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 Header Item Ceisteanna ó Cheannairí - Leaders' Questions

Wednesday, 20 February 2019

Dáil Éireann Debate
Vol. 979 No. 6

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  12 o’clock

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Micheál Martin: Information on Micheál Martin Zoom on Micheál Martin I have asked specific questions for some time about the Minister for Health's decision last April to offer a free out-of-cycle smear test to every woman in the country who wanted one and about who advised him on the decision. I have been subject to obfuscation since I first began asking these questions in January. As a result of that decision, CervicalCheck has an enormous backlog of up to 80,000 people waiting up to 27 weeks to receive reports on their tests, while thousands of women have received letters to tell them to come back in because the tests had expired and proved to be invalid. We have moved from a situation where tests were provided within four to six weeks to one in which they take between four and six months. The Minister's decision was the major contributing factor to this unacceptable situation. Last week, the Joint Committee on Health revealed that the new HPV test has been indefinitely delayed because of the backlog. We learned from the The Lancet Oncology journal today that the new HPV test, combined with an uptake in the vaccine, would have a dramatic impact on the reduction of cervical cancer in this country and beyond, but its introduction has been delayed because of the backlog caused primarily by the Minister's decision last April.

  Susan Mitchell wrote in last Sunday's edition of The Sunday Business Post that it was her understanding that the CervicalCheck team communicated its opposition to the provision of an additional smear test directly to the Department at a high level in advance of the offer being made. We now know that Professor Gráinne Flannelly, former clinical adviser at CervicalCheck, warned publicly of the inadvisability of this particular move during an interview. I listened to the Minister's interview last Saturday morning with Brendan O'Connor. I was taken aback when the Minister chose to launch an attack on the CervicalCheck team, stating that he had lost confidence in the people running CervicalCheck because of decisions on managing the audit, in response to a basic question of whether he had checked with CervicalCheck before making his decision. The Minister replied that he had not because he had lost confidence in the team over the audit and the communication of the audit.

  We now know, however, that the audit decision was shared with the Department of Health. The CervicalCheck team did not make the decision on its own but rather in conjunction with the Department of Health officials and the chief medical officer. They were all part of the decision on how to communicate the audit. Irrespective of one's views on the terms of the decision on the audit, the CervicalCheck team did exceptional work over a decade in building up its programme and saving thousands of lives. The degree to which the Minister dumped on the team last Saturday morning and attempted to destroy its reputation is unacceptable and mean spirited. One cannot destroy the reputation and work of people who have committed to the programme for more than a decade. Many people in the medical world are dismayed at the cavalier dismissal of people who have worked in the field for a considerable time.

  Did the CervicalCheck team communicate its opposition to the Minister's decision to someone at a senior level in the Department of Health? Does the Taoiseach now accept that the decision last May was a wrong decision without any clinical mandate? When can we expect the new HPV test to be introduced?

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar All of us in the House will acknowledge and know that cervical cancer is a terrible disease that causes the death of many women and results in life-changing surgery for many others. We also know that cervical screening works and that the number of women who have cervical cancer has fallen for many years as a result of a successful screening programme and the introduction of the HPV vaccine by the previous Government, of which I was a member. Our objective over the next couple of years is to make cervical cancer a rare disease and virtually eliminate it in the period ahead.

We will do so in three ways, namely, promoting the uptake of the HPV vaccine by girls; extending the HPV vaccine to boys, as we intend to do this year; and improving cervical screening by moving from the current test to the primary HPV test, which we will do as soon as possible, and we will be among the first countries to do it. I cannot provide a date for the Deputy and I acknowledge that he has asked the question previously. The dates I was given in the past by the Department of Health and CervicalCheck were not deliverable and, therefore, I will not commit to a date until I have confidence again that it can be delivered.

The free out-of-cycle smear tests were offered because a large number of women were concerned that their smear tests were wrong. They sought reassurance from their GPs and the helpline, and a decision was made to offer a repeat smear test out of cycle to give tens of thousands of women who were concerned about the accuracy of their smear tests the reassurance they sought. It was called for by a number of Opposition Deputies, as the record shows. When it was decided upon, it was welcomed by some medical bodies, including the National Association of General Practitioners and the Irish Medical Organisation, although it is true that some opposed it and warned of consequences. I understand from the Minister for Health that the chief medical officer supported the decision to extend the offer. While it has caused some problems and there is a backlog of slides awaiting analysis, that is due not only to the free tests but also to an increase in attendance for screening, which has continued even though the free out-of-cycle smear tests are no longer on offer and have not been for nearly two months. While the increased uptake in screening by women is to be welcomed, those two factors have led to a backlog and the HSE is working hard to clear it to return to the previous turnaround time of between four and six weeks.

Deputy Micheál Martin: Information on Micheál Martin Zoom on Micheál Martin I asked the Taoiseach whether the CervicalCheck team communicated its opposition to someone at a senior level in the Department of Health in advance of the decision. Will he answer that question?

The reason the new HPV test is not deliverable is the backlog created by the Minister's decision. Is the Taoiseach comfortable with the Minister's comments in that radio interview? The Taoiseach has stated he understands that the Minister was supported by the chief medical officer. We can find no written advice from the chief medical officer, however, and none has been offered. I tabled a parliamentary question and consulted the Office of the Ceann Comhairle. There was a consultation with the Department of Health, which replied to me. Yesterday, I was told that the chief medical officer's advice was reflected in the press release issued by the Minister. What kind of gobbledegook is that? Did the chief medical officer recommend the decision or not? I do not believe that he did; I believe that tracks are being covered.

We need to learn from the issue. The spending of €10 million of taxpayers' money, which could be used elsewhere in the health service, on a decision that has damaged the CervicalCheck programme and delayed the introduction of a much-valued, new and better test is something from which we need to learn lessons and which needs to be revealed in its full truth. There should not be this studied obfuscation. Will the Taoiseach ask the Minister to retract the commentary he made last Saturday in which he attacked an entire team of people who did much good work for the country in saving the lives of many women?


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