Tuesday, 5 February 2019

Questions (46)

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]

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Oral answers (6 contributions) (Question to Health)

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.