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Leah Farrell

Former CervicalCheck boss says Harris was warned that offering extra smear tests could cause delays

Micheál Martin said the decision was made by the government to “save their own skin and cover their own tracks”.

LAST UPDATE | 3 Apr 2019

THE FORMER CLINICAL Director of CervicalCheck, Grainne Flannelly, is to tell the Oireachtas Health committee that she had warned Health Minister Simon Harris about the challenges in offering additional smear tests to women.

Among the advice Flannelly offered was that additional (or out-of-cycle smear tests) would be “difficult to plan for and difficult to deliver sufficient capacity to avoid longer waiting times for results”.

On 28 April, Harris offered women who had availed of the national screening programme an additional free smear test to ease their concerns in the wake of the CervicalCheck controversy.

Harris has been criticised for making this offer without allocating additional resources to healthcare services. The backlog, which reached a peak of 83,000 in January, has led to 1,000 women needing repeat smear tests due to their sample expiring. 

Representatives of the HSE and CervicalCheck are due before the Oireachtas Joint Committee on Health from 9am today to give an update on the latest figures on the CervicalCheck programme and the implementation of the Scally report.

Flannelly is to tell the committee that at the end of April 2018, the head of screening at the National Screening Service Charles O’Hanlon informed Flannelly that the Department of Health had asked for their thoughts on offering out-of-cycle smears.

Flannelly said that she and O’Hanlon offered the following advice:

1. General Practitioners would not be able to be paid for this service as there was no mechanism for payment of out of programme tests
2. Laboratories would not have sufficient capacity – already laboratories had issues with recruitment and retention of cytologists
3. Colposcopy services will not have sufficient capacity, as capacity for new colposcopy was based on the number of women screened.
4. Most importantly, it would fundamentally undermine the screening programme.

In response to a parliamentary question from Fianna Fáil’s health spokesperson Stephen Donnelly, Harris said that he had not received advice prior to announcing the free smear tests:

Neither I nor my officials received advice that recommended against these tests in advance of the decision.  Subsequent to the decision, on foot of telephone contact by the Department, the National Screening Service raised a number of concerns verbally.

“Following the announcement, the Screening Service set out concerns in an email to my Department, which related to uncertainty about costs, volume, impact on turnaround times, impact on perceptions of the programme’s accuracy, challenges with processing GP payments, and the potential difficulty in ceasing the arrangements in due course.”

Harris made the announcement on 28 April; Flannelly said the National Screening Service were first contacted on 28 April, and they responded on 29 April. 

‘Save your own skin’

The issue was raised during Leaders’ Questions in the Dáil this afternoon. Fianna Fáil leader Micheál Martin said the government’s decision to offer repeat smear tests was wrong and done to “save their own skin and cover their own tracks”.

Martin said the decision “reeked of panic”, adding that the response of Harris and Leo Varadkar to the situation “lacks character”.

He told the Taoiseach the decision was made “to save your own skin because you panicked”.

leo Taoiseach Leo Varadkar during Leaders' Questions today. Screengrab / Oireachtas.ie Screengrab / Oireachtas.ie / Oireachtas.ie

Varadkar defended the move, saying the government was reacting to women’s genuine concerns and that a number of doctors, and members of the opposition, had called for repeat smear tests to be offered.

“The reality at the time was that there were a lot of women who were really concerned about the accuracy of smears,” he said, adding that Harris has already addressed the issue in the Dáil.

He said he expects the CervicalCheck backlog to improve in the coming weeks and months. 

HSE apology and 33-week wait

The HSE is set to apologise for the “regrettable and unacceptable delays” women have been facing in receiving their smear test results, which have been partly caused by offering these extra smear tests, at the committee hearing today. 

The HSE is to tell the committee that the maximum waiting time women now face before getting their smear test results is 33 weeks; that’s up from 2-4 weeks before May 2018. The average wait time is 15 weeks.

The HSE has said that while the delay is “undesirable”, that it poses a very low risk to women, as cervical cancer usually develops over a period of 10 to 15 years.

It did, however, add: “The HSE remains extremely conscious of women’s concerns regarding cervical screening over the past year and in particular women’s anxiety due to the delays in reporting on smear test results.

We are very sorry for these regrettable and unacceptable delays and remain committed to seeking solutions which will reduce women’s waiting times.

On the 28 March, there were around 79,500 tests waiting to be processed; that figure hasn’t changed much since January when there were 82,000 smear tests. Before the CervicalCheck controversy, the HSE says there was around 23,000 smear samples “in progress at any one time”.

Tackling the delay

The HSE has taken a number of measures to attempt to decrease the backlog: this includes prioritising certain samples, which includes smear tests from “high risk groups such as colposcopy”, and smears approaching the six-month storage limit, which are then tested for HPV before expiration for those tests.

The HSE has also made extensive efforts to source additional laboratory capacity, including in other countries.

Damien

Damien McCallion, the National Director of Screening Services at the HSE told the Committee today that of the number of women who availed of smear tests between May and December, a third are women who had not availed of the service and two thirds were women who had availed of the programme before.

Repeat smears

In an attempt to strengthen trust in the CervicalCheck programme, available for free to women aged from 25-60, Health Minister Simon Harris announced last year that women who had received a smear test could get a repeat done for free.

This offer was available between May and December last year; it has cost €9.6 million and today it was announced that the number of “early” smear tests was 57,810.

Concerns about the programme had been raised after 221 women who had been diagnosed with cervical cancer in the past 10 years were not told that their past smear tests had been audited, and was found later to have been interpreted incorrectly.

Since then, campaigners such as Vicky Phelan, Emma Mhic Mhathúna, Orla Church, and Stephen Teap, whose wife Irene died of cervical cancer, have all been fighting for improvement of the CervicalCheck programme, while also highlighting its importance in identifying abnormalities and its role in saving women’s lives.

Since then, changes have been made to the programme – in his February report, expert Dr Gabriel Scally said that he was “very encouraged by progress to date” in implementing the recommendations from his September report.

With reporting by Órla Ryan 

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56 Comments
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    Mute andrew sutton
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    Dec 29th 2016, 8:20 AM

    Customers can already self exclude and need to be 18 to enter a betting shop. A total BAN on the ” virtual product” including all racing ( horses, cars, dogs, bikes, football) and numbers generated games like the bingo and roulette needs to introduced. Most of the major shops in this country are making their huge profit in theses areas of gambling. As a former employee of 15 years ive seen with my own eyes the problems people have with it.

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    Mute Alan Ball
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    Dec 29th 2016, 8:32 AM

    @andrew sutton: much of what you say is true.I do believe that the consultation of people who were in the industry be seriously considered.I somehow doubt that they will consider such consultation feasible.Legislation appears for discussion regularly in the dail that seems to be the product of virtual research,take the HSE as an example…..Let’s ask a lot of administrative people the best way to utilise nurses and junior doctors. We all know how that works out.

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    Mute gold3n
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    Dec 29th 2016, 8:46 AM

    You are 100% right Andrew, plus with the self exclude all the responsability is put on the customer and the bookies take none. They pray on the lower class areas, look at the amount of bookies in and around the Henary street area compard to Graffton street. Paddy Power have 8 shop’s within an half mile of the spike .

    23
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    Mute Dave O Keeffe
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    Dec 29th 2016, 9:06 AM

    Why is the national lottery excluded? They made it even more of a mugs game by upping prices and increasing the number of balls this year. Scratch cards need to be included

    55
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    Mute Anthony Toby Kielthy
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    Dec 29th 2016, 9:25 AM

    Absolutely dave , also ” amusement ” arcades , the amount of under 25s losing their proverbials in these places is nauseating .

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    Mute Jim
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    Dec 29th 2016, 8:42 AM

    As a person who likes a bet every couple of weeks think it would be a good idea to get rid of online gambling with credit/visa cards.Let people top up in the betting shops with their customer cards and then use that to log on and bet online if they wish.All they can then bet is whats on their account.We all think alot more about what we spend when we see the money in our hands before its passed over the counter.Far to easy to bet online as it almost doesn’t feel like real money if that makes sense.

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    Mute gold3n
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    Dec 29th 2016, 8:54 AM

    Maybe even a national betting card with a limit. You put in you’re code and once you have gone over you’re monthly amount you cant gamble any more.

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    Mute John Weldon
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    Dec 29th 2016, 9:07 AM

    @Jim: Sounds like a thoroughly Irish solution, we should do the same with alcohol, cigarettes, fast food, luxury goods. Don’t mind that thousands of people do it every day without a problem. Lets screw everyone because of the few that take it too far.

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    Mute Damien Kirwan
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    Dec 29th 2016, 9:16 AM

    Spot on John

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    Mute Jim
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    Dec 29th 2016, 11:31 AM

    To be fair John, If you’re betting every day then it’s safe to say it is a problem.And it’s more than a few that take it too far.Its too easy to conceal a gambling addiction whereas with drink, cigarettes and drugs the signs are generally obvious.

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    Mute Scundered
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    Dec 29th 2016, 8:04 AM

    All it takes is one look at the clientele who attend the bookies on a regular basis to know it’s a losers game. The wealth of Paddy Powers alone should get the message through.

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    Mute John Donovan
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    Dec 29th 2016, 8:12 AM

    you are a moron if you are judging people by their looks and how regular they attend a bookmakers. having worked in many some years ago and known the clientele personally i can verify there is a wide array of people who frequent these eatablishments.

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    Mute Alan Ball
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    Dec 29th 2016, 8:16 AM

    @Scundered: interesting comment.You should read the article above,it is close to the subject you seem to be commenting on.
    That is the point of the comments section….Read article and then express a view.
    As an aside ,I doubt very much if you are a stranger to a bookies.There is more than a little latent bitterness in your ‘comment’.

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    Mute Drew TheChinaman :)
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    Dec 29th 2016, 8:33 AM

    As the saying goes ‘The house always wins.’ If they didn’t, as you rightly point out they wouldn’t be in business long.

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    Mute Alan Ball
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    Dec 29th 2016, 8:06 AM

    The government appears to be dragging out this much needed legislation. Self exclusion has been around for quite a while,5 years or so.Some of the practices employed by the online companies are criminal,almost.They will take a lot of study and I personally do not feel this government is committed to the completion of this legislation in any reasonable time frame. It is a cash cow and tax revenue will always trump social needs regardless of the damage to members of society.

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    Mute Vincent Jennings
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    Dec 29th 2016, 9:38 AM

    Over 10 years ago, a Fine Gael senator attempted to introduce a Private Members Bill that would have closed off the availability of the Tote at racecourses and dog tracks to under 18′s.
    The Bill was supported by Gamblers Anonymous but the Fianna Fáil led Government opposed it.
    The same Senator became Leader of the House in the previous administration but chose not to prevail on the Cabinet to change the law.
    Under age gambling is illegal in bookies shops and also National Lottery products yet every day youngsters attending horse and dog meetings are entitled to bet courtesy of the State-sanctioned Tote cartel. Go figure.

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    Mute Pilib O Muiregan
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    Dec 29th 2016, 11:56 AM

    @Vincent Jennings: In fairness if under 18s are placing bets at race tracks etc its not upto the government to stop them. Parents have to take some responsibility here.

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    Mute John Jones
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    Dec 29th 2016, 4:40 PM

    Paddy power will let u bet and bet but as soon as you try to withdraw money it then closes you’re account and then looks for I’d. It should be id first

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    Mute eastsmer #IRExit
    Favourite eastsmer #IRExit
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    Dec 29th 2016, 2:55 PM

    In 1967 when I was a kid, I placed a bet for my Granny in the local bookies on the Grand National.
    It didn’t turn me into a gambler, in fact I don’t think I have ever been into a bookies since.

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    Mute JJ Woods
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    Dec 29th 2016, 1:12 PM

    The Gambling Control Bill in it’s present state is not ready to legislate on .

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