Written Answers Nos. 427-446
427. Deputy Stephen Donnelly asked the Minister for Health if, further to the review of the Royal College of Obstetricians and Gynaecologists into cervical cancer cases, he will request a review of colposcopy practices as outlined in the report; and if he will make a statement on the matter. [51653/19]
View answerI welcome the aggregate Report of the Independent Expert Panel Review led by the Royal College of Obstetricians and Gynaecologists (RCOG) which was published on 3 December.
The RCOG report finds the CervicalCheck programme is working effectively and crucially that women can have confidence in the programme. I note the findings of the RCOG report in which the Expert Panel noted that colposcopy is an integral component of any cervical screening programme, that colposcopy management was in line with standard practice in the vast majority of cases reviewed and that the Review Team has said that women can have confidence in colposcopy services and in the Programme overall.
The report makes recommendations in regard to colposcopy services, and I have written to the HSE to request that it take full account of these recommendations in the detailed work underway to prepare for the introduction of HPV primary screening, including colposcopy capacity planning.
428. Deputy Stephen Donnelly asked the Minister for Health if he is satisfied with the way in which women and their families were treated as part of the review by the Royal College of Obstetricians and Gynaecologists in cervical cancer cases; and if he will make a statement on the matter. [51654/19]
View answerOn Tuesday 3 December, the Aggregate Report of the Independent Clinical Expert Panel Review of CervicalCheck, carried out by the Royal College of Obstetricians and Gynaecologists in the UK, was published following the Government meeting.
The first key objective of this Review was to provide women, or their next of kin, with independent clinical assurance about the timing of their diagnosis and treatment. An individual report was prepared for each woman. Significant planning and preparation took place to ensure that the process for communication of results to women and families was done in the most appropriate and sensitive way possible. This included providing all participants with options for how they might choose to receive their report, and providing the option for participants to have an independent advocate attend with them at a meeting about their report, if they chose to have one. The communication process began on 23 September, and all participants who wished to receive their individual reports did so in advance of the publication of the Aggregate Report.
A dedicated HSE Information Line for women and families who consented to participate in the RCOG review, which has been in operation since August 2018, continues in place. Queries to the information line, pertaining to the contents of individual reports, averaged less than five per day during November, the month during which the majority of the participants received their reports.
In May 2018, Government decided to offer a package of health and social care supports to women or their next of kin for whom the CervicalCheck audit had found a result that was discordant with their original result. At that time Government also decided this package would be made available to those identified as having discordant results through the RCOG process. This package of health and social care supports is being offered through dedicated Community Liaison Officers.
In recent weeks, some concerns have been raised in regard to the verification process carried out by the HSE to ensure that the correct report went to each participant, and in regard to the accuracy of reports. On foot of these concerns, the Expert Panel travelled to Dublin and met with patient representatives to explain the verification process and the rationale underpinning it to them.
Subsequently, both the HSE and RCOG have confirmed to the Department their confidence in the processes underpinning this review, and the participation of more than 1,000 women or their next of kin provides a robust and comprehensive analysis of the performance of the programme. The Expert Panel has noted that, should any women have any queries about the data in their reports, they are happy to investigate further and that throughout this process the objective has been to ensure that every woman received an accurate report. The HSE's Information Line also remains open if any woman has any outstanding queries or concerns.
429. Deputy Stephen Donnelly asked the Minister for Health the reason funding for the winter plan was not included in the 2019 HSE service plan and is being included in the Supplementary Estimates; and if he will make a statement on the matter. [51655/19]
View answerIncrease in demand was considered as part of 2019 HSE National Service Plan. However increase in growth and demand throughout the year placed additional pressures on the health services. Acknowledging these pressures, additional funding was ring fenced to address the surge in activity associated with Winter pressures, which led to the launch of the 2019/2020 Winter Plan. This was considered as part of the 2019 Supplementary Estimate to ensure that addressing this seasonal demand did not have an adverse impact on the service levels set out in the National Service Plan.
430. Deputy Micheál Martin asked the Minister for Health when funding will be made available to open a residential care centre (details supplied) in County Monaghan; if he met officials regarding same; and if he will make a statement on the matter. [51675/19]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
Significant resources continue to be invested in disability services. I am pleased that I have been able to both build upon significant existing resources and to obtain additional funding for disability services in the 2020 Budget. With these additional monies secured, the overall Budget for disability services is in excess of €2billion.
In relation to the building built by Respond in Carrickmacross Co Monaghan, and completed in late 2018, I have been assured by the Health Service Executive (HSE) that it is continuing to work with all relevant parties with regard to the development of the facility. The development of the facility is a service matter for the HSE, and so I have arranged for the question to be referred to the HSE for direct reply to the Deputy.
431. Deputy James Browne asked the Minister for Health the rent paid to date on a building (details supplied); and if he will make a statement on the matter. [51678/19]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
432. Deputy Robert Troy asked the Minister for Health if an appointment will be expedited for a person (details supplied). [51679/19]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
433. Deputy Michael Healy-Rae asked the Minister for Health if he will address a matter regarding a paediatric pain consultant (details supplied); and if he will make a statement on the matter. [51700/19]
View answerAs this is a service matter, I have asked the Children's Health Ireland to respond to you directly, as soon as possible.
434. Deputy Pat Buckley asked the Minister for Health the status of a building (details supplied); the plans of the HSE to use the property; the timeline for operation; and the cost to the HSE of renting the property while it has been out of operation. [51715/19]
View answerAs the Health Service Executive is responsible for the management of the healthcare property estate, I have asked the HSE to respond directly to you in relation to this matter.
435. Deputy Jackie Cahill asked the Minister for Health the status of a full assessment for a person (details supplied); and if he will make a statement on the matter. [51719/19]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
436. Deputy Peadar Tóibín asked the Minister for Health the problems that exist regarding the printing of documents from the information technology system in the health service; the number of persons affected by the inability to print documents; the cost of the system; the steps required to fix same; the estimated cost of the fix; and when it will be fixed. [51722/19]
View answerAs the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.
437. Deputy Niamh Smyth asked the Minister for Health the reason a reply has not issued to a local authority (details supplied) regarding its request for a meeting; if he will review same with a view to arranging the meeting; if he will contact the authority directly acknowledging its request; and if he will make a statement on the matter. [51725/19]
View answerRequests to meet my colleague Minister Harris are normally arranged through his office. I understand a reply issued from Minister Harris's office on 9th December 2019.
439. Deputy Bríd Smith asked the Minister for Health further to Parliamentary Question No. 128 of 5 December 2018, if, following a review (details supplied) he will direct the HSE to provide the information requested. [51729/19]
View answer440. Deputy Bríd Smith asked the Minister for Health further to Parliamentary Question No. 130 of 5 February 2019, if the analysis referred to the person with appropriate expertise is a reference to the 221 laboratory audit report, a report (details supplied) or a separate analysis; and if he will make a statement on the matter. [51730/19]
View answerI propose to take Questions Nos. 439 and 440 together.
Earlier this year, the HSE completed a report which provides a breakdown of the laboratories in which the smear tests of the 221 women involved in the CervicalCheck audit were analysed. A supplementary report was also completed at the request of the 221+ Group, which sets out the breakdown over time. The reports have been shared with the 221+ Patient Support Group and with members of the Joint Oireachtas Committee on Health.
As outlined in previous responses to the Deputy, it would be expected that false negatives would have occurred in all labs contracted by CervicalCheck since its inception. In recognising the serious consequences that screening failures have for affected women, the RCOG Expert Panel also recognised the inability of cervical screening to prevent all cases of cervical cancer. The Panel acknowledged that screening failures are, unfortunately, inevitable given the limitations of cytology-based screening and should not be taken to suggest the programme overall is not working.
The performance of laboratories used by CervicalCheck has been analysed and compared by Dr Scally and that performance has been found to be within the quality standards required and expected. The RCOG Expert Panel also found that the CervicalCheck programme is working effectively and, crucially, that women can have confidence in the programme.
In regard to the Deputy's question of 5 February, I can confirm that the person with appropriate expertise referred to was in the context of the laboratory audit report.
441. Deputy Bríd Smith asked the Minister for Health further to Parliamentary Questions Nos. 322 and 323 of 24 September 2019, if the fact that the HSE has established an expert group to review clinical audit of interval cancers is a reference to a review (details supplied) or a different expert group. [51731/19]
View answer443. Deputy Bríd Smith asked the Minister for Health if, following the Scally report and a review (details supplied), he will recommence the CervicalCheck audit that has been paused since May 2018; and if he will make a statement on the matter. [51750/19]
View answerI propose to take Questions Nos. 441 and 443 together.
Since 2010, as part of quality assurance measures, CervicalCheck reviewed the screening history of every woman notified to it as having a diagnosis of cervical cancer, who had previously been screened by the programme. The objective of audit and quality review at CervicalCheck was to facilitate continued improvement and ongoing learning within the programme. Following the issues which arose in relation to the non-disclosure of audit findings, a decision was taken to pause the audit.
The Scoping Inquiry led by Dr Gabriel Scally made a number of recommendations, one of which was that “Audit should continue to be an important component of cervical screening as this complies with all good clinical practice. Common, robust and externally validated approaches to the design, conduct, evaluation and oversight of audits should be developed across the screening services.” (Recommendation 26).
This recommendation was accepted by Government, as were all of Dr Scally's recommendations. Actions to implement these recommendations were set out in an implementation plan which was approved by Government and is published on the website of my Department.
As set out in the implementation plan, the HSE has established an Expert Group within the National Screening Service to review the clinical audit processes for interval cancers across all screening programmes. This is separate to the work of the Independent Expert Panel Review led by the Royal College of Obstetrics and Gynaecology (RCOG Review). The Expert Group, which includes two patient representatives, will develop a report setting out recommendations for the operation of clinical audit processes across all screening programmes. The Expert Group is expected to complete its work at the end of this year, following which its recommendations will be implemented by the HSE. I expect that the detail requested by the Deputy regarding the timing of the recommencement of the audit will be informed by the Expert Group's work and this detail will become available once that work is complete.
442. Deputy Denis Naughten asked the Minister for Health the reason a person (details supplied) would not receive a full reimbursement under the cross-Border directive; and if he will make a statement on the matter. [51734/19]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
444. Deputy Bríd Smith asked the Minister for Health the number of slides requested by a college (details supplied) to be included in its review and which had been given consent for inclusion by the women concerned but were not available to the review due to the fact the laboratory concerned could not locate them, by laboratory; if the slides have subsequently become available; and if he will make a statement on the matter. [51751/19]
View answerThe transfer of slides from CervicalCheck labs for the RCOG Review was a complex process that involved the retrieval, imaging, packing and transfer of over 1,700 slides spanning a period of approximately 11 years, since the commencement of the CervicalCheck programme.In addition to the over 1,700 slides which transferred, the HSE reported during the process that a total of 35 slides of women or next of kin who had consented to be included in the review were not located by the laboratories as of the closing date for slide transfers to RCOG on 7 June.
Nine of these slides have since been located. The majority of these unavailable slides were requested from Quest Diagnostics. This is in keeping with the fact that the majority of slide requests (over 1000 of the approx 1700) for inclusion in the RCOG review pertained to Quest.The HSE communicated with those affected in June 2019 to inform them of this issue. For the women whose slides were not located in time to be included in the Review, and who thus had slides excluded from the Review due to a factor outside their control, it was decided they may avail of the support package and access to the CervicalCheck Tribunal, if they so wish, as if they had been identified as having discordant results on review by the Independent Clinical Expert Panel.
445. Deputy Bríd Smith asked the Minister for Health if his attention has been drawn to the fact that a review (details supplied) suggests that twice as many high-grade abnormalities are missed by laboratories contracted to conduct the CervicalCheck screening programme in comparison to the referenced screening programme in the UK; and if he will make a statement on the matter. [51752/19]
View answerThe RCOG Expert Panel noted that the exercise most closely related to its Review is the English Cervical Screening Audit. The Minister notes that the findings of this much larger English Audit bear close resemblance to the findings of the RCOG Review.
As noted in the Aggregate Report of the Expert Panel, amongst the slides originally deemed negative by CervicalCheck, 55.1% were confirmed negative by the Expert Panel Review, which is almost identical to that seen (51%) in the English Audit. Almost 15% of CervicalCheck slides originally reported as negative were reported as low grade by the Expert Panel, compared with around 20% of original negatives in the English audit. 30% of CervicalCheck slides originally reported as negative were reported as high grade by the Expert Panel, compared with just under 20% of original negatives in the English Audit.
Of slides originally reported as low grade by CervicalCheck, the Expert Panel reported 66% as high grade; the rate of low grade to high grade was 47% in the English audit.
Of slides originally reported as high grade by CervicalCheck, there was 99% agreement with only 1% reviewed as negative or low grade, in line with similar findings in the English Audit.
446. Deputy Bríd Smith asked the Minister for Health if the exact same standards of measuring of that which constitutes a discordant slide upon review as opposed to a concordant slide are employed by the ongoing slide review involving cases of cervical cancer in the UK referenced by a college (details supplied) and its own methodology used in a recent review. [51753/19]
View answerThe protocol for the RCOG review is available on the HSE's website.
As noted in the RCOG Aggregate Report, the slides were screened in a manner similar to everyday practice by qualified screeners who held the NHS Cervical Screening Programme diploma or equivalent and had at least 10 years' experience in screening slides prepared with the liquid based cytology technology used in the CervicalCheck programme. Slides were screened according to the local standard operating procedure (SOP) which is designed to ensure all fields of view are carefully assessed with overlap moving across the slide.
