Transparency should be hallmark of our national screening programmes

ARE we any nearer to finding out what was going on behind closed doors in CervicalCheck, the national screening service?

It certainly seems to be a service that harbours secrets. We know that Vicky Phelan, who has terminal cancer, had a misdiagnosed test. Another 206 women also were given the wrong smear test result and went on to develop cancer. But as of yet we don’t know how many more were affected.

How many of these women are dead?

At least three women have died but the service has been running for 10 years so there may be more.

Could it be that these women died without ever knowing the test result they received was incorrect?

Possibly. CervicalCheck would have done a look-back on each of them once it was told they had developed cancer. They may have died thinking they were just unlucky and had developed an interval cancer between screenings which could not have been picked up in the test.

When will we find out?

A senior team of medics has been looking through files over the weekend and we should have a clearer idea of the numbers involved today. It raises questions about record-keeping at the service.

Last week, senior doctors were unable to say how many of these women were told by their consultant that an internal CervicalCheck report had been done on their case.

One thing that strikes the public is the lack of transparency about this service. It took a hard line with Vicky Phelan in defending the High Court case she brought. Is this a fair opinion of how it operates?

The details are certainly quite disturbing about how she was pressed to agree to a confidentiality clause which would have stopped all the information we now know about smear test mistakes and the failure to tell all women about reviews of their case coming to public light. Ms Phelan refused as she was concerned for other women.

There are echoes of how Brigid McCole, the mother of 12 who contracted Hepatitis C as a result of negligence by the blood service in the late-1990s, was treated as she was on her deathbed.

The State threatened to pursue her for costs if she did not accept a settlement offer. Lessons were supposed to have been learned, but clearly not.

It gives out a wrong message to women who are invited for tests. I thought national screening programmes had to have transparency as a hallmark?

You are right. It is all part of the quality assurance that should be part of a national screening programme.

Who was making the decisions about how CervicalCheck was run? The service is made up of lay and medical staff. The clinical director, Dr Gráinne Flannelly, has stepped down. She would have been key in deciding on the process by which women who have had internal reviews done on their cases were informed. The system was to leave it to the woman’s cancer specialist to decide how she be informed. CervicalCheck did not want to directly contact the women. This caused friction with some treating doctors. The protocol would also have been signed off at higher levels in the HSE.

Will others in the screening service resign?

Not at this stage. An external review is to be carried out. This is supposed to have a root-and-branch look at the service.

Are we any clearer on whether the quality of tests is below standard?

No. There is no evidence that the quality is below standard. There is a failure rate in all screening programmes. The review should tell us if there are weaknesses in the Irish system.

If women want a retest will they get it?

Yes, that is the promise. More detail is awaited this week about whether every woman will automatically get one if she requests it. The take-up rate for testing is around 79pc. The system should cope, although there could be delays getting an appointment and possibly a result. This is because priority must be given to the women who are having their regular three-yearly or five-yearly screening.

Where are the watchdogs in the Department of Health and the HSE whose job it is to do surveillance on patient safety?

There are medical officers in the department and even a patient safety office. The public expectation is that screening programmes are kept under review by senior officials. The response to date has been reactive and it raises concerns about the kind of checks that should be carried out.