Scally report finds ‘focus on price’ in cervical smear test outsourcing
The report, published on Tuesday by Dr. Gabriel Scally, flagged a number of concerns
A report into the outsourcing of smear tests has flagged concerns over a focus on price over quality, and a lack of transparency from laboratories.
The report, published on Tuesday by Dr Gabriel Scally, flagged a number of concerns about how the Irish government outsourced cervical smear tests which led to a lack of transparency from private laboratories towards the Scoping inquiry investigating the issue and the women involved.
— aoife-grace moore. (@aoifegracemoore) June 11, 2019
Scally report: "It is my view, based on the documentation and expert opinion available to the Scoping Inquiry, that the tendering process appeared to move over time to place an increasing emphasis on price rather than quality."
“The number of laboratories involved in CervicalCheck work was not six, as I was informed when I commenced the Scoping Inquiry in May 2018; nor was it 11, as I reported in the Scoping Inquiry Final Report in September 2018. The final total is in fact 16 (two in Ireland, two in the UK, and 12 in the US),” Dr Scally wrote.
“The use of many of these laboratories for CervicalCheck screening was not approved in advance by the HSE/National Screening Service, as was required under the various contracts, nor was their use known to the HSE/National Screening Service.
“It is profoundly disappointing that the Scoping Inquiry only learnt about the additional laboratories as a result of our extensive and intensive probing.
“There has been very limited evidence made available to the Scoping Inquiry to show that CervicalCheck was ever consulted actively and in writing about the potential or actual use of the 10 additional laboratories.”
He added that the two major accreditation standards applicable in different countries appear to be comparable and do not create any cause for concern in terms of the quality of laboratory services provided.
However, he says the system in place in Ireland for responding to errors in screening is inadequate to the task.
“It is my view, based on the documentation and expert opinion available to the Scoping Inquiry, that the tendering process appeared to move over time to place an increasing emphasis on price rather than quality,” he added.
“The lack of transparency by the major private sector laboratory companies about the precise locations of their screening services provided to CervicalCheck, and therefore to Irish women, is entirely unsatisfactory.”
Dr Scally’s report is the latest review into the CervicalCheck scandal.
His previous review into CervicalCheck in September 2018, identified at least 221 women who were diagnosed with cervical cancer who were not previously told that their slides from earlier screenings could have been interpreted differently, and could have been alerted to their early stages of cancer beforehand.
The scandal came to light when women diagnosed with cervical cancer, campaigners like Vicky Phelan and Emma Mhic Mhathuna, contacted the media.
At least 21 women have since died, including Ms Mhic Mhathuna.
A number of women have sued the state for damages since their diagnoses.
In the September report, Dr Scally made 50 recommendations which were aimed at restoring public confidence in the cervical screening programme for Irish women.
Tuesday’s report saw two further recommendations made: That future CervicalCheck contracts should contain even more explicit provisions to ensure that no contracted activity should be carried out anywhere other than in the precise locations, and by the company identified in the written contract, without prior written permission from CervicalCheck.
Secondly, the quality assurance (QA) process developed and operated by CervicalCheck must be based on a consistent and thorough approach to the quality of the laboratory services being provided to the programme. This system must be designed and operated irrespective of the location of laboratories and any external accreditation should not be viewed as in any way replacing the need for QA processes.
Health Minister Simon Harris said following the report: “Government’s focus will continue to be on working towards full implementation of all of Dr Scally’s recommendations.”
A HSE spokesperson said: “Dr Scally finds that use of additional laboratories did not result in a reduction of the quality of the screening provided to Irish women and there is no evidence to suggest deficiencies in screening quality in any laboratory.
“We welcome Dr Scally’s view on the accreditation schemes used by laboratories, that there are no overall differences that may impact significantly on the quality of the final reports on cytology.”