RTÉ’s Áine Lawlor; Dr Peter McKenna of the HSE
This afternoon on RTÉ’s News At One.
Journalist Áine Lawlor spoke to Dr Peter McKenna, the clinical director of the women’s and infants’ programme with the HSE – after nobody from the HSE was available to speak to RTÉ’s earlier shows Morning Ireland or Today with Seán O’Rourke.
The lunchtime interview followed it emerging last night that approximately 800 women who had CervicalCheck tests carried out between October 1, 2018, and June 25, 2019, have not received their test results.
This has been blamed on an IT issue at a Quest Diagnostics laboratory in Virginia in the US.
Most of the women affected were getting repeat tests for the human papillomavirus HPV – which can cause cervical cancer – because Quest had previously failed to carry out HPV testing on the women’s initial smears within the 30-day limit.
RTÉ reported last night that the HSE told the Department of Health on Wednesday that it became aware of the IT problem in June.
This lunchtime, Dr McKenna told Ms Lawlor that the HSE knew there was a “computer glitch” in February.
From the interview:
Áine Lawlor: “The lesson on Gabriel Scally’s report about open disclosure and honesty and transparency with the women who are fundamental to the future of CervicalCheck and who depend on CervicalCheck – that lesson has not been learned by the health service.”
Dr Peter McKenna: “I wouldn’t agree with that, in principle. I think that there’s elements of this problem that only emerged to the HSE in the last ten days or so. And the extent of what needs to be communicated with women is not yet currently absolutely certain.”
Lawlor: “OK, well let’s try and establish the facts. So we’re talking about 800-plus women who had repeated cervical smear tests done between October 2018 and June 2019. Is that right?”
McKenna: “Yes, and these are women whose cytology results were known and they had a minor degree of abnormality and in order to see whether they needed to go for coloposcopy or not, an additional test of HPV was carried out.”
Lawlor: “So, in lay person’s language, they had had a previous smear test that had shown some abnormalities related to HPV and this was a repeat smear test to see whether there’d been any changes. Is that right?”
McKenna: “It’s a refinement, it’s a, a papaloma test, rather than a repeat smear test.”
Lawlor: “OK, so it was a more advanced test.”
McKenna: “It was a more advanced test, now, if you…”
Lawlor: “And the computer broke down when?”
McKenna: “No, no, sorry, just to go back even further than that. These 800 women were women who had had a HPV test carried out but, as you may remember, towards the end of last year, it transpired that the tests had been done on an out-of-date kit. I don’t know if that…”
Lawlor: “I think everybody remembers every twist and turn of this unfortunately Dr McKenna. So they had gone for tests again after that, is that right?”
McKenna: “No, so the kit was out of date. And those women that had come back as positive – they were treated as if the result was correct.
“And those women, who the result had come back as negative, it was said ‘no, we should take this seriously and we will repeat the test’. And so, 800 of these women, whose tests have come back as negative initially on the HPV, were then retested.”
Lawlor: “OK. And when did the computer breakdown?”
McKenna: “It was known in February that there was a computer glitch and…”
Lawlor: “Where was it known exactly, Dr Peter McKenna, because most of us knew nothing about this until yesterday and today. So the question is: this computer failure goes back to February.
“Who knew about that back in February? And who has known about that since?”
McKenna: “Well, my understanding is that, if I could just finish, that it was known in February and…”
Lawlor: “By whom?”
McKenna: “In whom the tests results altered were informed by CervicalCheck in February. So there was a small number of the 800 women, in whom the results were different, and they were informed directly by CervicalCheck. So the women who were affected were informed as soon as it was known.”
Lawlor: “But who knew about the fail…what does the computer failure involve? When did it happen and who knew about it?”
McKenna: “The computer is designed to…the computer of the labs overseas is designed to communicate with the computer here. And that triggers a, a cascade of letters. It was appreciated that wasn’t working and a manual system was put in place, as far as the HSE knew.”
Lawlor: “OK, it was appreciated by whom? Who appreciated this? And who made the decision to put the manual system in place? And why was none of this made public?”
McKenna: “Right. The answer to the names, I couldn’t give you. I don’t know. But however, it was appreciated within the screening service because the screening service put alternative, manual arrangements in place.”
Lawlor: “And did the HSE know that these computers weren’t working? And that manual arrangements were now being put in place to write to women? And was anybody checking that that was actually happening?”
McKenna: “The service did know that the computers were not speaking to each other – that is absolutely correct and the HSE were reassured by the fact that the women were being written to manually, or sorry, their GPs were being written to manually.”
Lawlor: “So the women’s doctors were being written to, by whom? Who was responsible for…”
McKenna: “By the laboratory.”
Lawlor: “By the laboratory.”
Lawlor: “So CervicalCheck told the HSE and everybody understood that the laboratories would write to the women…”
McKenna: “Would write to the GPs….”
Lawlor: “Would write to the women’s doctors…”
Lawlor: “And when did it emerge that this was not happening?”
McKenna: “This only came to the knowledge of the screening programme and the HSE in early July.”
Lawlor: “In early July, but a number of months had passed. Had it not occurred to anybody to get back and check, given the sensitivity and, as you say, there have a lot of twists and turns in all of this and we have had the Scally Report which has emphasised the importance of transparency – particularly if women are to go on turning up for smear tests as part of the cervical screening programme.”
McKenna: “I can absolutely understand that question. The HSE and the screening are very disappointed that the arrangement that they thought had been put in place wasn’t working. And this will be investigated as to why this element was not followed through by the contractor.”
Lawlor: “But this is what happened in the first place isn’t it? Somebody thought somebody was telling the women but nobody was?”
McKenna: “No, it’s not quite the same as that. That was the result of an audit. This is probably, in some ways, more important than actual clinical results – there was a delay in communication.”
Lawlor: “I’m still kind of flabbergasted. Just one other thing – did the minister know? The minister’s department? We know that the HSE knew about this and understood it was being dealt with by the laboratory, and this only emerged in the last while, that you found out that the letters weren’t happening.
“Was the minister’s office across this?”
McKenna: “I would not…I don’t know the answer to that. I’m sorry.”
Lawlor: “OK, so you don’t know whether the Department of Health was involved?”
McKenna: “I don’t. No.”
Lawlor: “You said you can understand why women might not have confidence after everything. I mean this comes across like almost like a last straw, doesn’t it, for many women?”
McKenna: “It certainly doesn’t sound good. But I think it’s important to point out that these women have had cervical cytology – they do not have a severe grade of cervical abnormality. If they did they would have been referred directly to colposcopy. This is a delay in communicating the result of a second or a refined test which would indicate whether they should or shouldn’t go on to colposcopy.”
Lawlor: “Well we appreciate you coming on the programme to talk to us today.”
Listen back in full here
Minister for Health Simon Harris has described the latest CervicalCheck issue as one of "great frustration, annoyance and worry" for women. Speaking in the Seanad, he said he does not want women to be worried about a clinical risk that may not exist.
— Fergal Bowers (@FergalBowers) July 12, 2019