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Senior doctor warned Harris of 'dangerous' delays due to surge in demand for free smear rechecks

The letter says that there had been a delayed diagnosis after the results of a smear test taken in June were received in October.

An example of abnormal squamous epithelial cells (file photo).
An example of abnormal squamous epithelial cells (file photo).
Image: Shutterstock/Komsan Loonprom

MINISTER FOR HEALTH Simon Harris was warned by a gynaecologist located in the Mid-West region that his announcement of free repeat smear tests was “dangerous” and put the CervicalCheck screening programme at risk.

The letter, received on 15 October by the Department of Health and released to TheJournal.ie under a Freedom of Information request, says that the Mid-West region alone has seen a “300% increase in referrals” for further examination. 

“It is impossible to meet the current demand within recommended guidelines, making the system unsafe,” the letter says, which was sent to 20 other healthcare professionals and the Royal College of Obstetricians and Gynaecologists.

The latest figures indicate that over 80,000 smear test samples are still in the CervicalCheck system, compared with around 23,000 at any given time prior to that. Between May and October this year there was an increase of 75,000 smear tests being carried out, when compared to the same period last year.

“Smear reports are now taking over four months. This is dangerous,” the letter to Harris warns.

The comparable turnaround time for smear reporting in the UK is two weeks. We cannot be held responsible for the resulting delay in cancer diagnosis.
The first delayed diagnosis has arisen last week in our unit from a smear test taken in June 2018 and only now reported. 

FOI CervicalCheck snippet 1 Source: FOI/Department of Health

The increase is due to a number of factors: over 43,000 out-of-cycle smears, or free repeat smear tests have been carried out; an increase in the number of women attending their regular smears; and an increase in colposcopy referrals, which could be related to the increase in smear tests.

A colposcopy is an examination of the cervix, or the neck of the womb, to discern whether abnormal changes in the cells are present.

On 28 April last year, Harris responded to the public concern created in the aftermath of the CervicalCheck controversy by offering women repeat smear tests for free from 1 May. 

“Have heard from many women today who have had smear tests and would like a repeat test to reassure them,” Harris tweeted at the time.

On 6 December, the HSE said GPs had been informed that the free repeat smear tests would end on 31 December, “as scheduled”. 

The CervicalCheck controversy came into the public eye when Vicky Phelan, whose cervical cancer is now terminal, settled a High Court action against the HSE and the US laboratory tasked with reviewing one of her smears for €2.5 million.

Phelan’s 2011 smear test results were reviewed in 2014, and it was found that her slides had been misread. She wasn’t told about the review or the error until 2017, three years after receiving a cervical cancer diagnosis.

It was subsequently revealed that 221 women who were diagnosed with cervical cancer weren’t told that their earlier smear tests had been reviewed and had not been read correctly. Of that total number, 18 women had since died.

The smear test scandal has lead to a number of ongoing legal actions, and the resignations of the Clinical Director of CervicalCheck Grainne Flannelly and the Director General of the HSE, Tony O’Brien.

In an interview with the Sunday Business Post after his resignation, O’Brien accused Harris of “running scared of headlines”, and criticised his decision to offer repeat smear tests without applying additional resources to the healthcare system.

shutterstock_1217068168 Normal squamous epithelial cells of cervical woman on white background view in microscopy.Superficial and intermediate epithelium cells.Cytology criteria from pap smear. Source: Shutterstock/Komsan Loonprom

In a statement to TheJournal.ie, the Department of Health said:

“Following a government decision on 1 May, the Minister for Health asked CervicalCheck to make the necessary arrangements to provide that any woman who had previously had a CervicalCheck smear test could access a further test without charge, following consultation with their GP.

“This decision was made in consideration of the need to provide reassurance to women in advance of a comprehensive review of the screening service, and the provision of free out-of-cycle smear tests has now ceased.

CervicalCheck laboratory activity has been significantly above normal levels. There are a number of reasons for this including increased uptake in the programme generally. This has impacted turnaround times for results of smear tests.

The issue remains “a priority concern” for the Minister and his Department, the statement says.

The Minister regrets the delays experienced by women but has been assured capacity issues are the subject of ongoing discussions between his Department and the HSE.
In addition, the Minister has sought a plan from the HSE to take account of available capacity and expected demand. The report, which is due shortly, will aim to bring the programme into stabilisation this year.

“A smear test is not a diagnostic test, but is a screening test which can detect changes in a person that does not display any symptoms. The HSE advises women that if, at any time, they have concerns or symptoms they should contact their GP immediately, even if they have had a recent normal smear test.”

Waiting times

According to the HSE, there would be a waiting time of 4-6 weeks for the results of a smear test, although women who have had their smear before said it was closer to 2-3 weeks.

Now, “results may take up to 20 weeks from the time you have had your test,” the HSE website states.

“The public confidence in the whole Cervical Smear and Colposcopy service has been shattered. Morale amongst staff is at an all time low and litigation at an all time high,” the letter concludes.

Before Christmas, the government announced that it would set up a Tribunal of Inquiry later this year into the claims that have arisen from the CervicalCheck controversy.

A report into the CervicalCheck controversy was also completed in September last year by Dr Gabriel Scally. As part of his review, he announced that an immediate ex-gratia payment of €2,000 should be paid to each woman involved in the Cervical Check scandal and to the next of kin of the deceased.

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