We learned from The Irish Times today that a further 60 women have applied to join the 221+ support group for those affected by the CervicalCheck scandal after the Royal College of Obstetricians and Gynaecologists, RCOG, expert panel review found abnormalities in their smear tests as opposed to the original tests. These were women who were originally given the all-clear and later developed cancer. The review has produced a result that was different from the original CervicalCheck finding with very negative implications, as we know, for the treatment these women had to go through and for their health outcomes.

I met one such woman last evening, Bernadette Kiely from Cork, with her daughter, Claudia, who has been advocating for quite some time on behalf of Bernadette. What is quite extraordinary is that it was only in November Bernadette Kiely discovered she was part of the original audit by CervicalCheck. If it was not for her solicitor who sought access to her medical records in October just past, that fact would never have come to light. Mrs. Bernadette Kiely was never informed of the fact she was part of the audit and the audit letter, dated 8 July 2017, from Dr. Flannelly was never disclosed to her.

Ms Kiely has applied to become part of the 221+ group. She is a victim of non-disclosure. She has been rebuffed by the Department. She rang the Minister's office 23 times to try to have a conversation with, and to get access, to him but to no avail. She had to email the Taoiseach's office because she was originally refused a medical card. The daughter did all this work on behalf of her mother because the treatment has left an impact so the daughter is fighting the case. Bernadette should have been entitled to the ex gratia payment just like everybody else. She should have been part of the group. It is inexplicable she was not included from day one.

We need answers to her specific case. As the Taoiseach knows, the HSE has admitted liability for non-disclosure to quite a number of women but not to Bernadette. I have all the documentation and all the letters here confirming all of this. The outcome of the RCOG panel review is that both the cytology and the follow-up on colposcopy were inadequate and lacked active management. Both of these represented missed opportunities to prevent cancer or diagnose it at an earlier stage. There was an earlier referral in 2009 for colposcopy. It was 2015 when the second colposcopy happened and she was detected to have cancer.

How many more Bernadettes are out there that we do not know about? It is extraordinary, given all of the controversy surrounding this issue for the past two years, that there are still stories like Bernadette Kiely surfacing and emerging. All the focus to date has been on cytology. Is the Taoiseach satisfied in terms of the quality control mechanisms on the colposcopy dimension to this issue with regard to many of the women involved?

I thank the Deputy for that. I am not familiar with that individual case nor is the Minister for Health, but we will certainly check it out. The Minister has undertaken to speak to the Deputy personally afterwards and take any documentation from him. We will see if we can look into it and see if anything that needs to be rectified can be rectified.

Today will be another difficult day for women affected by cervical cancer, and for their families and friends. I hope it will be another step in restoring confidence in the CervicalCheck programme, which we all know has saved many lives, detected cancer early and prevented many hysterectomies and more radical surgeries as a result of that. I know that when the CervicalCheck audit first became public in May 2017, it caused enormous concern and controversy and led to a very difficult debacle that we have all been managing since then.

Looking back on it, I did not handle it in the way I should have. I made some mistakes, as did the Government, the Opposition and, as Dr. Scally pointed out in his report, the media. I hope that on this occasion we will all handle it a little bit better than we did two years ago. It is encouraging that on this occasion it was ensured that the individual women involved got the information, either by letter or in a meeting if they preferred, long before the report came to Cabinet or was published. It is a significant improvement on two years ago that those affected were informed before the report came to the Cabinet or this House or entered the public domain.

The audit will be published at 3 p.m. today. It was discussed at the Cabinet meeting this morning. Patient advocates are also being briefed on it today. Briefings are being provided for members of the Opposition who want them, particularly the relevant spokespersons. Again, that will happen this afternoon. The Royal College of Obstetricians and Gynaecologists has agreed to come before the Oireachtas joint committee in the next two weeks to explain its report and to answer any questions Deputies may have about it. It is a very technical and scientific area and the college is better placed to explain it than politicians, although we will do our best. The Royal College of Obstetricians and Gynaecologists is the professional body for obstetricians and gynaecologists in the United Kingdom. Its members are experts in their field. It carried out its work totally independent of Government and I thank it for that work, which will help to improve this programme into the future.

I put two questions to the Taoiseach. Media reports suggest that 60 more women have applied to be part of the support group for women who have been involved in this controversy. I asked the Taoiseach how many more Bernadette Kielys are out there. There is correspondence going back to 2016 and 2017 between CervicalCheck and Bernadette Kiely's consultants. Some of the letters have a familiar ring to them. It is interesting that a letter to her consultant stated that a review of colposcopy was conducted based on the cervical screening history of Ms Kiely prior to her diagnosis. I will not go through the whole letter but it states the case had been discussed at multidisciplinary team meetings for quite some time. My understanding is that there would have been a comprehensive trawl of all records and that all of the women involved would have been identified. It is extraordinary that this documentation only emerged in November following a discovery order to the hospital. The letter also states: "Please ensure that this correspondence is added to Ms Kiely's medical record" and "If open disclosure is indicated in this case, please follow the local hospital guidelines." We have seen those lines before.

How many additional women who should be part of the support group have been discovered through the Royal College of Obstetricians and Gynaecologists process? The media estimate a figure of 60. With regard to the question I asked on quality control and the colposcopy element of this matter, the expert panel review is very critical of the lack of active management of this case and the lack of follow-up. Is the Taoiseach satisfied that colposcopy services have performed adequately in light of this ongoing controversy?

Once again, I am not at all familiar with Ms Kiely's case. We will have to look into it. Not being familiar with the case, I cannot tell the Deputy how many cases are similar to it. I would not be able to answer that question. It might be worth sharing the six conclusions of the report with Deputies. The first is that cervical screening saves lives, including many of those women who consented to take part in the review. The second is that cervical screening cannot prevent all cases and will fail to prevent between 30% and 35% of cancers, even in well run programmes. Of the 1,034 women who took part in this audit, it is to be expected that 30% to 35% would have discordance. That was the case. Some 29.8%, or 308 women, had discordance and in approximately half of these cases, it may have had a clinical impact. I suppose that is the number of women who could apply to join the group.

The third conclusion is that the pattern of discordance in this review resembled that in a similar but larger-scale slide review in England. When the service was audited in England, the same or similar levels of discordance were found.

The fourth conclusion is that screening failures have serious consequences for the women affected, as we know.

The fifth relates specifically to colposcopy. Scrutiny of colposcopy revealed that there were cases where better management could have yielded better outcomes. It found evidence that clinical practice guidelines had not always been adhered to. While this will not usually result in cancer, when we examine cancer cases following colposcopy it is expected that suboptimal management will be identified. This is far from concluding that colposcopic practice in the CervicalCheck programme is substandard, but it serves as a reminder that guidelines are in place to minimise poor outcomes.

The sixth finding is that the CervicalCheck programme is working effectively. There is no evidence that the population risk of cancer, having been screened in the programme, is significantly higher than that in any other national programme.