Wednesday, April 03, 2019

Update: The HSE has been “trawling the world” to find extra screening capacity for cervical smears, the head of the health authority’s national screening service told the Oireachtas health committee.

The health authority’s national director of screening services, Damien McCallion, said there is currently a backlog of 79,500 slides, with some samples taking up to 33 weeks to be reviewed.

“We would always have around 20,000 slides working through the system if things were on an even keel,” said Mr McCallion.

“Significant improvements” had been made in turnaround times for tests at two laboratories – it was three weeks at the Coombe Hospital in Dublin and seven weeks at the US-based Quest Diagnostics.

They are working on a solution for the third laboratory – MedLab in Sandyford, Dublin where the turnaround time is 33 weeks.

“Clearly that is a major concern and that has deteriorated,” he said.

“We have literally have had to trawl the world – from Australia to America, through Europe, to try to find capacity,” said Mr McCallion, who added that a full quality assurance process was completed before any new contracts were signed with a new laboratory.

Mr McCallion said a public laboratory at the Coombe Hospital would be built. Funding was received this year but the project would take time.

In the short term, we have to avail of capacity in other jurisdictions to try and help us get out of the problem that we are in at the moment.

Replying to Sinn Féin’s Louise O’Reilly said Mr McCallion said the quality assurance process involved on-site visits.

He also described recent reports of slide tests expiring as “misinformation”. There was always a percentage of samples that would expire for a variety of reasons and they monitored the situation very closely.

“There was an issue around October/November last year and that was addressed with the laboratories and the rate was within the norms that we would always have,” he said.

“There has been no change in that normal rate that any screening programme would have around that.”

Ms O’Reilly said that given the backlog she was concerned that the numbers were going to be quite high but Mr McCallion said the numbers would still be “minuscule”.

In terms of expired sales and vials – in a typical month it could be about 40 to 50. Over a year, between expired samples and expired vials, you are looking at around 500 to 600 a year.

Clinical director of CervicalCheck, Dr Lorraine Doherty, said they could not give a ‘fixed date” for when primary HPV screening would start.

“But we certainly anticipate that we would certainly be looking at no longer than early next year to introduce this programme,” she said.

Earlier: Harris to blame for ‘crisis of confidence’ in CervicalCheck, says Fianna Fáil

Health Minister Simon Harris bears the brunt of the blame for the “crisis of confidence” in the CervicalCheck programme, according to Fianna Fáil’s Stephen Donnelly.

Mr Harris had been warned weeks in advance that the case of campaigner Vicky Phelan was going to emerge and it was likely to cause a crisis in confidence.

Despite being warned, no preparations were made, Mr Donnelly told a meeting of the Oireachtas Health Committee.

“Within 48 hours the minister expressed no confidence in the management team of CervicalCheck without meeting them,” said Mr Donnelly.

That was largely taken as the Government having no confidence in the CervicalCheck programme, he said.

“And having created anxiety and fear then an offer of a free test was made,” said Mr Donnelly, who is the party’s health spokesperson.

But they now knew that there was very strong clinical advice not to do that.

Dr Grainne Flannelly

The former clinical director of CervicalCheck, Dr Grainne Flannelly, has revealed that the Government went ahead with the offer despite her raising concerns with HSE officials.

In a submission made to the committee, Dr Flannelly said she warned the repeat smear tests would “fundamentally undermine the screening programme”.

Mr Harris announced the free tests in April last year following the CervicalCheck scandal.

It was the mishandling of the situation by Mr Harris that caused the crisis of confidence in CervicalCheck, said Mr Donnelly.

They now knew that the offer of the free tests had caused a huge backlog of slides and, as a result, officials could not give a date for the introduction of the new HPV test.

I think largely this mess was created by the minister and the Government aided and abetted by the Oireachtas. There was certainly loose language in the Oireachtas that was very unhelpful as well.

Earlier, Mr Donnelly said Dr Flannelly’s submission to the committee “directly contradicts” the minister’s position. What she said suggested that he misled the Dáil.

“She predicted what would come to pass and what we are all dealing with today,” he added.

Chief clinical officer with the HSE, Dr Colm Henry, said he only became aware of the advice last night.

It was, he said, reasonable, looking back to judge any decision in the context of the time, the anxiety that prevailed and the misinformation and misunderstanding about screening.

Clinical director of CevicalCheck Dr Lorraine Doherty said the organisation was dealing with a “very difficult situation” in relation to confidence in the programme.

Dr Doherty said the medical benefit of an out-of-cycle smear could cover a range of issues including psychological.

“In this scenario, the decision was taken collectively in government to offer women to avail of a free smear test,” she said.

Sinn Fein’s Louise O’Reilly said it was “very clear” that advice was given that should have made its way to the minister and it was a “serious issue” if expert advice was being ignored by health department officials.

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