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WOMEN WHO HAVE been referred for colposcopies after their GPs noticed abnormalities in their cervixes are being told they will have to wait months for an appointment because of the backlog created by the CervicalCheck controversy.
One woman who was informed in June that she needed a colposcopy – a procedure used to examine the cervix – was told that she could be waiting more than six months for an appointment.
The woman who spoke to TheJournal.ie said her GP noticed a visual abnormality during her smear test in June.
“I was told that normally, before the scandal, you’d be sent to the clinic for the colposcopy without needing the smear results back. But now it’s changed and they won’t see me until the results of the smear come back. I was told the waiting time was 6.9 months for the results,” she said.
I’m lucky to be able to afford private health insurance so I am getting a referral to a private gynaecologist in the meantime so I can get checked out.
“Particularly with womb cancer the odds aren’t great and the whole idea is to catch it before it goes too far. If they can actually see something that might not be right when they examine you, I don’t see the logic in stalling until you get the smear results.”
‘Huge waiting lists’
A consultant in one of the country’s 15 colposcopy clinics told TheJournal.ie that GPs are “understandably more cautious now” and are referring more women when they notice potential visual abnormalities in the cervix.
As a result of the Minister for Health’s decision to offer repeat smears to every woman in the country, there are also more abnormal results coming back that require a referral for a colposcopy.
“These two factors combined have resulted in a large increase of numbers of referrals to colposcopy clinics, which now all have huge waiting lists to work through,” the consultant said.
“Strictly speaking the colposcopy clinics are there for people with abnormal smears, not for people with abnormal looking cervixes, but previously they would have been seen at the clinic anyway because that’s the best place for them to be seen.
We had the capacity to see them in the clinic and still be able to see patients with abnormal smears in an appropriate time frame , but now we can’t because of the increased number of patients.
He said because of the way the screening programme operates, clinicians have to prioritise patients with abnormal smear tests over patients who are referred because of visual abnormalities.
Now when a GP refers the woman because of a visual abnormality, in many cases they are being told the clinic has to wait until the smear test results are back, which now takes months.
‘The system couldn’t cope’
The consultant said these patients could be referred to a gynaecologist outside of the colposcopy clinics instead, but these clinicians would not have a colposcope and would likely end up referring the patient on to one of the clinics anyway.
“The general gynaecology clinics have their own capacity issues and large waiting lists,” he said.
He said the backlog with smear tests is also resulting in delayed diagnoses and gave one example of one of his patients whose “smear took such a long time to report that when the result arrived she ultimately had cancer”.
“There is now a long waiting list of people to be seen in colposcopy who could have cancer.
The last year has been major challenge in trying to see patients in the clinics in an appropriate time frame.
He said the decision by Minister Simon Harris to offer repeat smear tests without the adequate resources in place was a “naive” move.
“It undermined the screening programme and resulted in a huge surge in referrals which the system couldn’t cope with.”
In a four-hour session, the consultant said he is now seeing 16 patients. He said he is hearing the same problems from colleagues at clinics all across the country.
He said the HSE has provided more resources but it will take time for them to get a handle on what exactly is needed to tackle this massive addition to the workload.
The HSE did not respond to a request for comment on these delays.
Smear test backlog
Yesterday the HSE apologised to 800 women who did not receive their smear test results because of an IT glitch.
The issue occurred at Quest Diagnostics Chantilly facility in Virginia, USA which currently performs HPV testing for the CervicalCheck service.
Dr Colm Henry, HSE Chief Clinical Officer, said any delay and inefficiency in the cervical screening service “is hugely disappointing for the women involved and for our service”.
Speaking in the Seanad, during a debate on a Bill to establish the CervicalCheck tribunal, Minister Harris said a lot of progress has been made in dealing with the backlog of smear tests.
He said the backlog would be “effectively gone” by mid-September when the Dáil and Seanad resume after the summer recess.
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What a mess and I really think this story could only happen in Ireland. We had a functioning cervical screening Programme. As good as most in the world. Then due to a combination of poor clinical communication, irresponsible journalism, greed from medical negligence lawyers and weak government we have destroyed it. We have done this to ourselves and it could have been all stopped by strong political leadership last year.
@Dr Donal O’Brien: if I recall at the time this is exactly what many clinicians warned about at the time of the ministers announcement. I wonder, will we see a further increase in the backlog as a response the the recent legal decision of ‘Absolute Certainty’ in the test results? By hey, why listen to medical experts, we’ve become like our neighbour, ‘we’ve had enough of listening to experts’ we trust Dr. Google and social media posts more readily than a doctor/consultant who has spent years studying
@Vocal Outrage: Cervical Check themselves warned against Minister Harris offer re additional cervical smears screening&can’t understand why Taoiseach,being a doctor,didn’t realize this could call significant backlogs!
The term the judge used was “absolute confidence” as stated in Indo article :’Why ‘absolute confidence’ is a benchmark in the UK but not here’s by Eikish O Regan.
In May this year article in IT:’Medlab to stop accepting new smears from GPs in bid to clear backlog’.Backlog stood at 80,000& MedLabs share of that was 60,000 ish& they have got that down in June by 11,000 but still substantial nearly 50,000 left.Its awful pressure on labs.
In June this year article in ITs again:’US Lab to help clear backlog of smear tests.Total backlog then was 65,000
.No mention by HSE about the IT glitch they knew about since February.What happened the transparency pledges given after what happened re Cervical Check & in particular the Scally findings?!
@Nuala Mc Namara: Eilish!
@Nuala Mc Namara: that’s the point I was making about the warning. I think the main issue with the judgement was use of the word absolute, regardless of confidence or certainty, as no screening programme can be absolute, there are always some false positives and false negatives
@Vocal Outrage: Dr Scally when cervical screening does not reveal cancer or pre cancerous changes there are 3 reasons:
1) No cells
2)Cells may be present but person reading the slide may not spot an abnormality.
3)Very plain error where there are sufficient signs but the person reading slide missed it.
These are Dr Scally’s words.
In Scally’s Report last year he said”I find the whole approach to Quality Assurance extraordinarily unsatisfactory.Screening services are absolutely dependent upon a very tight Quality Assurance Process because of the balance between benefit and harm.”
Scally’s 1st Report gave 50 Recommendations & his latest Report gave a further 2 Recommendations so why yet again was there lack of transparency since HSE knew of February re IT glitch affecting women being fully informed recreation results?This is the middle of July,so when exactly did IT glitch happen & how long did it continue!?
@Nuala Mc Namara: the lack of ABSOLUTE comes from your second point, and leads to a false negative, there maybe too few cells for the person viewing the slides to see, point 3 is what leads to false positives, the person viewing thinks they see an anomaly that transpires to be erroneous, non-cancerous or something else. Any system subject to human evaluation is susceptible to these errors
@Nuala Mc Namara: btw, the main issue with the cervical check has not been these false positives or negatives, which Dr Scally confirmed where within thr probability ranges for the type of testing employed, the issues was, is and most likely will continue to be unless radical changes occur has been a complete and utter break in communications between lab, consultant, GP, HSE and patient compromising patient welfare, and that is inexcusable
@Vocal Outrage: Re 3:there is a very plain ERROR by the person reading a slide where there are SUFFICIENT SIGNS but the person misreads it!It’s not what you think!
Re 2:Yes,there would be too few cells present that could lead person reading slide to miss them.
The difference between 2&3 is that in scenario 3 there are SUFFICIENT SIGNS present of abnormalities that shouldn’t have been misread.Because they were misread,the women wouldn’t have been referred for colposcopy.
@Vocal Outrage: You ignore point 3 again re ‘VERY PLAIN ERROR’where smears which showed SUFFICIENT SIGNS which should have been spotted, weren’t spotted!That’s what comprises patient welfare,do you not get this!?
Did you read the Scally Reports?
Note what he said about Quality Assurance,calling the approach ‘extraordinary unsatisfactory.He also finds there was a focus on “price rather than quality” in cervical smears tests outsourcing.That is shocking!He said the “lack of transparency by the major private sector lab companies over the precise location of their screening services to Cervical Check & therefore to Irish women is ENTIRELY UNSATISFACTORY”.
Dr Scally has made 50recommendational re 2018 Report&2recommendations re 2019 published Reports.I hope all these recommendations are acted on especially re further Cervical Check contracts& quality assurance.
I don’t think much of harris, not qualified, incompetent, but despite having private health insurance, at least he went through the public health system when he was ill last week. Credit to him for that. If our politicians aren’t willing to use the public health system (and all the other gov services) that they manage for the rest of the people, then they shouldn’t be in their political jobs in the first place. All our politicians should be using the public health system, and aim to bring the standards up to the level they’d have the confidence in to use themselves.
They knew last Febuary there was “glitch” in the labs. But that information only comes out when the Dail is off on holidays. Harris was hospitalised for a few days last week. While i don’t wish any ill on the man, you have to ask would an ordinary person depending on the public health service be looked after so quickly.In all probability no is the answer.
Ordinary people don’t matter, and it seems women matter even less where their reproductive health is concerned.
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