the Republic. I have outlined matters truthfully to the Deputy and the Amnesty International and other groups she brought to see me that day and we are trying to find a way through it. What I am outlining in the Dáil today is the fact that eligibility for public health services is based on a person being ordinarily resident in the State. The work taking place is to find a legal way around this. I am committed to working hard on the issue with the Office of the Attorney General and keeping the Deputy up to date. It would be useful to meet her, any other interested colleague and the group to which she referred in the coming weeks.

We will be very happy to take the Minister up on the offer of a meeting. We want to see some progress. It is not as if we would have to reinvent the wheel because there are already circumstances in which health services in both jurisdictions are accessible from either side of the Border. It is possible to do this. I do not want to pour cold water on the Minister's commitment, but while we welcome the offer of a meeting, we are conscious of the fact that, albeit the numbers are small, women continue to travel. While I accept that €450 may not be a barrier for some women, it is a significant barrier for many others-----

-----and one we would like to see removed. As such, I restate Sinn Féin's commitment to work with the Minister to deliver this. I welcome the opportunity to meet him. I hope we can mark some progress at the meeting and put in place a deadline for the conclusion of the negotiations or work that must take place to be able to say with confidence that this will be delivered by a certain date.

I would like to work with the Deputy to arrive at that point also. I would also like to work with her and groups in Northern Ireland on the support the 24/7 helpline we now operate can provide for women, regardless of where they live on the island. It ensures women can talk to qualified healthcare professionals and councillors and that all of their options can be signposted in terms of how they can access services. While we are proactively promoting the existence of services in this jurisdiction, the helpline ensures there is knowledge and awareness of the existence of the services and information and support north of the Border also. We do not disagree on where we want to get to, but I need to find a way to get there. I am not the font of all wisdom on this issue and while I have access to the Office of the Attorney General and the like, I am also happy to hear the Opposition's ideas on how we can legislate in that regard. I will be in touch to arrange the meeting with the Deputy.

Cancer Screening Programmes

Alan Kelly

Question:

46. Deputy Alan Kelly asked the Minister for Health if a guarantee will be provided that the 24-week delay in smear testing under the CervicalCheck programme has not adversely affected the health outcomes for some women [5414/19]

As stated, there are comprehensive delays in screening women for cervical cancer. The delays have maximised at 24 weeks, if not longer. While I accept the Minister's bona fides in respect of why he did this, I ask him to provide a guarantee for the House that the delay will not have a significant impact on any woman's health prognosis.

I thank the Deputy for his question and acknowledge the significant advocacy work he has done in this area. The unprecedented demand for cervical screening in 2018 owing to understandable concerns of women, as well as an increased uptake of screening, has led to long and very regrettable delays in the reporting of results. The fact that new women have opted into the programme for the first time is important. The HSE has advised me that results are being reported on average within 22 weeks of the test being taken. As with all averages, some case results are reported in a much shorter period, while in other cases, the period is longer. Addressing these delays is a top priority for me, my Department and the HSE. The HSE is working actively to manage the issue and identify additional capacity, where possible. However, the global shortage of cytology capacity must be borne in mind as it means that this is very challenging.

To provide the information the Deputy seeks, in particular, I note that, clinically, the HSE has advised that the natural history of cervical cancer indicates that the disease will normally develop over a period of ten to 15 years. Owing to this very fact, it is important that any woman of screening age attend for cervical screening when she is invited to do so. In that context, the current reporting time for cervical screening results, while absolutely undesirable and regrettable, poses a very low risk to women. As the Deputy knows, false negatives are inherent in all cervical screening programmes and screening cannot prevent all cancers. However, cervical screening saves lives. Regular smear testing is the most important thing a woman can do to prevent cervical cancer, which is why my focus is on ensuring the continuation of the screening programme and that the current challenges in relation to smear test turnaround times are addressed.

I am obviously not a medic, but the medical advice I have been given is that the delays pose a very low clinical risk to women. Obviously, I want to see the delays continue to reduce. I do not find the current delays acceptable, but I want the Deputy to know, as I think he does, having come to know a lot of the people working on this issue in the HSE very well in the last while, that they are doing everything possible to identify additional capacity. I will certainly keep the Deputy and others informed as it comes on stream.

I accept the Minister's bona fides regarding the decision-making on this issue. However, I must question the making of a decision like this without knowing whether we had the resources to meet demand. The Minister is in a unique position which those of us in opposition are not. As for the consequences, I was glad to hear in reply to a previous question that the Minister's chief medical officer supported him 100% and advocated that we do this. We had not heard that before in the House. Specifically I want to know the following. In November I stated at the joint committee that women who were being referred for their triennial smear test or who were being referred for six-monthly or annual checks and needed greater priority could not be distinguished between. Therefore, women have had to wait 24 weeks, whether they were seeking six-monthly smear tests due to significant issues of change or they were presenting for their triennial check. I am not a clinician either, but that certainly creates risk. Mr. McCallion said it to me at the time. I seek an assurance that the lack of capacity to prioritise between the different women referred for checks does not create a risk to their health.

While the Deputy said I was in a unique position to know certain things and while I accept that, as Minister, I have access to officials, advisers and the Chief Medical Officer, no one, including the Deputy or me, could have known the degree of public unease that would develop in this situation last year, the length of time for which it would go on or the number of women who would take up the offer of a free repeat smear test. I do not know how the Deputy views it, but certainly the numbers would have been almost impossible to estimate. What was very clear, however, was the need to provide the tests. The Deputy and I do not differ on this issue. I welcome the opportunity to state in the House that I did not act against official advice. Such cheap political charges which the Deputy did not make only added to the unease. I met the 221+ group of women and their partners who had been through cervical cancer and relatives of people who had died. They get very annoyed when we start to play petty party politics by putting half-truths in the public domain. I know the Deputy agrees.

I have asked about triage which I think is what the Deputy is referring to. He is asking whether, if we know that there is a greater risk, we can ensure those subject to it will be seen sooner. I have been assured that work has been done on this issue. I will be attending the Joint Committee on Health tomorrow and will answer questions about CervicalCheck in the House tomorrow. I might provide the Deputy with a definitive answer on this issue in our next exchange in 24 hours' time.

What I am getting at is very clear and I think the Minister knows I am into the detail. I accept that some of the women concerned could have had false negatives. Some could have issues related to the laboratories about which we do not yet know because we do not know about percentages in the RCOG review. The issue is whether the Minister can guarantee that no woman's health has been affected because of the lack of prioritisation in a triage setting.

I have been contacted by some people who have deep concerns that this delay, possibly combined with other issues, has put their medical situation in a far worse position than it should be. This is a big problem for the Minister. A second tranche of women being affected could also have a financial impact on the State. I need an assurance from the Minister today. Given what I said at committee meetings in November, given the fact we now know of the 1,000 cases where the slides must be redone, and I understand the distinction between these and the 6,000 cases, and given the situation we know about with regard to false negatives, and we do not know the full details of potential issues with laboratories, is the Minister able to guarantee the delay has not had a negative impact on the health of these women?

The Deputy mentioned the Royal College of Obstetricians and Gynaecologists, RCOG, review. As he has done so, and in the interest of completeness, I want to take this opportunity to inform him and the House that I am pleased to say slides have begun to transfer to the RCOG. This was an issue causing concern and it is now under way.

As the Minister for Health, I rely on clinical advice. The clinical advice available to me is what I have stated on the record of the House. The HSE has clinically advised me that the natural history of cervical cancer indicates it is a disease that would normally develop over a period of ten to 15 years. Due to this fact, regular screening is very important in terms of reducing the risk. Medically and clinically I am told that in this context, although the current reporting time of cervical screening results was absolutely undesirable and regrettable, it poses a very low clinical risk to women.