Minister for Health Simon Harris TD has today published the Implementation Plan for the recommendations set out in Dr Gabriel Scally’s Report of the Scoping Inquiry into the CervicalCheck Programme, following a Government decision earlier today.
This follows the acceptance by Government of all 50 recommendations of Dr Scally’s Final Report in September this year.
Minister Harris said “The publication of this Implementation Plan marks a key step in the delivery of the changes recommended by Dr Scally. It will underpin the work required to ensure that the issues which have arisen in relation to open disclosure, governance and management and other key areas are fully addressed. I requested Dr Scally to undertake an independent review of the Plan, and I welcome his initial assessment of this Plan and his confirmation that he is satisfied that all parties are taking seriously his findings and recommendations, that resources have been allocated to take the work forward at a high level of priority, and that the proposed work programme is impressive in its commitment to making rapid progress.”
“I want to take this opportunity to thank once again the women and families who met with Dr Scally, and whose contribution was vital in the development of his report’s recommendations”.
The Implementation Plan sets out 126 actions addressing Dr Scally’s recommendations, across the areas of women and women’s health, organisation and governance, laboratory services and procurement, open disclosure, cancer registration, other screening programmes and resolution.
The development of the Plan was overseen by the CervicalCheck Steering Committee, established by the Minister in June to provide oversight and assurance in relation to managing the response to the CervicalCheck issues, and ensure the implementation of the key decisions taken by Government.
In parallel with the implementation of Dr Scally’s recommendations, the Committee will continue to progress strategic priorities including the implementation of the switch to HPV testing as the primary screening test, in tandem with the extension of the HPV vaccination to boys.
Minister Harris concluded "We know that screening alone is not enough to prevent all women from getting cervical cancer – false negatives are an inherent part of such a programme. But a well organised screening programme, when combined with HPV vaccination for boys and girls, can make this a rare disease. That is this Government’s goal and that is why we are committed to introducing the HPV vaccine for boys, as recommended by HIQA, as well as to implementing the recommended improvements in our cervical screening programme."
Notes to the Editor
Read the implementation plan on our website here.
Background and further information
On 12 September, the Report of the Scoping Inquiry into CervicalCheck was published on the website of the Department of Health. On publishing the Report, the Minister for Health, Simon Harris, T.D., undertook to return to Government within three months with a full Implementation Plan. The Plan has now been approved by Government. The Plan includes implementation actions for all 56 recommendations of the Scoping Inquiry – the 50 recommendations set out in the Final Report of the Scoping Inquiry, and the six recommendations included in the Progress Report and First Report of the Scoping Inquiry, published on 12 June.
The CervicalCheck Steering Committee
The Implementation Plan has been approved by the CervicalCheck Steering Committee, which was established by the Minister in June this year. The Committee includes patient advocates and clinicians as well as senior officials of the Department of Health and the HSE. Since September, the Committee has overseen the development of an overall Plan, incorporating implementation plans of each body which is responsible for implementation recommendations in the report. On 4 December last the Committee approved the Plan.
Future evolution of the Plan during the implementation process
The Plan is not a static document. It is expected that it will be revised at various stages of the implementation process. For example, some timelines and future actions cannot be confirmed until the early stages of implementation are progressed. There may be unforeseen issues that impact timelines. Actions in the Plan may have to be adapted to take account of additional requirements that could be identified as the work progresses. At each stage where the Plan is revised, the new update will be published.
Independent review of the Plan as recommended by the Scoping Inquiry report
The Report of the Scoping Inquiry called for an independent review of the implementation plans of the various bodies involved. The Minister asked Dr Gabriel Scally to undertake this review. Over the past two weeks, Dr Scally has been meeting with the various bodies involved. On 30 November, Dr Scally wrote to the Minister and confirmed that he is satisfied that all parties are taking seriously the findings and recommendations of the Scoping Inquiry report, and that resources have been allocated to take the work forward at a high level of priority. He also noted the impressive commitment to rapid progress.
Dr Scally’s engagement with the bodies concerned is ongoing. When this is complete, later this month, he intends to write to the Minister again to set out in more detail his observations on the Plan.
During his engagement so far, Dr Scally has already identified some ways in which the actions set out in the Plan can be clarified, to better reflect the detailed work ongoing. While commending the commitment shown in the Plan to making rapid progress, Dr Scally has also suggested some timelines may be too ambitious. Once all of his observations have been formally received in December, this Implementation Plan will be reviewed to take account of all Dr Scally’s observations. The new update will be published once approved by the CervicalCheck Steering Committee and by the Minister.
Funding for the implementation of Dr Scally’s recommendations
Additional funding was provided for the screening service in Budget 2019 to address the implementation of Dr Scally’s recommendations This funding will support implementation of those actions that require additional posts or other investment in 2019. In addition, the funding provided for 2019 provides for the planned switch to the HPV test as the primary screening test. Funding in 2019 is also provided for the extension of the HPV vaccine to boys.
Supports for women and families affected by the CervicalCheck issues
On 11 May, Government approved the provision of a comprehensive person-centred package of support measures for women diagnosed with cervical cancer since 2008, for whom cytology review recommendations following clinical audit differed from the original test. This resulted from the Government’s desire to assist women, and their families, affected by a lack of disclosure.
Alongside the provision of medical cards, primary care supports, including counselling, have been made available to those requesting them. A range of other health supports is being provided including in response to requests for physiotherapy, occupational therapy, dental, ophthalmic and nursing services among others.
The Government decision of 11 May provided that where women had been prescribed a medicine by their treating clinician, any out-of-pocket costs would be met. This includes medicines not officially approved for reimbursement and any other non-standard therapies, once prescribed for the patient by their doctor. It was also decided that reasonable costs that arose prior to 11th May would be reimbursed.
The HSE has put arrangements in place to reimburse a range of costs that the women and their families have incurred including travel costs, childcare costs and medical appointment costs among others.
Introduction of HPV as the primary method of testing
The outcome of a Health Technology Assessment (HTA) carried out by the Health Information and Quality Authority (HIQA) for the National Screening Service was that the HPV test is a more accurate testing mechanism for cervical screening than the current liquid-based cytology, that the use of the HPV test would result in fewer false negative results, and that the use of the HPV test would result in more cancers being prevented.
Currently cervical screening samples undergo cytology screening as the primary screening test and following the move to HPV testing, cervical screening samples will undergo a HPV test as the primary screening test and women whose samples show HPV infection will be triaged using cytology to determine if there are any abnormal cell changes.
The Minister approved the switch to HPV testing as the primary screening mechanism for the CervicalCheck programme in February. Work on implementing this switch is well underway. While the extent to which the HPV testing can be done in Ireland is being assessed, it is likely that a tendering process will be needed to meet at least some of the HPV testing requirement.