Susan Mitchell of The Sunday Business Post wrote at the weekend that last week was one of the worst in the history of the Irish health service. She was summing up the understandable anger at how Vicky Phelan was treated, the failure to tell women the truth about their misdiagnoses, forcing a sick woman through the courts and questions regarding the quality of our national cervical cancer screening programme. It is fair and objective to say that the response of the HSE directorate, the Department and the Minister in the early days compounded the crisis. Nobody appeared to be in charge and women were justifiably worried, anxious and angry.

Major issues have yet to be resolved. General practitioners, GPs, have yet to be properly advised, resourced and prepared to respond to the crisis. The help line has been way behind and has not been effective, as I know from people who contacted me over the weekend. Thousands of people are awaiting callbacks and, according to some reports we received this morning, some women were more worried after the calls than they were beforehand. Clearly, it is a rushed initiative that is not properly resourced. Many promises have been made. Will every woman who seeks a free smear test, as announced last week, get one? Is that the correct initial response? Does the capacity exist to do that? What criteria have been given to GPs to select and refer women for further smear tests? Surely, an initiative should be taken to proactively target women who are at higher risk of cervical cancer in an initial look-back exercise. There could be women walking around today who received false negatives and who actually have abnormalities and pre-cancerous cells. Some consideration must be given to a look-back programme that would focus on women at high risk.

We welcome the inquiry but, given the role of the Department, it should report back to the Taoiseach's office or to a different Department. There is precedent for that. While focusing on an inquiry, we must be conscious of the victims of this scandal, namely, the women whose screenings were misread on a number of occasions. We must listen to their voices. I was contacted by one of the 209 women this week. Her tests were missed on a number of occasions on an annual basis. She had to have a radical hysterectomy that could have been avoided. She was not told of this until late last week. She said, "The impact of finding out that cancerous cells were running around our systems for longer than we thought, in some cases years, due to the missed scans only raises fears of recurrence."

She does not want her medical team to be scapegoated and has stated:

My medical team are my only security. Whatever happens in this inquiry, any damage to them will damage me and I refuse to allow any further damage. Enough is enough and I want assurances that my consultant will be able to focus on me and my care and not on bureaucracy.

The Deputy's time is up.

In the bubble of Leinster House, we can go in one direction but we must listen to what victims say to us and we must be proportionate. The woman who contacted me asked us to be balanced and proportionate and, above all, to keep her needs as a victim as our number one priority in whatever we do.

The Deputy must have spoken to a very strong, very brave and very sensible woman who is clearly somewhat forgiving of the mistakes that were made in her case. He is right that at the forefront of our minds at all times must be our concern and regard for the women who have been affected and also the many others who are not affected but who are understandably concerned because of the fact that confidence in our screening programme has been so diminished. The Deputy is correct to say that the week gone by has been dreadful for our health service. We have many problems with our health service that need to be resolved, whether it be people waiting too long to see specialists or to get the treatment they need or whether it be some of the patient safety incidents we have become aware of in recent weeks and those of which we have been aware for a very long time.

We must not forget some wider truths. In no way would I like to diminish or play down the seriousness of any of the issues we have been talking about in recent weeks but we need to recognise that there are also many good things happening in our health service. Life expectancy is improving all the time and people are living longer and healthy lives. This is due, in part, to our health service. When we ask patients what they think of our health service, 85% say they have a good or very good experience of it. We know that cancer survival rates are improving all the time. More people survive cancer than was ever the case previously. We have better outcomes in so many different areas, whether stroke, heart attack or cystic fibrosis. We now have nearly 10,000 doctors working in our health service - more than ever before - 1,000 more nurses and student nurses than we had a year ago and 114 primary care centres open, with another eight to open in the year ahead. This is just to give a small example of the kinds of things happening in our health service every day that are bringing about real improvements for patients and real changes for the better in people's lives. We do a disservice to the hard-working staff in our health service - all 100,000 of them - if we do not recognise the very good work they all do on a day-to-day basis. We also do a disservice to patients when we are not measured in how we speak about the health service. The Deputy has been very measured in the comments he has made to date.

I will pick up on some of the questions the Deputy asked. He asked about the smear test. The smear test is available to any woman who is concerned and would like to have a repeat one. The terms of this have been agreed with both the GPs and the smear takers. A financial agreement on the fee was made last Friday and the Minister for Health informs me that guidance has been issued to GPs as to how to go about the process. Obviously, there will be logistical and cost issues in getting the tests done as soon as possible but we will overcome them, and the agreement is in place with the GPs and smear takers. The clinical review being carried out will give consideration to whether or not a look back would make sense and be appropriate. Obviously, there are pros and cons to that but it is certainly under consideration. When it comes to the helpline, I am informed that 11,000 calls have now been logged and 7,678 women have requested callbacks. All the calls are being answered quite quickly but it does take time to get back to people because generally what is required is a relatively long clinical consultation with a doctor or nurse. Often these callbacks - these conversations - can, for understandable reasons, take 20, 30 or 40 minutes because women have concerns and questions. Those questions need to be answered and time needs to be given to women and to patients for that. So far, 2,686 calls have been returned, but it should be borne in mind that before the call can be returned, a doctor or nurse needs to check records and data quality and needs to assign a call to a health professional. The initial call is answered and, once the information is collated, a longer callback occurs involving a doctor or nurse.

I thank the Taoiseach. His time is up.

I can accept some of the criticism the Deputy puts forward. If we had been in a position to plan for this, we would have planned for it and would have had all these things in place. However, the Minister for Health, the Government and all the people working around us had to respond to this very quickly and to put things together in a matter of days. In normal circumstances, we would have had time to prepare but we did not have it in this instance.

The point is that arguably the system did have time to prepare and did not respond initially as it should have to the Vicky Phelan case. That is why we have had these panicked, rushed measures that have not been properly thought through. There are 7,000 women waiting for a callback. That is an appalling number. Proper thought did not go into what type of helpline should be established and whether it would be a phoneline or a genuine resource that was resourced as such. A more primary-care focused response should have been developed.

On the free smear test, presumably there will be a fee for every general practitioner, GP, in respect of every woman who comes back. However, first of all we are looking to get the quality assurance right and restore confidence in that. It needs to be thought through. Women at a higher risk should have been targeted first, working with primary care and their consultants, because there are different categories and some are more high risk than others. There is an urgent need to focus on that aspect of it.

A redress scheme was announced last week and no one has an idea what it means. Initially, it gave the impression that everyone whose results were misread would get redress. During the weekend, there were newspaper reports that it would be for anyone who was not told. It seems as though things are being made up as they go along.

I want to hear more from the Taoiseach about the logistics of smear tests from every GP. Will the Taoiseach indicate what is envisaged by the Government on this?

The offer of repeat smear tests was a response to concerns expressed by women. A large number of women who contacted the helpline wanted to have a repeat test and the Minister for Health responded to that by making it available. The possibility of a look-back is under consideration but that would be based on a smear that may have been taken six months, a year or maybe two years ago or longer. A more up-to-date test might be the best way to get reassurance for people who want it.

As I told the Dáil last Wednesday, the Government's intention is to establish a redress scheme. The first thing we must do is establish the facts of the case and we do not yet know all the facts. There are women for whom open disclosure did not occur. While the State may not have a legal liability in that regard, in my view it does have a moral liability and consequently we will need to provide redress to women who were not told this important information about their health. We also will need to look at the various different cases, of which there are approximately 166, of women who were diagnosed with cervical cancer where it subsequently turned out they had been given a false negative smear. We will need to examine that in some detail because there are different forms of false negative, namely, those within acceptable bounds of normal margin of error and those which should not have been missed. Part of what we are doing is ensuring that this clinical review is undertaken not just of the 208 women, but of all 1,400 who were part of the cervical screen audit.

On Tuesday night, the Minister for Health announced that about 1,600 cases that had been notified to the national cancer registry of Ireland had not been notified on to CervicalCheck. Much work has been done in recent days to go through that. We can confirm that the vast majority of those 1,600 cases will not need to be part of the audit because, as we suspected at the time, many of those women did not have a smear test or had not had one for a very long period. We will have the exact figures quite soon.