Dáil Éireann díospóireacht -
Tuesday, 20 Apr 1999

Written Answers. - Cervical Screening Programme.

Dinny McGinley

Ceist:

377 Mr. McGinley asked the Minister for Health and Children the action, if any, he is taking to ensure the integrity of the cervical screening programme in view of the revelation that 68 women in the North-Western Health Board area have been given inaccurate results; the steps, if any, he is taking to reassure the integrity and quality control of these tests in the future; and the services and support being made available to the women traumatised. [10361/99]

Minister for Health and Children (Mr. Cowen)

The internal quality assurance practices in Sligo General Hospital include primary screening of all smears; rapid rescreening of all smears; any abnormal smears from borderline up reviewed by a consultant pathologist; all smears from women who have had a previous abnormal smear or those who are clinically indicated are re-checked by the consultant pathologist; review by consultant pathologist of all previous tests for any patient presenting with an abnormal smear.

The errors in the relevant reports were identified as a result of these quality control measures which are currently in place in Sligo General laboratory. The errors in the screening process occurred outside the region.

The main priority for the North-Western Health Board has been the health and welfare of the women directly affected by the situation. The board regrets the trauma caused for the women and their families who have been affected by the errors made by the external laboratory and has apologised unreservedly. The health board considered that in the first instance, the most appropriate means of contacting these women was through their general practitioners. An information pack was prepared, but only as an adjunct to the general practitioners' approach. It was arranged with general practitioners that women who needed a repeat smear would be offered this as soon as possible. A taxi service was contracted to transport the slides directly to the laboratory. A fast track service within the laboratory will ensure that results are available within the week.

For those women who need further investigation by colposcopy, the board considered it important that they should have a choice as to where and when this would be carried out. Three clinics have been organised, one in Sligo and two in Derry, and additionally some appointments were arranged in Dublin where this was more convenient.

Telephone support lines were established, staffed by trained nursing and medical staff. Over 90 calls were received during the four days that they were in operation. Some women required and received follow-up phone calls from the support staff. Further counselling will be made available for women whose general practitioners request it. In partnership with their general practitioners, the board will continue to provide ongoing care and support to all the women into the future.

I want to acknowledge the tremendous support given by general practitioners, area medical officers and other board staff to ensure that the women directly involved received the best possible service. I also wish to acknowledge the support received from Altnagelvin Hospital and consultants at Holles Street hospital. The health board assured me that it will take any and all further steps to support and help those affected in any way.

Following receipt of the health board's report, of the results of the rescreening of the 2,115 smears previously read by a private laboratory, I immediately took steps to identify the extent to which the laboratory was used for cervical cytology. It has been established that no other health board used the laboratory. In the North-Eastern Health Board a voluntary hospital – now in the ownership of the health board – and Beaumont Hospital between them sent some 350 smears to the private laboratory. These smears are in the process of being rechecked and this will be completed this week. I have also instructed the hospitals where the people involved were or are employed to review the smears processed and to take any necessary follow up action.

I am fully committed to the introduction of a national cervical screening programme. I am equally determined to ensure that it will be properly managed, resourced, computerised and that comprehensive quality control is an integral part of the programme at every level. For these reasons the programme is being piloted in the Mid-Western region to identify and resolve any difficulties which might arise. I have instructed senior officials from the Department to meet with the project directors to ensure that the pilot commences screening as early as possible in January 2000. All laboratories have been asked to implement the recommendations of the report of the Department of Health and Children's cervical screening committee which placed a heavy emphasis on quality assurance.

I met last week the chairman of the Expert Advisory Committee on Cervical Screening whose terms of reference include advising the Department of Health and Children on quality assurance. A sub-group of that committee has made much progress on the development of quality assurance guidelines on all aspects of the programme. I have requested that the sub-group meet this week and conclude their work. These guidelines will ensure that quality assurance can be comprehensively addressed. I am determined that they will be implemented and strictly enforced in our cervical cytology laboratories. I am equally determined that a national programme cannot be introduced until the system is geared up to deal with it.

However, as with all screening tests there is a chance that some abnormalities may not be detected. That is one of the reasons why regular cervical smear tests are recommended at minimum intervals of five years. It is also important that laboratories and smear takers do not encourage the taking of smears more frequently than is necessary. To do otherwise contributes to backlogs, which in turn causes anxiety for women and may compromise quality assurance.

Finally, I want to say that I fully sympathise with the women who have had to have their smears retaken and I want to assure them that any further requirements by way of services or counselling will be made available to them.