I remind leaders that we will have expressions of sympathy after Leaders' Questions and I ask them to, please, observe the clock.

Today we learned that the CervicalCheck screening service has a backlog of approximately 78,000 slides to examine and that it is taking up to 27 weeks to provide reports on those tests. It is taking laboratories an average of 93 days to report on smear checks. Ms Anne O'Connor, the interim director general of the HSE, stated to the Oireachtas Joint Committee on Health this morning that approximately 370,000 women presented to the programme in 2018, an increase from 280,000 in 2017. There is no question that that increase of circa 90,000 tests results from the decision in April of last year by the Minister for Health, Deputy Harris, to offer a free out-of-cycle smear to any woman who wanted it. My sources confirm that the overwhelming impact of that decision has been to create this shocking backlog which is now damaging the programme and undermining its overall objectives.

There has been too much secrecy on this issue for far too long. We need a candid acknowledgement that the wrong decision was made because there was no clinical rationale for it. It was a knee-jerk political reaction by the Minister which has damaged the overall programme and cost approximately €10 million that could have been better used elsewhere in the health service. In May of last year, after the decision was made, I asked the Taoiseach on Leaders' Questions if it was the correct initial response and whether the system had the capacity to fulfil it. I suggested an alternative approach. The Taoiseach replied that, "A financial agreement on the fee was made last Friday" and went on to say that, "Obviously, there will be logistical and cost issues in getting the tests done as soon as possible but we will overcome them". However, the Taoiseach and the Government have not overcome them. The programme is under significant pressure and is in crisis mode dealing with these backlogs.

The then director general of the HSE, Mr. Tony O'Brien, did not advocate or recommend the approach taken. He stated that it was not actively advised at the time and that the message the HSE was trying to communicate was that women should attend for their scheduled programme appointment - nothing more and nothing less.

The Minister, Deputy Harris, received a significant amount of communication following the decision, including from a gynaecologist in the mid west who stated, "This is dangerous", and that there had been a delay in reporting a test carried out in June. As early as August of last year, GPs wrote to the Minister and the programme to state that smear tests were expiring. In October, the Minister was warned by gynaecologists in the mid west. Of course, in October the CervicalCheck programme recommended the discontinuation of out-of-cycle testing because of the damage that was being done.

Looking back, does the Taoiseach accept that the decision to recommend a free smear test to every woman was wrong? Does he accept that it had no clinical basis, was not resourced properly and has caused unacceptable stress and backlogs costing approximately €10 million overall?

In the first instance, we should recall that cervical screening works. It saves lives. As a result of cervical screening, the incidence of cervical cancer in Ireland has fallen considerably in recent years. Fewer women die from cervical cancer and fewer women face life-changing operations or treatment. It is encouraging and welcome that the number of women attending for smear tests has increased over the past year, notwithstanding the screening controversy. The objective of the Government is to make cervical cancer a very rare disease such that it is almost eliminated. We will achieve that by improving screening through becoming one of the first countries in the world to move to the new primary HPV test and by promoting the uptake of the HPV vaccine by girls and extending it to boys for the first time this year. Those measures are programmed and funded for this year.

I acknowledge that there is significant anxiety and concern among tens of thousands of women who have had a smear test and are awaiting the result. When the programme was working at its best, women received a result within four to six weeks, but it now takes closer to four to six months. There are two reasons for the delay, namely, the general increased uptake in the number of women attending for smear tests, which has continued into this year even though the free test is no longer available, and the decision last year to offer a free test to any woman who wanted one on foot of a consultation with her GP. Those two factors have given rise to the backlog. We are doing everything we can to reduce it. Additional laboratory capacity is being sought. Laboratories are taking on extra staff and, where appropriate, staff are working overtime to speed up the analysis of the tests. We anticipate that the backlog will start to decrease, although it may take some time before we get back to results being received within four to six weeks.

It is worth acknowledging that although some doctors opposed the decision to offer a free smear test, others called for it, as did some patient advocates. It was one of the major concerns raised by women who called the free help and information line. The decision was welcomed by many patient advocates, the Irish Medical Organisation and many Opposition Deputies.

The core lesson that should be learned is that politics does not make for good clinical decision making. It is a very worrying development that a gynaecologist has stated that tests have expired and that a diagnosis has been made in the case of a woman whose test results were delayed. The laboratories have written to the Minister to state that they cannot sustain this level of testing.

We need to be candid. There has been an attempt to cover this up and attribute it to several factors. The decision to provide out-of-cycle testing led to approximately 90,000 additional smears over approximately 230,000 annually. That had a significant impact on the cytology laboratories, which were not resourced to deal with that decision. The programme has been damaged as a result.

The Taoiseach referred to the HPV vaccine. It was promised for last September but that target was not met. It was then promised for January.

Is the Deputy referring to the test?

The Deputy has mixed up the vaccine and the test.

At the meeting of the health committee this morning, Deputy Donnelly asked whether it would be introduced in 2019. The witnesses were unable to provide any commitment or date in that regard.

The fundamental point is that €10 million was spent on the free test. There was no clinical rationale for it at all. The Minister said the assistant secretary and the Chief Medical Officer did not recommend it.

They supported it.

The Chief Medical Officer did not recommend it. The Minister should show me the note.

They supported it.

The Minister should show me anybody in the CervicalCheck team who recommended it.

The Taoiseach to respond.

The CervicalCheck team is appalled by the decision.

The Taoiseach to respond.

Many people in the programme are. The only reason they are worried is out of concern for the programme. They believe the programme has been damaged. I agree with the Taoiseach it has been very effective but this decision damaged it. We should learn lessons from it.

If we change the time, we change the time-----

I have reflected a lot on CervicalCheck, how it was handled, the extent to which it was handled well, and the extent to which we in government might have handled it better. I still reflect on it and on how we will handle these ongoing issues in the future. The truth, which I remember well, is that during the period in question, the Government was under a huge amount of pressure to act quickly. There were very few people in this House and in the media, and even more generally, who were willing to wait for all the information and the facts. We were under enormous pressure from many quarters to act quickly. Everything we did was in good faith. Sometimes we acted perhaps from the heart rather than the head but this decision was made in good faith. Tens of thousands of women were genuinely concerned about their smear tests and the accuracy. Tens of thousands of women attended for the tests. It is true that some doctors warned this backlog would arise but others called for the decision. The Chief Medical Officer supported the decision to do this. When the contract was negotiated with the general practitioners to provide the service, the IMO welcomed it.