I propose to take Questions Nos. 27, 51, 64, 68, 86 and 111 together.
I am fully committed to the national roll-out of a cervical screening programme in line with international best practice to reduce incidence and mortality from cervical cancer. My Department is in detailed discussions with the Health Service Executive in relation to the most efficient and cost effective way to deliver a national programme. The plan is to have cervical screening managed as a national call-recall programme via effective governance structures that provide overall leadership and direction in terms of quality assurance, accountability and value for money. All elements of the programme — call-recall, smear taking, laboratories and treatment services — must be quality assured, organised and managed to deliver a single integrated service. I am convinced that we must also have in place tailored initiatives to encourage take up among disadvantaged and difficult to reach groups. I made available an additional €9 million to the executive for cancer services development in 2006, including the continuation of preparations for a national programme.
I consider that the programme should be best rolled out in the primary care setting, subject to affordable and acceptable arrangements being agreed. A review of the contractual arrangements for the provision by general practitioners of publicly-funded primary care services is being conducted at present under the auspices of the Labour Relations Commission. I have requested that the general practitioner elements of a national cervical screening programme be tabled at these discussions. Any remuneration arrangements agreed must be capable of delivering a high uptake among women. Payments must be primarily based on reaching acceptable targets. The actual costs of the programme will depend significantly on the level of primary care fees, the screening intervals agreed and maximising laboratory efficiencies, including the application of new technologies. I wish to see the programme rolled out as quickly as possible but only when the essential infrastructure, organisation and services are in place that are quality assured and meet international standards.
Cervical smear testing is not currently provided by GPs under the scheme for medical card holders. However, where cervical smears form part of recognised protocols for the ongoing treatment of individual patient illnesses, they should be provided free of charge to eligible women under the GMS scheme. Any necessary follow-up treatment is available to all women, including medical card holders, within the public hospital system.