The State’s cancer screening programmes, including CervicalCheck, are being threatened by the risks posed by the dramatic rise in legal claims over the last five years.
Briefing papers prepared for new Health Service Executive (HSE) chief executive Bernard Gloster flags the “legal environment” facing the National Screening Service (NSS) as one of the “key challenges” it faces in the coming years.
There has been an escalation in legal actions in the five years since the CervicalCheck screening service became embroiled in controversy in 2018.
It emerged that more than 220 women with cervical cancer had abnormalities detected in a subsequent review of previous smear tests, which had not been detected at the time of screening.
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The State Claims Agency (SCA) agency has received 384 claims related to CervicalCheck.
A total of 196 cases have been concluded – some through settlements or court awards but others due to discontinued claims among other reasons.
The SCA confirmed that 188 claims are ongoing.
Separately the agency is currently managing eight ongoing claims related to BreastCheck screening services.
The potentially life-saving nature of screening is set out in the briefing papers for Mr Gloster.
They outline how a 2022 report on breast, cervical and bowel screening over 25 years found “a noticeable increase in earlier diagnosis, and a demonstrable reduction in mortality rates.”
[ Analysis: Fears over future of cancer screening as legal actions continue to riseOpens in new window ]
However, the document warns that one of the three “key challenges” for the NSS in the coming years is the “legal environment which risks the viability of current and future screening programmes”.
Uptake of screening amongst the public is another challenge highlighted as: “confidence in screening is critical to achieve the minimum uptake levels for screening programmes to meet their aims and improve health outcomes.”
Recruitment and retention of qualified staff is the other issue – partly due to the “the risk of litigation” – as well as a global shortage of radiologists, radiographers and pathologists, according to the documents released to The Irish Times under the Freedom of Information Act.
The HSE told The Irish Times that the legal actions against the NSS relate to the development of cancer despite earlier participation in a cancer screening programme.
It said that it is “accepted internationally that screening programmes do not detect all cancers.”
The HSE continued: “People who feel they have been harmed by the limitations of screening are entitled to seek recourse through the legal system.”
However, it added: “There is a risk that if claims continue, the programme may become unviable”.
This is because “either the public no longer have confidence in screening and no longer participate” or staff do not want to work in a service that has “high levels of litigation”.
Another risk is “that the cost of providing the service and its legal costs outweigh the benefit of screening, and public funding for screening should ethically be better spent elsewhere.”
The HSE set out a number of actions it is taking aimed protecting the future of screening services.
These include implementing HPV (human papillomavirus) testing – which is said to be “more accurate” than the previous cytology test used. The HSE saying: “We anticipate fewer legal claims will result over time as the test produces fewer false negative results.” Another measure is a public communication and information strategy to “increase ... understanding and promote informed choice in screening.”
The HSE said it has also brought in patient-requested reviews for interval cancers – those illnesses that develop between screening tests – “to support patients to seek answers to their questions”.
