Expert says decision to outsource smear test analysis shortshighted

The Academy of Clinicial Science and Laboratory Medicine said the decision to outsource the analysis of cervical smear tests to the United States in 2008 was "shortsighted".

Academy president Dr Irene Regan told the Oireachtas health committee that the Irish accredited laboratories that tendered for the cervical screening service in 2007/2008, were informed that they had scored highly in all areas (quality and turn-around times) except cost.

She said the Academy has recommended that when the planned new HPV screening system was introduced, "the entire cervical screening service be re-established in Ireland to ensure an entirely integrated service for HPV, Cytology, Colposcopy and Histopathology for the women of Ireland in the one health system, ensuring continuity of care, and clinical governance".

“The Academy advises that this laboratory service be configured, led and managed by consultant medical scientists and pathologists, a service configuration that is now emerging as standard practice in the UK.”

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Medical laboratory scientists said they warned the Department of Health and the Health Service Executive a decade ago that foreign-based cervical smear testing posed risks for patients.

The Medical Laboratory Scientists’ Association (MLSA) said both then had no interest in developing Irish testing and, instead, wanted to award the contract aboard.

Irish laboratories were not able to bid for later tenders because 60 laboratory scientists had been deployed to other work, the association said.

The MLSA said cervical cancer screening has saved lives, but “it is now clear that it did not operate to necessary standards culminating in the serious failings” in CervicalCheck.

Cervical screening was first introduced in Ireland in the 1960s. By the mid-1980s, 15 private laboratories carried out up to 145,000 smears a year, though delays were common.

The State was advised to set up a screening programme in 1996, based in Limerick. In a 2004 review, UK expert Dr Euphemia McGoogan recommended a countrywide service.

Four regional screening centres backed by primary and colposcopy care were needed, along with a single standard test and faster processing of cervical smears.

Faced with continuing delays, the HSE decided in June 2006 to have tests reviewed abroad for two years, with an option to extend for two years. The contract was not sent out for tender because the HSE cited “urgent medical need”.