CervicalCheck queried policy of ‘open disclosure’ on cancer audits in 2016

CervicalCheck questioned whether a policy of “open disclosure” should be applied in weighing up whether women with cervical cancer should be told about incorrect smear test results in their screening history.

Newly released documents show that the national screening programme shared a briefing note it prepared for consultant doctors with the Department of Health in June 2016 about passing on details of cancer audits showing incorrect results to patients.

It is the first time since the Cervical Check controversy emerged that publicly released documents have shown the screening programme discussing “open disclosure” – Government policy since 2013 – and raising an issue about whether it should be followed when it came to telling affected patients about incorrect smear test results.

‘Media interest’

On June 29th, 2016, department officials were forwarded a briefing note drafted by the screening programme for treating clinicians and a question-and-answer document “in the event of any media interest”.

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“While CervicalCheck supports the principles of open disclosure, it is recognised that there are limitations to its universal implementation, particularly for screening services where there is an inherent recognised error rate,” the note said.

“The assessment of avoidable harm that doctors are asked to make, which should be done in consultation with the relevant consultant doctors, should take this into consideration.”

The briefing note was sent by Simon Murtagh, then acting head of the National Screening Service, to Michael Conroy, a principal officer in the department’s cancer unit, at the department’s request following a meeting earlier on the same day.

He told Mr Conroy that 17 letters concerning test reviews were issued in February 2016 and a further 39 in June 2016, with another 200 to 230 letters to be issued between early July and August.

The records show that high-ranking officials, including the State's chief medical officer (CMO), Dr Tony Holohan, the most senior health adviser to the Government, were aware of CervicalCheck's policy on communicating the cancer audit results two years ago.

The department said in a note accompanying the release of the records yesterday that it had “no reason to believe” that plans to communicate the results to women “would not be accomplished”.

It was revealed last month that 162 women with cervical cancer were not told about the incorrect test results.

Minutes of a meeting on June 30th, 2016, between the HSE and the office of the chief medical officer at the department show that Dr Holohan would be sent copies of letters informing doctors about their patients’ incorrect smear test results.

The meeting, which was not attended by Dr Holohan, heard that the HSE said that “230 letters will be issued over the next six to eight weeks. Copies will be sent to the CMO for information,” the minutes say.

‘Pause all letters’ memo

The newly released documents also reveal that the March 2016 “pause all letters” memo was prepared by Majella Byrne, the then head of the national screening service, on behalf of Stephanie O’Keeffe, the HSE’s national director of health and wellbeing.

Their names did not appear on the memo when it was released by the HSE to the Public Accounts Committee last week.

The records show that Dr Holohan emailed senior official Tracey Conroy, an assistant secretary with responsibility for overseeing Government policy on acute hospitals, on March 31st, 2016, attaching the memo.

“We might have a word about this,” he said to her in the email.