I thank the witnesses for coming in this afternoon and for always making themselves available to answer questions. It is very welcome. The witnesses have said that CervicalCheck is a decent programme for an organised screening programme. That is true. I am more than happy to say that I am a beneficiary of that programme in more ways than one and am grateful for it in many respects. When this issue first came to light, many disrespectful comments were directed at the women who use the service, implying that we did not understand that it was a screening service or that we thought it was diagnostic. We did not think that, because most of us speak to our doctors. We are adults, otherwise we would not be having the test in the first place. The problems lay in the withholding of information, which is a fundamental aspect of this report.
It strikes me that Dr. Scally's job in chasing down where the issues were would have been much easier if those laboratories had been based here in Ireland. The decision to outsource the testing was political rather than clinical, according to the Academy of Clinical Science and Laboratory Medicine, which never advised it. In fact, the opposite is true, in that it sought a small amount of investment from the Government at the time to upskill labs and make them fit for purpose in order that we could continue to test here. That is not to say that the same issues regarding withholding information would not have occurred here. That may have still been an issue but we would have had the capacity to cite the laboratories and find out exactly where the tests were. Many women were concerned when they found out first that there was outsourcing, which was bad enough, but that the tests were then re-outsourced and in some instances even re-outsourced again. That is worrying. I refer to page 36 of Dr. Scally's supplementary report, which states:
The NCSS specifically stated that they would ‘not be supportive of this aspect of the plan ’, but when issuing a new request for tender later in the same year, the NCSS reduced the focus on capacity by almost eliminating it from the scoring despite these issues having occurred.
The report also shows that quality assurance declined from a 25% weighting in 2008 to a 15% weighting by 2012. That is screening on the cheap, to use layman's terms. It reduces the emphasis on quality and capacity and increases the emphasis on price. CervicalCheck was chasing down costs and was not keeping a close eye on quality. My understanding is that site visits for quality assurance purposes were not conducted. That is clear, because if they had been conducted we would have known where the sites were. I asked Dr. Scally about this when we met previously, but I am interested in why price reductions were pursued instead of quality and capacity. The outsourcing of the tests occurred because we were told there was a capacity issue at the time. That could have been dealt with here in this State but was not, and was then outsourced for that reason. Are the witnesses confident that, when the television cameras are shut off, a heavier emphasis on quality will now prevail, in order to ensure this does not happen again? Could they also offer a view as to who was driving the agenda?