There have been fears about the future of cancer screening for years amid the rising number of legal actions taken by people who believe they have been failed by the service.
These concerns have not dissipated since the huge controversy that engulfed the CervicalCheck service in 2018 after the High Court case taken by Vicky Phelan.
The settlement and apology for Ms Phelan, who died late last year, exposed big issues with the cervical cancer screening programme and it quickly emerged that more than 200 women were affected. Smears tested between 2008 and 2018 could have given a different result and women warned that they were at increased risk of developing cancer.
In 162 cases, women had not been told about the results of internal CervicalCheck audits, which had revealed errors in the reading of their smear tests.
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The concerns over the future of cancer screening services in Ireland have been raised by medical professionals and National Screening Service management (NSS) in the intervening years. The ongoing threat to the viability of the programme has been highlighted again in a briefing paper for new Health Service Executive chief Bernard Gloster – the rise in the number of compensation claims, and the “legal environment” facing the NSS is flagged as a risk on the HSE risk register.
[ Viability of cancer screening programmes flagged as a risk to new HSE chief Opens in new window ]
The vast majority of cases relate to CervicalCheck – accounting for 384 claims received by the State Claims Agency (SCA). Some 188 of these are ongoing. There are a further eight ongoing claims related to the BreastCheck service.
In 2020, an expert group that examined interval cancers – those illnesses that arise between screening tests – estimated that the liability to the State from CervicalCheck cases “could be in the range of tens of millions to hundreds of millions of euros”.
This was based on limited information available from the small number of cases concluded at the time with the number of future cases unknown. The report said: “Since the 2019 operating budget of CervicalCheck was €34 million, such liability would render the programme unsustainable.”
It remains to be seen if the scale of the cost to the State estimated by the expert group report will become a reality.
The majority of the cost of settlement payments to people who have taken claims so far appears to have been borne by the private laboratories. The Dáil was told in December of legal costs of €4.7 million at the time.
There is a risk of future liability for the State as the processing of CervicalCheck samples returns to Ireland at the National Cervical Screening Laboratory at the Coombe hospital.
Another problem is believed to be the impact the CervicalCheck scandal has had on public confidence in using the service – essentially fewer people taking up the opportunity to be tested. Achieving minimum uptake levels is “critical” to meeting the aims of screening and improving health outcomes for people.
The HSE’s communication strategy seeks to reduce the risk to public confidence by increasing “public understanding and promoting informed choice”.
The letters sent to women when they are notified it is time to get a cervical screening test sets out how “having regular cervical screening is one of the best ways to reduce the risk of cervical cancer”. It adds that all screening has “limitations” and stresses that “attending screening regularly is important because no screening is 100 per cent accurate”.
The other big risk to the viability of services is difficulty recruiting staff who, put simply, may not want to work in an environment where they will be processing a high volume of tests while running the risk of getting sued.
As the briefing for Mr Gloster outlines, over 25 years, cancer screening has led to earlier diagnosis and reduced mortality rates.
In his report on the CervicalCheck controversy public health doctor Gabriel Scally found the service was “doomed to fail at some point” due to a “demonstrable deficit” of clear governance and reporting lines between the services, the NSS and HSE management.
The briefing for Mr Gloster quotes Dr Scally’s final progress report on the implementation of his inquiry’s recommendations which says: “women can have confidence in and should take full advantage of the cervical screening programme”.
“It has saved many lives and will continue to do so.”
Five years after the controversy that rocked Ireland’s cancer screening service, its future remains uncertain.