Department was warned about risks of smear test decision

A decision to offer free out-of-cycle smear tests would lead to increased anxiety for women and undermine the CervicalCheck programme, the Department of Health was warned less than an hour after making the announcement in April last year.

The Minister for Health Simon Harris announced on Twitter on April 28th, 2018, that the State would meet the cost of repeat tests for women who wanted them.

He has come under political pressure to clarify if he was warned against the decision after it emerged that the former CervicalCheck clinical director Gráinne Flannelly said on April 28th that the proposal would “fundamentally undermine” the screening service. These concerns were relayed through an official to the Department of Health verbally.

Mr Harris made his decision “around lunchtime”, one source said. That decision is partly to blame for the current backlog of 80,000 women who are waiting up to 33 weeks to receive their test results.

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Mr Harris has said neither he nor his officials were warned against the move before the decision was made.

Key information has now emerged in an email sent to the Oireachtas Committee on Health that shows that 45 minutes after he announced his plans on Twitter that day, the department was warned about the risks of proceeding with the plan.

Number of risks

The email was sent by Charles O'Hanlon, the head of the National Screening Service, to Michael Conroy, a principal officer in the Department of Health. Mr O'Hanlon said he wanted to make the department aware of a number of risks associated with the decision.

He said the “volume of clients who might avail of this additional service is unknown”.

“The policy change will potentially strengthen the message that the current test is inaccurate. This could further undermine the current programme and messaging.

“Laboratory turnaround timelines will certainly increase, meaning women could be waiting, leading to increased dissatisfaction with the programme and increased anxiety for clients.”

He warned it would be “very difficult to turn off, ie cease additional test where requested by the client”. This would “lead to the movement towards opportunistic testing which is recognised to be suboptimal to client recall procedures”, he said.

“This raises potential ethical issues regarding over-testing and over-diagnosis/harm.”

Negative publicity

He also pointed out that the move could lead to further negative publicity.

“Other important considerations are: the costs of such a policy change is unknown. Payments are likely not to be processed by GPs in a timely fashion as a separate manual process will have to be instated, resulting in the potential withdrawal of GPs from the service or further negative publicity.”

“It is understood that we take direction from the department as to access policy, but it is also important for the above risks to be fully articulated into your deliberations.”

Fianna Fáil health spokesman Stephen Donnelly said questions needed to be asked about why the Minister did not heed the advice.

“When we add the contents of this email to what we already know about the verbal warnings to the [Minister] by the National Screening Service before the announcement was made, we start to build up a picture of a Government that was ignoring the medical advice given to them. I have one simple question, why did the [Minister] not listen to the experts when it came to the CervicalCheck scandal?”

Earlier on Wednesday, at the Oireachtas Committee on Health, Mr Harris accused Mr Donnelly of making false political charges against him over the decision. He said he stood over the decision, which was “consistent with the advice of the chief medical officer and there has been no evidence produced to suggest that I didn’t”.