As the health service was engulfed by the scandal over the CervicalCheck screening programme, top medics and officials wanted that there wasn’t capacity to deal with the crisis while also maintaining the service’s normal operation, writes Health Correspondent Catherine Shanahan.
The severe pressure on CervicalCheck to maintain its normal screening programme, while simultaneously struggling to manage the crisis engulfing it, is set out in a series of Freedom of Information documents released to the Irish Examiner by the Department of Health.
Because of the demands on the national screening programme, compounded by the loss of key personnel, officials warned that the introduction of HPV testing, a more sophisticated test for cervical cancer, could be delayed.
Health Minister Simon Harris committed to its introduction last September, but it could now be pushed out to next year, due to a smear-test backlog of 80,000 (women are waiting more than eight months for results).
That backlog has been blamed on the minister’s decision to offer repeat out-of-cycle smears to women after the CervicalCheck scandal broke.
A text message from the minister to his chief medical officer, Dr Tony Holohan, refers to contact he had from the National Association of General Practitioners (NAGP), saying they were “being overwhelmed with worried patients and we have had an emergency meeting today and feel that worried patients should be allowed to have a repeat smear, whether they are officially due one or not. Would you support this?”
Later that day, April 28, the minister announced free out-of-cycle smears. Earlier this week, former CervicalCheck clinical director Gráinne Flannelly said she had advised the HSE/Department of Health against offering out-of-cycle smears, because of inadequate lab capacity, which would “fundamentally undermine the screening programme.” Mr Harris has denied receiving any such advice.
In a document entitled Management of CervicalCheck Issues, which was received by Mr Harris on May 31, 2018, Dr Holohan, and Tracey Conroy, assistant secretary, Department of Health, advise that CervicalCheck “does not currently have the capacity to simultaneously manage the crisis, maintain normal operations, and progress future developments, including HPV”.
The decision by Dr Flannelly to step down, within days of the crisis emerging, after the minister said he could not express confidence in the way the service was being run, resulted in “significant challenges in dealing with queries that require clinical expertise,” the note says.
Moreover, attendances at Oireachtas committees had impacted on staff ability to deal with normal operational matters, the note says. Further challenges were posed by the number of legal requests.
CervicalCheck was “aware of in the region of 60 legal requests”.
“They are dealing with these with the assistance of a solicitor and have developed a protocol for the release of information,” the note says.
“The volume of cases suggests that there is an urgent need to consider development of a framework for addressing questions of distinguishing between error and false negative, defining harm, etc.”
Fears were also raised about a possible loss of confidence in CervicalCheck, fuelled by media coverage, “which has not been well-informed”, with a further negative impact on public opinion, if communications “are not well-managed” in relation to laboratory turnaround times and further legal cases.
Officials also advised the minister of difficulties in getting under way a Royal College of Obstetricians and Gynaecologists’ (RCOG) review of women’s slides. The RCOG were
engaged to conduct a review of the smears of women who have developed cervical cancer since CervicalCheck was established in 2008.
Officials warned that the “major challenge is the absence of resources in CervicalCheck” to engage with the RCOG review, resources that were “simply not available in CervicalCheck currently”.
The minister responded, saying, “please direct the HSE to put in place all necessary resources” to address the items raised. He requested that all patients’ files be made available to them, “with no bureaucracy or delay,” and said he “urgently” required a commencement date for the RCOG process.
Concern at the delay in getting the RCOG review underway is also reflected in an email from Mr Harris to Dr Holohan on June 24, 2018, and in Dr Holohan’s response the same day, in which he is critical of the HSE.
Mr Harris emailed Dr Holohan, saying: “It is essential that the contract is signed this week. I have been informed that it will be signed ‘this week’ for at least the last three weeks, including a draft memo to government. The Taoiseach has been informed likewise on a number of occasions,” he wrote.
Dr Holohan responded with: “As previously discussed, the issue had been getting final numbers for the HSE, as requested by RCOG, so that RCOG could calculate the scale of the work, in terms of person-hours and number of investigations, as this needs to be known for the final contract. The HSE did not supply these numbers.”
He believed this was due to “the continuing challenge that the HSE has in matching the scale of work required in CervicalCheck with sufficient resources”.
In an email of May 3, 2018, the minister said work on the RCOG review “needs to be completed by the end of May”.
The review, to which more than 1,000 women have consented, is still continuing.
The CervicalCheck controversy erupted after Limerick woman Vicky Phelan stood on the steps of the High Court on April 25, 2018, and told reporters that CervicalCheck had essentially failed her and she now had terminal cancer.
Her solicitor, Cian O’Carroll, said Vicky was not the only woman affected. It subsequently emerged that at least 221 women who developed cervical cancer were not told their smear histories were part of a
CervicalCheck audit and that the audit had identified errors in original smear results. It meant the women were not necessarily offered appropriate treatment, impacting prognosis and outcomes.