At the weekend I met a woman; let us call her Anna. She had two smear tests, one in 2011 and one in 2015. Both came back as negative from Quest Diagnostics. A year later in April 2016, Anna was diagnosed with an 8 cm tumour. Thankfully today she is in remission, but the treatment means she cannot have children, which is a huge blow to her, a woman in her 30s, and her husband. We cannot adjudicate here as to whether it was excusable not to detect her cervical cancer. However, why is there an aura of such confidence in smear tests when they are, in fact, so fallible? Why were women with symptoms like Anna's dismissed by their own GPs when the clear smear test was cited to refute their concerns?

Last week Anna listened as the head of the HSE, Mr. Tony O'Brien, told the Joint Committee on Health that every slide is examined by two pairs of eyes. He was categorical about that. Last week, at the same committee I asked doctors from CervicalCheck if there is any difference in the results between the three labs, the public lab here in Ireland and the two private outsourced labs, one of which is in the US. They said "No". Strangely, they did not have the figures to back that up, but those figures have since become available when one went looking on the website. They reveal that over three years the outsourced labs have consistently lower detection rates, in particular Quest.

Let us consider the year 2013-14. I believe the Taoiseach took over as Minister for Health during that year. In the Coombe, the detection rate for abnormalities logged was 14.1%; for MedLab, it was 12.4%; and for Quest, it was 5.8%. The following year, the Coombe was 13.07%, MedLab was 11.2% and Quest was 7.8%. In 2015-16, the Coombe was 11.7%, MedLab was 9.3% and Quest was 8.46%. I know differences in demographics have been cited, but there would want to be massive differences in demographics to bring about those differences in results. The detection rate at Quest was nearly half of that of the Coombe, for example.

Why was Quest repeatedly given the contract when it has consistently shown these lower detection rates over these years? This is particularly true for lower grade abnormalities. Do Quest and the outsource labs meet the standard in the CervicalCheck quality assurance document of screeners not screening for more than five hours a day? Do its technicians screen not more than the 12,000 per annum or 50 a day? Why, based on the tendering document I have seen, are we not meant to give contracts to companies whose directors have been convicted of conspiracy, corruption and bribery and yet everybody knows the history of Quest from the 1990s, making settlements of $40 million in one decade, paying $11 million to the US Government in respect of lies over testing; and paying doctors kickbacks? Does the truth lie elsewhere in the tendering document that the most economically advantageous tender is the one that has to be accepted? Would the Taoiseach agree that it is serious cause for concern that for-profit private companies have been handed such a vital part of our women's healthcare?

I am very sorry to hear about Anna and very sorry to hear of her case, which the Deputy has shared with the Dáil. I am very sorry to hear what she has been through. I am glad she is now in remission but obviously the consequences of her cancer will be with her for the rest of her life.

The Deputy is correct in saying that we here cannot adjudicate on the issues she has put forward. That is exactly why we have established this inquiry - a scoping inquiry which starts today to be followed by a commission of investigation.

When it comes to any contract such as this, laboratories must be up to standard before getting a contract.

The issue as to which one comes in with the best price or the most economically advantageous price or bid only arises provided those labs are up to standard in terms of the quality of service they can provide, their accuracy and their ISO accreditation. Therefore, the cost only comes into it after standards are upheld. Cost is not a factor and if standards are not up to scratch, the laboratory would not even be permitted to make it to the final stage of the tender.

I am speaking on this as somebody who knows a little about how these things work but it certainly was never the case that any contract was ever run by a Government Minister for approval. That is not how contracts work and it is not how public procurement works, as the Deputy will be aware. It is also important to say that detection rates are not the same as error rates and it may well be the case that the batches sent to different labs are not all the same.

The whole point of establishing this inquiry is to get to the facts. We want to get to the bottom of this, we want to get to the facts, we want to put things right and we want to restore confidence in our cancer screening. Therefore, it is a specific term of reference of the scoping inquiry established today to, "examine the tendering, contracting, operation, conflict of interest arrangements, performance information and performance management, accreditation and quality assurance of contracted cytology laboratory services by CervicalCheck from initiation of the programme". That is exactly one of the terms of reference the scoping inquiry will examine not just for recent years, but going all the way back to 2008, to establish whether the suggestions the Deputy has made in the Chamber today stand up to scrutiny and are in line with the facts.

Again, I would encourage people to give their support to Professor Scally and Dr. Denton in the work they are going to do in the weeks ahead to try to answer those questions for all of us as soon as possible. I recognise the involvement and engagement of Opposition spokespeople on health in contributing to the terms of reference of this inquiry last week.

Since this scandal broke, the dogs in the street have been asking how it is good medical practice to outsource cervical screening to a privatised lab 3,000 miles away in a different time zone. Have we not arrived at the truth with these figures, given it is paying its technicians a fraction of what professionals are paid here? A private, for-profit company like Quest would be known to cut corners. I would like the Taoiseach to comment on its track record and why several Ministers stood over it being re-awarded the contract.

I do not expect us to adjudicate on the particular case because that will have to be done elsewhere. However, such big variations between one lab and another, which are clearly shown by this, should have warranted investigation over the years.

Research has shown that women are not listened to, and we know this because medical studies show women tend to get treatment later and are subjected to more pain before they get treatment. That has been combined with the perfect storm of privatising the screening service in this way and we are paying the price for that now.

The whole point of this, in many ways, is that we have not yet got to the truth and the Deputy is coming to particular conclusions without knowing all the facts. What we want is to get to the truth, and that is why we have established this inquiry and why it is a specific term of reference that the inquiry will examine the issues the Deputy raises. I ask her and all Members of this House to allow the inquiry to make its inquiries, allow it to look at the facts and allow it to get to the truth, and then we will find out whether there was a failing in that regard.

I ask Deputies, in the interests of women and their health, and in the interests of not causing additional concern or worry, not to jump to such conclusions until the inquiry actually happens and we find out the findings of that. Again, I inform the Deputy that, as I am sure she is aware, no Minister, current or past, has a role in contracts, tenders or public procurement. That is not how it works.

That concludes Leaders' Questions. We have gone significantly over time today but I suppose, in light of the vital importance of the subject, that is understandable.