Dáil Éireann díospóireacht -
Thursday, 24 Jan 2019

Vol. 978 No. 4

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Dara Calleary

Last April and May, the CervicalCheck controversy shook our nation's faith in our health service right to core. The heartbreaking stories of the families, and their courage and dignity in the face of what was facing them was seared on all our minds at the time. The Government and the Minister for Health made many promises in the immediate days and weeks after the controversy broke. It appears now, however, that the gap between those promises and their actual delivery is one into which thousands of women are beginning to fall.

Yesterday, Deputy Micheál Martin raised the impact of increased smear test demand causing backlogs, delay and, ultimately, invalidating several tests because of missed expiry dates. The Taoiseach in response would not or could not give a figure for the number of recall tests as a consequence of those missed dates, despite the fact that my colleague, Deputy Lisa Chambers, had been asking questions at the beginning of December on this issue. Last night, the HSE confirmed to “Morning Ireland” that 6,000 women would have to be recalled for a test as consequence. This underlines the scale of the problem. It is even worse than anybody would have thought yesterday.

This revelation, as well as the manner in which it came out, is once again causing concern. The Government has failed to draw a clear line under the controversy. It made significant promises but did not put the necessary resources in place to back them up. Now, we are in a situation of concern.

On 10 January 2019, through a freedom of information request published in journal.ie, we learned the chief executive officer of Sonic Healthcare, which runs Medlab Pathology and which handles 50% of samples sent in through CervicalCheck, wrote to the Minister for Health on 15 June 2018 looking for what it termed his urgent intervention to address the unprecedented number of samples. It warned him that without immediate action it believed the future viability of the cervical screening programme would be in jeopardy. The Minister, however, did not act with any urgency about this.

On 18 October 2018, Deputy O'Reilly asked the Tánaiste during Leaders’ Questions about the issue and the backlogs. Again, the Tánaiste acknowledged there was a difficulty, gave words of comfort but nothing came of that in terms of extra resources or an action plan.

The hike in demand as a consequence of the changes last May has led to a massive delay and is undermining the system. We all believe in this essentially important scheme and want to restore confidence in it. Once again, it is under significant pressure, however. A rushed decision, not backed up by proper resources, has us back at this point again. The Minister, despite many warnings, has put his head in the sand about dealing with it.

How long have the Minister for Health and the Government known of the need for a recall test of the 6,000 women in question? When was the Taoiseach informed about that particular figure? What measures is the Government taking? I was in contact with GPs this morning. The first they heard about this issue was on “Morning Ireland” this morning. They are the first port of call for people who hear that story. What actions is the Government taking in this regard? Will the Minister for Health publish all of the medical advice he received before he took the decision to launch the free smear test process? Will he come into the House to take questions from health spokespersons on every aspect of this issue? More importantly, will he take questions on his plans to restore confidence in this considerably important programme?

The Tánaiste

I thank the Deputy for raising this issue and giving me an opportunity to provide some clarity and, I hope, some reassurance to women concerned about this issue. Before answering the Deputy’s political charges and questions, I want to reassure the many women who understandably want to know exactly what is going on.

In May, the Minister for Health made the decision to offer free out-of-cycle smear tests to women who were concerned about their health following issues which had emerged regarding the CervicalCheck controversy. This decision was made in good faith to address the considerable fears of many anxious women throughout the country. The Government’s approach has always been to seek to provide reassurance to women and to be fully transparent about that. This clearly heightened concern and awareness around CervicalCheck, and the offer of free out-of-cycle smear tests has contributed to capacity issues - it is not a resource issue - resulting in the emergence of a backlog. We know that because it has been raised multiple times in the House.

The new issue which has arisen is separate to that backlog. It is entirely inaccurate to claim that the repeat smears which women were offered have expired. The new issue is separate to this and relates to one company only of the three involved in providing screening services. Quest Diagnostics has advised CervicalCheck of a specific problem with standard human papillomavirus, HPV, tests which have been carried out outside of the manufacturer's recommended timeframe since secondary HPV screening was introduced. The HSE's clinical review has assured women that this poses very little risk to women's health. Evidence shows that HPV tests of this kind are effective outside of manufacturers’ recommended timeframes.

However, as a precaution, the HSE will be writing to women to attend their GPs for repeat smear tests to confirm the results and to provide them with the reassurance to which they are entitled. The HSE expects up to 6,000 women are likely to be recalled for a repeat smear. These tests will be processed by the laboratory as a priority.

Regardless of the politics of this issue, all in this House have an obligation to reassure women and give accurate information on what is being discussed and how we are going to solve it. Priority number one is to reassure people. The Minister for Health is not available next week but is happy to come into the House the following week to take questions and to give a detailed statement to respond to any of the queries which the Deputy may have.

Deputy Dara Calleary

The Tánaiste spoke about reassurance and about providing full transparency. These are essential to rebuilding trust and confidence in this necessary programme. This information, however, has had to be dragged out yet again. It was not provided through the HSE or primary care practitioners but on “Morning Ireland”. Surely the first port of contact should not have been “Morning Ireland”. The Government was made aware of the second issue in November. It is now the end of January. There would have been no attempt to communicate if it had not been for the questions that Deputy Micheál Martin asked in the House yesterday. This morning the director of the screening programme said the demand and the backlog of tests is one of the reasons that this second issue was exposed. There is a link.

The most important thing is that we restore confidence.

The Minister may not be available but it is essential that a junior Minister would come to take questions as we do not have ten days. We need to restore confidence immediately.

Deputy Mattie McGrath

Hear, hear.

Deputy Dara Calleary

The issue of capacity in the labs is essential and the Government cannot continue to say there is a capacity issue while not outlining any plan to deal with it. I understand one of the labs has reduced its staff complement from 16 to four; demand for screening has gone up by a third but it cut staff by 75%. As the Government was made aware of the backlog on 18 October, what did it do to get extra resources to address what the Tánaiste has defined as a capacity issue?

The Tánaiste

Let me reassure the House that this is not a resource issue. When I say it is a "capacity issue", I refer to the capacity in the labs. At a GP level, doctors have coped extremely well with the significant increase in the demand for smear tests and out-of-cycle smear tests offered without charge. My understanding is that the challenge has been at the lab level, and this is not about resources; rather it relates to the capacity of labs with regard to testing and throughput.

The Deputy is giving the impression that somehow the Government is trying to hide something and we would not be talking about this if it had not been for the Fianna Fáil leader raising it yesterday. That is not true. The HSE stated it was made aware of this matter in November and the Minister was made aware of the issue with secondary HPV testing in December. The issue was discussed at the CervicalCheck steering committee, including with patient representatives who are working very hard on that committee on the range of issues involved and outlined in published weekly reports. The Minister sought regular updates but a final report was not available to him relating the numbers involved or who they were. When the matter was raised yesterday, he did not have the information and could not provide it until it became available.

Deputy Dara Calleary

It was three hours later.

Deputy Pearse Doherty

In the past fortnight we have, regrettably, borne witness to the fact that the health service is in complete chaos. The cost of the proposed national children's hospital is spiralling out of control and will have serious impacts on other health projects over this year and beyond. On Tuesday, 500 ambulance personnel staged a strike because the HSE bluntly and blatantly refuses to recognise the union seeking to represent members. There is now a scenario where thousands of letters are being delivered to patients, many of whom have waited for long periods, telling them surgeries have been postponed because of the inevitable industrial action from nurses and midwives because of the Government's continued failure to address a recruitment and retention crisis. To top all of this, in the past 24 hours another CervicalCheck scandal has emerged, as serious issues have arisen relating to the screening programme. We have a health service that is in a state of constant chaos, and nobody on the Government benches seems to be willing to accept the seriousness of the position.

The latest developments concerning CervicalCheck will be a source of serious concern and worry for many women. We have been assured the risk to women is low but it is yet another example of the incompetence that prevails in a chaotic system. Guaranteeing free smear tests for all women in the aftermath of the CervicalCheck scandal was the correct action but the Minister, Deputy Harris, announced that move without first consulting with GPs or labs. Ensuring the labs had the capacity to deliver on the increased workload and complete the tests within the necessary time would have been correct as it would have avoided the problems we now see. Lo and behold, we are now witnessing serious issues again.

When this scandal was its height last year and people were demanding information and accountability, the buzzword was "confidence" and we can hear it again today. Building public confidence in the cervical cancer screening programme is necessary as we know screening saves lives. Problems like this, however, rock the confidence of people in the process. We have been told that the Minister, Deputy Harris, was informed in December but will the Tánaiste be a bit more specific about when the Minister found out that the screening was inadequate and retests would have to be done for up to 6,000 patients? Why will it be February before these women can be informed that they need to have another test? That will be two months later so what has the Minister done in the intervening period? Why is it so late in the day while women have not been informed that the information they may have received on their second test - this would have been done because of a potential abnormality in the first test - could be inaccurate because it was done outside the timeframe stipulated by the manufacturer? How can we be assured that this is the end of the matter and no more women will get a letter to the door or a phone call from a GP telling them information relayed to them relating to life-saving screening may be inaccurate? Will the Tánaiste answer those questions and clarify for those concerned women out there that this is the end of the matter, a line has been drawn under it and we can now move on?

The Tánaiste

Managing a health service in any country always throws up significant challenges at different times because mistakes are made and need to be fixed. Lessons must be learned and we must constantly improve how we provide healthcare services. Those challenges are consistent across every developed country. We spend €16 billion per year on healthcare and there is a constant demand for change and improvement. When mistakes are made, the Government must be held to account in how it fixes those errors and learns lessons from them. The cost overrun for the national children's hospital has been mentioned and we have commissioned PwC to look in detail at how that has occurred.

Deputy Brendan Howlin

That will be another €500,000.

Deputy Dara Calleary

It is €450,000.

The Tánaiste

We need to pay for that to ensure the job is done properly. That is instead of trying to score political points on the back of getting a proper and professional piece of independent work to ensure we get an accurate assessment of what happened and we can learn lessons for other projects. The Deputy mentioned the potential nurses' strike and that is before the Workplace Relations Commission, the machinery of the State, and I hope it will be able to bring sensible proposals that can be the basis for an agreement to avoid the significant impact on patients that strike action would bring. We all hope that will be possible.

The CervicalCheck matter has been very demanding, particularly for so many women and their families who have felt its impact. It has also had an impact in the Department of Health, the HSE and the Government, and we are ensuring we are doing everything we can to protect a screening service that saves lives while putting in place the necessary changes to improve it. We must ensure all of this is transparent. It is what we have been trying to do and will continue to do.

The Deputy mentioned secondary testing where low-grade changes have been detected on a cervical smear test. A second so-called triage test that looks for the HPV virus is carried out by laboratories in those cases. An issue has emerged with one of the three labs involved and we are working to correct it. We will continue to do that.

Deputy Pearse Doherty

The Tánaiste did not answer any of the questions I asked. When did the Minister, Deputy Harris, become aware of this? Will the Tánaiste be more specific than just telling us it was in December? What did he do about it? How come we are now in late January and 6,000 women who now need a repeat test have still not been informed? Has the Minister been assured that this is it and there will be no more than 6,000 affected people out there? Will he assure us of that? From what time did this laboratory, Quest Diagnostics, make such a mess and how did it get things so wrong? The director has told us that despite the lab being aware of this in November, it still does not have a clue how this happened.

Mistakes have occurred and will continue to happen in the health service but we have just emerged from a major scandal and many women are still dealing with its consequences. People have lost their lives because of the CervicalCheck scandal and now we have found out that another 6,000 women must have a secondary test done again because the laboratory got things wrong. What happened and why did the Minister not bring this to the attention of the Dáil?

What did he do? How can the Tánaiste assure us that we should have confidence? We need to know that somebody has a grip on this in government and we need to know how it went wrong so I ask the Tánaiste to answer my specific questions. Can he also tell the women in question when they will be contacted?

The Tánaiste

The test for HPV should be carried out within 30 days of the sample having been given by a woman. This is the secondary test when low-grade changes are detected. The HSE is working with Quest Diagnostics, which is one of the three laboratories used by the cervical cancer screening programme, to address the situation that has been identified regarding HPV tests. Of the approximately 500,000 samples tested by Quest since 2015, the HSE has advised that some HPV tests have been performed outside the recommended 30-day timeframe. I am assured that this issue affects a very small portion of people, approximately 1%, of the tested total. There will be cases where this means that a woman who has already had a test will be written to and requested to present for a re-test on a precautionary basis. The HSE will write to those women and their GPs next week to request that they return for a further test. It is expected that up 6,000 women will be invited to attend for a repeat test. These tests will be processed by the laboratory as a priority. The HSE has advised that all of the evidence suggests that even though the test was done outside of the 30-day window, the original results are still very reliable. Consequently, can we please try to reassure people here that there is no cause for undue concern? This is about full transparency because that is what patients should be entitled to expect. It is about correcting a mistake that should not have happened and giving women reassurance through a repeat smear test. The information I gave earlier to this House is that the HSE became aware of this issue in November. The Minister became aware of it in December, had discussions on it, has asked for reports relating to it and has not yet received a complete report on it. Consequently, the information I am giving to the House today is current.

Deputy Brendan Howlin

This is Cervical Cancer Prevention Week. The Tánaiste is right; all of us in this House support medical screening for the early detection of cancer and other diseases. The medical evidence that screening saves lives is overwhelming and we all need to ensure that we encourage men and women to avail of all screening opportunities. In that context, it is essential that we and the public have full confidence in all our screening systems, including CervicalCheck. However, there has been a litany of problems. We know of the suffering and courage of the group of 221 women and we will continue to press the Government to respond to their needs. We now see that 1,000 smears have been compromised over the summer due to delays. The smears were waiting too long in the queue to be examined in the laboratory and now women need to have those smears repeated. In the latest twist that was unveiled yesterday, it appears that a further 6,000 tests, a figure we received only late last night, are compromised due to HPV testing in the same laboratory, which has led to technical problems that, again, require those 6,000 women to endure a repeat test. The delay in getting the cervical smear test is now 22 weeks according to the HSE. If there are problems with the check and a re-check is required, this results in a further delay of 22 weeks. Many women are availing of private healthcare options to get a faster check but that is not an option for everybody. It is another example of the two-tier system. I was contacted by somebody today who said that when she was told about this inordinate delay, she was advised that she could get a fast test if she paid for it.

Delays in CervicalCheck are also causing delays to life-saving procedures. For example, if women are to get a number of other medical procedures such as kidney transplants, they need up-to-date smear tests. The delay in getting that check can cause delays to other life-saving procedures. How much scandal can the screening programme take? We are in favour of screening but the problems besetting CervicalCheck indicate that something is deeply wrong. These problems are further eroding confidence in screening and people are anxious.

On behalf of the Government, can the Tánaiste confirm how much additional funding was allocated to CervicalCheck last year? Will the Government commit to full staffing and funding so that we can get CervicalCheck back on track and delivering the quality service we all want? As a result of what has happened, as an emergency measure will the Government undertake to refund the cost of private checks, which might be of the order of €100 to €200 per patient, to address the backlog and remove the inequality between those who can pay privately and those who cannot?

The Tánaiste

Regarding the question about how much scandal the screening programme can take, it is up to this House and the Government to deal with the issues that have emerged and to ensure that we move from scandal to reassurance. This is what the Scally report and the support packages for victims of this scandal were all about and that is what the Minister for Health has been trying to do, in my view, effectively, to bring order to how we respond to this in an appropriate way. The Deputy talks about scandal. We can contribute to that scandal and that sense of fear and uncertainty if we do not respond appropriately in this House and create fear unnecessarily. We have a new issue that we did not know about and which needs to be addressed. It was raised with the Minister in December-----

(Interruptions).

The Tánaiste

No, it was raised with the Minister in December and was subsequently raised in the CervicalCheck steering committee. It is appropriate that patients' representatives and the steering committee would be the first to hear about this and that patients themselves would hear about these issues before the Dáil hears about them.

(Interruptions).

The Tánaiste

Yes, they did.

The Minister asked for and was awaiting a report in terms of the detailed numbers on this issue when it was raised yesterday and became a political issue in the Dáil. That is why we have had to respond today in the way that we have.

Deputy Brendan Howlin

Words lose their meaning if the Tánaiste does not apply the word "scandal" to what happened to women involved in CervicalCheck last year.

The Tánaiste

I did apply that word.

Deputy Brendan Howlin

He is talking about me using the word today as if it was inappropriate and was raising fears.

The Tánaiste

That is not what I said.

Deputy Brendan Howlin

That is what it sounded like. The issues that arose last year require at least this lesson to be learned, which is full transparency. We must treat people in this country as adults who deserve to know the full facts about their own healthcare. Women have yet to be given information the Tánaiste said the Minister for Health had since December. The Tánaiste also said that-----

The Tánaiste

The Deputy should not mislead the House.

Deputy Brendan Howlin

The Minister was told there was a problem last December.

The Tánaiste

But he did not have the full details.

Deputy Brendan Howlin

The Taoiseach could not give the numbers yesterday when he was asked for transparency in this House, yet they were available three hours later to be given by the HSE. Is it that the HSE does not talk to the Minister or Government? After what happened last year, we need to know the full facts. I asked three specific questions. Since the Tánaiste will not have time to answer them here, could he respond to me in writing to deal with the anxieties of women and the inequalities facing those who cannot afford to wait 22 weeks for a result?

The Tánaiste

Let me clarify what I said. I said that the way in which this House responds to scandals like this either adds to the scandal and the sense of uncertainty and fear that many women face or has the opposite effect. In all the decisions it has taken, all the reports for which it has asked and all the recommendations from experts for which it has looked, the Government has always focused on full transparency and trying to reassure women about their healthcare. That is what we are doing here.

My understanding is that when the Minister was informed that there was an issue, he was not given details in respect of numbers or details of who those patients were. He did not have that information and so could not share it. The issue was discussed with the CervicalCheck steering committee which, of course, does include patient representatives and other experts. The Minister asked for a detailed report on this issue so that he would be fully informed. He did not have that and so could not provide it to the House. That is my understanding but the Minister, who is on paternity leave at the moment, is happy to come in and answer all the questions the Deputy would like to ask of him regarding political accountability on these issues as soon as he returns to the House the week after next. This morning, however, let us try to provide some reassurance, on the basis of the medical advice we have, to women who may be concerned today and who may be getting letters in the post next week regarding the repeat smear tests they will be offered.

Deputy Michael Harty

I wish to raise the issue of how Ireland is responding to its obligations to balance its ability to generate sufficient power to satisfy its needs with its obligations in respect of decarbonisation and climate change. It is Government policy that the ESB's coal-burning power station at Moneypoint in County Clare will cease production by 2025. Moneypoint is an old coal-burning station, which at its full capacity has the capacity to provide 900 MW of power and which plays a very important role in electricity generation in Ireland. It provides a cheap, stable source of electricity. The closure of the plant at Moneypoint presents the Government with a major problem in maintaining sufficient production of reasonably priced energy for a growing economy while meeting its international climate change obligations. According to EUROSTAT, the cost of producing electricity in Ireland in 2017 was quite high. Burning coal leaves a huge carbon footprint, which results in Ireland facing large fines of up to €600 million for missing its carbon emission targets and climate change obligations. Emitting greenhouse gases comes at a price.

What will replace the power station at Moneypoint in 2025? How will the ESB replace its capacity to generate power if the station is closed completely? What are the plans in that regard? Can Moneypoint be converted into a station which uses an alternative source of energy such as biomass or gas? Can electricity generated from renewable sources such as offshore wind energy and tidal energy, which is available in abundance in the Shannon Estuary, be harnessed and channelled through Moneypoint? Can the station be used as a landfall location for electricity produced from such renewable sources?

Moneypoint is an important part of the electricity grid structure, the high-voltage lines of which radiate across the country. The question is whether it can generate enough renewable energy to replace that generated by coal. Will the Tánaiste give me an indication of what the Government plans to do in respect of the plant at Moneypoint, which will cease burning coal in six years? We need to be proactive on this matter and not wait until the last minute.

The Tánaiste

I am glad the Deputy asked this question because this action is one of a series of significant measures the Government is pursuing to reduce the amount of emissions coming from this country and its economy. Moneypoint, and energy generation generally, is a little different because it is in the traded sector and so does not have as direct an impact in terms of our national targets as do other emission sources. Having said that, it is inappropriate to produce power from coal any longer. We have to give the ESB the time to find viable alternatives that can use the significant grid infrastructure that connects Moneypoint across this country. The station is connected to two 400 kV lines and is the most significant piece of electricity grid infrastructure we have so we should be using it in the future to transport power around this island. However, we have to find alternatives to coal in order to do that. It is up to the ESB to work with the Minister, Deputy Bruton, to find alternatives that use the grid to its full capacity and that recognise the employment challenges that may come from a move away from generating power from coal.

There are multiple opportunities arising from renewables, both onshore and offshore; from gas, which is an awful lot cleaner than coal although it is still a carbon fuel from which we need to move away; and from biomass, where there certainly are opportunities. However it is up to the ESB to come up with viable commercial alternatives that can protect employment in the region and that can use the existing infrastructure, just as it is up to Bord na Móna to do so with respect to the transformation process in which it is involved. It is worth noting that the ESB announced this week that it is engaging in the development of a very significant offshore wind project off Dundalk. This will be a very significant contributor of renewable energy to the Irish grid in the future. This is the change that is happening. The use of coal to generate energy must end by 2025 but we need to use the infrastructure which has been built up over many years and which will still be part of our power solutions.

Deputy Michael Harty

I thank the Tánaiste. He obviously understands the difficulties, particularly those facing Moneypoint. The question is really what are the alternatives? I know that the ESB is to produce a report on how it will use alternative energy sources in electricity generation at Moneypoint but we have to have a clear pathway in respect of how those changes are going to occur. There is potential for renewable energy, the question is whether there is going to be sufficient renewable energy which can be channelled through Moneypoint.

I have another question on an area in which the Tánaiste may be an expert. On Brexit and interconnectivity with the UK and Northern Ireland with regard to delivering electricity to this country, what will be the effects of Brexit on electricity sources in Ireland? Finally, the Tánaiste mentioned that this measure will have profound implications for employment in County Clare. The power station at Moneypoint is responsible for approximately 400 jobs in west Clare. How will those jobs be replaced when we move from coal to some other form of energy generation? Will they be protected? Will other employment opportunities be generated from Moneypoint?

The Tánaiste

Deputy Harty has raised many very valid questions. On Brexit, we plan to publish the heads of the legislation which is being prepared for a no-deal Brexit later on this afternoon. One of the 17 heads of that Bill addresses the single electricity market. It is not the only response required in that regard but an element of the response to the challenges we would face in respect of the single electricity market in the event of a no-deal Brexit is included in that legislation.

I am very familiar with Moneypoint. I have visited it on a number of occasions. I was previously the Opposition spokesperson on energy. Of course the ESB faces challenges in this area in terms of finding viable alternatives to coal, supporting its employees, and ensuring that the infrastructure that has been built and which connects Moneypoint remains a key positive factor in terms of grid management and electricity supply in the future. I believe that enormous opportunities for job growth in County Clare and the west coast generally will arise from offshore renewables in the future. The ESB will obviously come back to Government with a specific plan, as has Bord na Móna, with regard to how it proposes to move away from coal as a power source and towards alternative fuel sources which will be more climate-friendly.