Earlier this week the figures provided by the National Screening Service to my colleague, an Teachta Cullinane, show a massive backlog in cancer screening throughout the State. It highlights that a catch-up programme is urgently needed. The figures show that fewer than 100,000 people have been screened through the State's three cancer screening programmes this year compared with five times that - half a million people - who were screened last year. More than 450 cancers and 1,600 precancer diagnoses may have been missed this year, according to the Irish Cancer Society. We understand that services have had to be curtailed due to Covid-19, but we need a catch-up programme and the Government must deal with that urgently.

Today, I raise a report published last week into gynaecology services in Letterkenny University Hospital. The report was commissioned after a hard-fought battle by patients and their families who knew that there was something deeply wrong about the services in that hospital. Hospital consultant, Dr. Margaret McMahon, who watched her sister die from endometrial cancer, was at the heart of this. She contacted Saolta University Health Care group in Letterkenny and made it aware that she believed women's lives were at risk as a result of the practices in the hospital. She knew from her sister's experience that it was a serious issue, but it fell on deaf ears. She contacted the Minister for Health, Deputy Harris, in 2016 and relayed the same information to him. Desperate, in 2017 she contacted him again and told him she would leave her consultancy practice in England and jump on a plane if he could give her five or ten minutes to explain to him why women's lives were being put at risk in Letterkenny University Hospital. I understand that the Minister responded by giving her the address of the Ombudsman.

Margaret McMahon and other patients' families have been completely vindicated by the report that was published last week because it is clear that the situation in Letterkenny University Hospital did put women's lives at risk and women have lost their lives as a result of the practices there. Of the 133 cases of endometrial cancer over a ten-year period, one in three women experienced a delay in their diagnosis, one in five women who had endometrial cancer suffered significant consequences as a result of a delay. Ten of these women have passed away since, and a significant portion of those deaths is because of the delays and the service. The report reveals a litany of failures which had devastating and life-changing consequences for these women. At the time of the independent review, when Margaret was forced to go public and reach out to politicians like myself who raised these cases in the Dáil, two women were waiting for urgent referral to that hospital for four years. That is how bad the situation is.

I will put some of the findings on the record:

It is clear that the experience for these women, and the service provided to them, was unsatisfactory. All cases, in one form or another, are typified by delay – delay from an urgent GP referral to a gynaecology outpatient appointment; from gynaecology outpatient appointment to urgent diagnostics ... and-or from diagnostics to intervention.

It says there were suboptimal practices with no evidence of implementation of recommendations that were previously given. A significant amount of responsibility lay with the oncology liaison nurse who had no written description of her roles or responsibility.

Will the Minister ensure that each and every recommendation by the independent panel is reviewed? Will he ensure that there is a proper review that goes wider than endometrial cancer in that hospital? Will he consider the independent panel recommendation for a full audit to be carried out throughout the State to ensure that Letterkenny is not an outlier?

I thank Deputy Doherty for raising the case, representing the family in question, and trying to relieve some of their terrible loss by ensuring that if there are failings in our system, they do not go unchecked and are actually addressed. I commit to following up with the Minister for Health to ensure that the report's findings are implemented. Our cancer system has improved significantly in recent years - everyone would recognise that - but that is not to say there are not failings in the system. A key issue we need to improve is the connection between the GP primary care system and our hospital system so that referrals happen in a seamless, quick, timely manner, which is one of the recommendations of that independent report. While there have been improvements in our cancer treatment system, we cannot rest. We must ensure that we press on and where there are failings in the system, be it in any one hospital or be it systematic, that we address them. I will certainly follow up on that.

On the Deputy's first point, it is a valid point as well that we must ensure that, in managing our Covid system, we do not lose sight of other preventative measures that can save lives. Critical to that is ensuring the return of cancer screening. I understand that BreastCheck is due to return next month. It cannot happen soon enough because we know that early intervention, particularly in cancer, and catching cancer cases early is critical to good outcomes, whether in cervical, breast, prostate or other cancers. We will look at the report and I will make sure that the Department and the Minister for Health in particular come back to the Deputy on the recommendations. We must also work collectively across the board to ensure that screening and testing systems for cancer are restored, enhanced and are fully operational again within the Covid period so that we catch cancers early and avoid the terrible losses the McMahon family and many other families have suffered from this terrible disease.

This was not only an issue of delay but also of misdiagnosis. It was an issue of serious flaws at management level in Letterkenny University Hospital, at Saolta level, but also at governmental level. One of the recommendations of the review is that a maternity or obstetrics ward would be commissioned. That ward was built, not yesterday or the years before that but in 2000. A state-of-the-art theatre has lain idle for 20 years which has resulted in some of the issues I outlined.

We cannot brush over the fact of the matter, which is that the consultant and families such as those of Annie Farrell, who had to go public, went through all the right channels. They went to the hospital, to Saolta and to the Minister and met with deaf ear after deaf ear. They continued to fight and had to explain their story in the media and reach out to others to ensure that the review took place. We cannot get away from the issue, which is that women in Donegal lost their lives as a result of the practices in that hospital. That is at the core of this.

On the recommendation that an audit be carried out throughout the State on endometrial cancer, will the Minister ensure that that happens? Will he ask for a wider review about what is happening in Letterkenny because many of the patients are not happy with how Letterkenny University Hospital or Saolta are dealing with them, even at this point today?

I cannot commit here to specific reviews being carried out because that is a matter for the Department of Health and the Minister who has to read the report, listen to the expert advice and ensure that we do apply the lessons and learn. Where there is a case that a ward has been in place for 20 years but is not properly equipped, staffed or operational, we must examine that.

I do not have the full details, so I am reluctant to comment on any hospital or any one unit within a particular hospital for fear that I would not be accurate or fair in approaching it.

I fully agree with the Deputy on the following. There can be no hiding from instances where there is failing in the system. There has to be full transparency and accountability. If it is shown by the Department of Health that an audit is needed of such diagnostic facilities throughout the country, I would fully support it, but that has to be done on a science and health basis. I cannot give a commitment in the Chamber without referring to the best scientific and health advice. The report will be considered in real detail. I will certainly commit to asking the Minister for Health to follow up and make sure it is not ignored or swept under the carpet, and that the issues and recommendations within it are addressed in a proper, scientific and healthcare manner.