A Government briefing note in 1986 stated that it might be cheaper to send cervical smear samples to England to be tested, rather than pay for laboratory staff in Ireland to be trained.
Concerns about the cost of cervical smear testing and related delays were raised as far back as the 1980s, three decades before the CervicalCheck controversy was uncovered.
In 2018, it emerged that hundreds of women diagnosed with cervical cancer were not told about an audit of past smear tests.
The Health Service Executive (HSE) said at the time that in the cases of more than 200 women, the audit found on look-back that their screening tests “could have provided a different result or a warning of increased risk or evidence of developing cancer”.
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The issue surfaced after Limerick woman Vicky Phelan settled a High Court case against a US laboratory that was subcontracted by CervicalCheck, the national cervical screening programme, to assess the tests. She was given incorrect smear test results in 2011. She was diagnosed with cervical cancer in 2014, but was not informed of the audit until 2017.
Phelan campaigned on the issue until her death in November 2022. The following year, legislation that established mandatory open disclosure in the healthcare system came into effect.
In files released as part of the State Papers, a briefing document from December 1986 revealed that smear test delays and screening costs were also an issue for the Government then.
The file detailed a meeting between Department of Health official Dermot McCarthy and junior health minister John Donnellan at which they discussed cervical cancer screening facilities.
[ Vicky Phelan ‘inspired not only ourselves but an entire nation’, say familyOpens in new window ]
The document raised the possibility of sending smear tests overseas to be checked, as a cheaper alternative to training technicians in Ireland.
“It might be an option to send some proportion of the smears to England (for testing); this in fact could be less expensive than the cost of training a technician,” the document noted.
“These technicians have to be trained in England, at any rate. Furthermore, the laboratories in the maternity hospitals might be used to a greater extent.”
At the time, cervical cancer screening was available in around 200 centres around Ireland.
“The Department [is] concerned that the available resources should be channelled [sic] towards women in the lower socio-economic groups who do not use the services to the same extent as those from the higher socio-economic groups,” the meeting note stated.
A pilot scheme – which ultimately paved the way for the CervicalCheck programme – was about to be conducted across Dublin, Wicklow, Westmeath and Longford.
There were already existing delays in processing smears, the briefing document noted.
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McCarthy stated that the delay in St Luke’s Hospital in Dublin was about 17 weeks at the time.
The file stated that, on December 3rd, “a special allocation of £41,000 was made to St Luke’s to cover overtime payments, to reduce the delay”.
“While St Luke’s is the National Centre for this purpose, smear testing and processing is also carried out in general hospitals and in maternity wards.”
The file said the Department of Health intended “to initiate discussions with St Luke’s about the future provision of the service”, adding that officials would “look at the way the lab is organised to see if work can be done more productively”.
“It is known that some labs in other hospitals have spare capacity, so it may be more efficient to divert some of the processing work elsewhere.”
