A blunt warning from the National Screening Service (NSS) to the health minister about the significant risks that would arise from offering free out-of-cycle smear tests had “nothing new in it” and was not passed on to him at the time, Simon Harris has told the health committee.
“There was nothing in it that they [senior department officials] hadn’t already identified. These were readily identifiable risks,” he said. As a consequence, the email of April 28, 2018, hadn’t been passed on to him.
The minister was defending his offer of free smears, made by tweet on April 28, 2018 - now acknowledged as the main cause of the current 80,000-strong smear backlog.
The email from NSS head of screening, Charles O’Hanlon, released to committee members today, highlights “key risks” arising from “open access” to smear tests, including:
- not knowing the volume of clients who might avail of free smears
- the policy change could potentially “strengthen the message” that the current test was inaccurate and further undermine the screening programme
- it would be difficult to “turn-off” the offer, leading towards opportunistic testing, thereby raising “potential ethical issues regarding over testing/over diagnosis/harm” .
The email from Mr O’Hanlon to Michael Conroy, a principal officer in the department, also warns that the cost of open access “is unknown”.
Fianna Fáil health spokesperson Stephen Donnelly said he found it hard to believe that Mr Harris had not received contrary advice prior to making his announcement, including the advice of Dr Gráinne Flannelly, former head of CervicalCheck, that offering free smears would fundamentally undermine the screening programme.
Dr Flannelly has claimed the department was made aware of her concerns prior to the minister’s offer of free repeat smears, which the minister has denied.
Mr Donnelly also challenged Mr Harris’s claim that his chief medical officer, Dr Tony Holohan, supported his decision.
“Expert clinical advice was given and expert clinical advice was ignored,” Mr Donnelly said.
Mr Harris told the committee his offer was “consistent with the advice of the CMO” and that there was “no difference of opinion between me and my senior officials that it [the smear offer] was the right thing to do”.
Asked by Mr Donnelly why he hadn’t rolled back on the offer when backlog problems started to arise by August, Mr Harris said he was waiting for the Scally Report. As soon as it came out, he wrote to the HSE saying to halt the free smears. However the HSE had women already booked in and asked to go ahead with those appointments, Mr Harris said.
Fianna Fáil TD Lisa Chambers said it was “reckless” to offer free smears without the appropriate resources in place. She said a year on, there was still no extra capacity. Sinn Féin TD Jonathan O’Brien said he agreed with the free smear offer, but not with making it “without knowing if appropriate resources were there”.