CervicalCheck Audit 2018
Page last updated: 12:45 01 April 2019
Latest update: Delays in screening test results updated from 27 weeks to 33 weeks
Many people continue to have concerns about the CervicalCheck – the National Cervical Screening Programme.
We are particularly aware of the anxiety caused to women because of the delays in getting their smear test results.
We are continuing to manage issues related to the CervicalCheck crisis. Our 3 key areas of focus are to:
- improve and strengthen our cervical screening programme, including the smear test results delay
- continue to support women and families impacted by the CervicalCheck crisis
- introduce a new HPV screening test
We continue to update this website with key information regarding the CervicalCheck crisis for women and healthcare professionals. If your question is not answered by the information below, you can email us at firstname.lastname@example.org or make a request for a call back here. You can also call us on Freephone 1800 45 45 55 (+353 21 4217612 from outside Ireland).
Here we have information which may answer some of your questions:
- smear test results delay
- backlog of smear test samples
- what we’re doing to reduce the backlog
- risk of the results delay to you
- repeat HPV tests
- supports to 221 women and families
- report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis
- independent Expert Panel Review (RCOG review)
- HPV primary screening
- implementation plan for Scally recommendations
Smear test results delay
There is, currently, a long delay in reporting smear test results.
In the past, you would get your smear test result within 4 to 6 weeks of your test. Currently, results are taking up to 33 weeks from the time you have your smear test. In some cases, this is taking longer.
The delay is because of the increased demand last year for repeat smear tests.
We usually process about 280,000 smear tests each year. Last year, we saw about 370,000 women. This was an increase of 90,000 compared to 2017. This increase was due to understandable concerns about cervical screening.
The delay is affecting both repeat and routine smear tests. We are sorry for this delay. We are working to reduce current waiting times.
We will write you a letter to let you know when your results are available.
If you are waiting for your smear test result, you may get a reminder letter for your next routine smear test before your results letter arrives. You should wait for your results letter to find out what to do next.
We also recommend you check our online register to make sure your contact details are up-to-date when results do become available.
Backlog of smear test samples
There is currently a backlog of about 78,000 smear test samples. Normally, about 23,000 tests would be progressed at a time.
What we’re doing to reduce the backlog
We are looking for more labs which specialise in processing smear test samples.
This has been difficult because there is a worldwide shortage of labs and lab technicians specialising in processing smear tests. This is because many countries are introducing a different way of using HPV screening as part of a cervical screening programme and so don’t need the level of cytology services currently used.
High insurance costs in Ireland have also had an impact on getting providers of cytology services to set up in Ireland.
Despite this, we are still trying to reduce waiting times. Some of our current labs have successfully reduced the wait times. We are working with other private labs and public service labs in other countries to help reduce the backlog.
The labs are prioritising women who have had a colposcopy. This is because these women have the highest clinical needs.
We have agreed with the lab with the largest backlog that they carry out a HPV test on smear test samples before cytology. This will help them prioritise slides.
Since 2015, we have used HPV testing as an extra test for any low grade changes that are found through cytology. This extra test is used to help decide when a woman needs to have their next smear test.
Risk of the results delay to you
Cervical cancer normally takes 10 to 15 years to develop.
While the delay of up to 33 weeks for smear test results is not desirable, it poses a very low risk to women.
The risk is also low if a woman needs to have a repeat smear test because her previous sample has expired.
We know that these delays are extremely difficult for women. We are making every effort to improve this situation.
It’s important that you continue to attend for a smear test when it’s due.
Repeat HPV tests
Quest Diagnostics, 1 of 3 labs we use, told us last November that some HPV (human papillomavirus) tests were carried out beyond the manufacturer’s recommended time-frame of 30 days. HPV tests have been a routine part of cervical screening tests since 2015.
When we were told about the issue, we took action to:
- get all the facts
- look at the information supplied by the lab
- review any clinical impact and communicate with women and their healthcare professionals
HPV tests are still likely to be accurate even if carried out after the recommended date. Our clinical team has assured us of this. They believe that the risk of incorrect results is low. But, in order to provide complete reassurance, we have asked some women to go for a repeat cervical screening test.
These tests will be prioritised. This is to ensure a timely response for those women. Repeat cervical screening tests will be processed within 4 to 6 weeks from the time the lab receives the sample from your smeartaker.
We have contacted all women affected and their healthcare professional. This includes women who do not require any follow up.
Supports to 221 women and families
We continue to support the 221 women and families impacted by the CervicalCheck crisis.
This has included:
- the provision of medical cards
- the upgrading of eligibility for medical card holders
- provision of access to a broad range of HSE and HSE-funded supports
- the reimbursement of expenses and costs
We have recently completed a report about the 221 patient group.
This was developed in conjunction with the 221+ group. This group represent the women and their families. It will help provide future supports for the group. The report provides a summary report on the 221 women.
We also continue to provide the women and their families with access to their cervical screening record, including slides from labs for legal review.
A dedicated Client Services Unit in our National Screening Service manages this process.
Report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis
The HSE has published the report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis.
The purpose of the project was to produce a summary report on the 221 women and their families impacted by the cervical screening crisis.
The intention of this report was to answer two questions that were frequently asked about the 221 women:
- what their current state of health is
- what resources might be needed to address their ongoing problems
This report does not provide an individual report on each of the 221 women. It is not an audit or a clinical review.
A clinical review is currently being undertaken by the Royal College of Obstetricians and Gynaecologists (known as the RCOG review).
This report does not provide any opinion on the CervicalCheck audit as this was reported upon in the ‘Scoping Inquiry into the CervicalCheck Screening Programme’ by Dr. Gabriel Scally (September 2018).
Whilst the report aims to provide an overall picture of the group of women, it has some data limitations where it was not possible to gather all data. For example, the HSE is not authorized to access data on women who had private healthcare.
Independent Expert Panel Review (RCOG review)
We are continuing to support the Independent Expert Panel Review being undertaken by the Royal College of Obstetrics and Gynaecology (RCOG) in the UK.
Over 1,070 women or their next of kin have consented to take part out of an eligible group of 1,702. This included:
- setting up a national helpdesk
- developing a dataset with the National Cancer Registry
- putting in place a client management system to support the RCOG
An information line has been set up. This is to address any queries or concerns from women and families invited to take part in the review. This line is open Monday to Friday, 9am to 6pm.
We have been working closely with the labs to help with the transfer of slides for this review. This is to make sure that the slides are protected and handled correctly.
The labs have begun transferring slides. All slides have been transferred by Coombe Women and Infants University Hospital. Quest Diagnostics and Sonic Healthcare have also began the transfer process.
The British Society for Colposcopy and Cervical Pathology are also providing input to the review. The review will take at least 6 months to complete.
HPV primary screening
We hope to introduce HPV primary screening as soon as possible.
HPV primary screening is a more effective form of cervical screening.
Plans to introduce HPV primary screening have begun. We have looked at HPV primary screening programmes in other countries. Testing of new systems is underway. We are also developing education and training materials.
We have begun the tender process for labs. This will ultimately determine when we can introduce the HPV screening.
Implementation plan for Scally recommendations
The HSE has welcomed the publication of the Implementation Plan for the Scoping Inquiry by Dr Gabriel Scally.
The plan sets out how all 56 of Dr Scally's recommendations will be put in place.
It was published on 11 December 2018.
A senior manager has been put in place to oversee the implementation of the recommendations in Dr Gabriel Scally’s report.
A HSE implementation oversight group has been set up. This is jointly chaired by our Chief Clinical Officer and Deputy Director General - Operations.
A set of 94 actions from the recommendations have been developed. These are our responsibility to implement.
Progress to date includes key appointments and governance changes.
An interim management team has been established with the reassignment of senior staff to key positions while we fill key positions on a permanent basis.
We have recently appointed a Director of Public Health for the National Screening Service, and a Clinical Director and a Laboratory Quality Assurance Lead for CervicalCheck.
A Risk Committee for the National Screening Service, which is independently chaired, has been in place since last year.
An interim Quality and Risk manager was also appointed last year.
Implementation of Dr Scally’s recommendations on strengthening our Quality Assurance processes has begun.