Freephone information line: 1800 45 45 55

Information for Healthcare Professionals from CervicalCheck - Latest update

(11 Dec 2018)

Letter to registered smeartakers regarding the cessation of out-of-cycle consultations and smear tests - 4 December 2018

Letter to doctors nurses registered with CervicalCheck - CervicalCheck Update for Health Professionals - 2 May 2018

Information for women who are concerned about their smear test results can be found here >

Smear test result delays

Letter to doctors/nurses registered with CervicalCheck: CervicalCheck Update for Health Professionals - 7 August 2018

CervicalCheck daily reports from the HSE Serious Incident Management Team can be found here

Letter to GPs from HSE and CervicalCheck (pdf) - 9 May 2018 – clinical advice and reimbursement overview

Reimbursement Notice from HSE and CervicalCheck (pdf) - 9 May 2018

CervicalCheck advice and support sheet for women (pdf) - 4 May 2018

This is an update for GPs and smeartakers contracted to the National Cervical Screening Programme. The update is about the cervical screening programme and its recent audit process. We would specifically like to seek the support of you and your teams in helping women to allay concerns caused by the way this issue has been communicated and how it may be resolved.

The HSE and the CervicalCheck programme has reiterated its deepest apologies to women for any worry caused by this ongoing situation. The HSE is keen to provide reassurance to women who may be affected, and to those involved in their care and from who they may seek advice and support. With this in mind, we have outlined below an overview of what has happened to date and advice for both healthcare workers and women.

Implementation Plan for Scally Recommendations

The HSE has welcomed the publication of the Implementation Plan for the Scoping Inquiry by Dr Gabriel Scally.

The plan sets out how all 56 of Dr Scally's recommendations will be put in place.

It was published on 11 December 2018.

You can read the Implementation Plan for the Scoping Inquiry on the Department of Health’s website.


A Scoping Inquiry into Cervical Check was undertaken by Dr Gabriel Scally. His report was published in September 2018.

It contained 50 recommendations and 6 interim recommendations.

In response, the HSE established an Implementation Oversight Group. The group worked with the Department of Health and other relevant organisations.

The aim was to develop a plan for putting in place all 56 recommendations.

Governance of Implementation Oversight Group

The HSE has responsibility for implementing 31 of the 56 recommendations.

Along with the Department of Health, we have responsibility for 9 further recommendations.

The Department of Health has had lead responsibility for drafting the Implementation Plan. This is part of its remit as a member of the Cervical Check Steering Committee.

The HSE and the National Cancer Registry of Ireland (NCRI) have also helped develop the plan. They have worked on it along with patient representatives.

HSE Recommendations

We are working with the teams responsible for each recommendation. This is so we can devise detailed action plans for each recommendation.

Each set of actions has a detailed action plan. This includes timelines for starting and completing each recommendation.

This plan is iterative. This means it will be reviewed and improved at each stage. So actions will change as the plan progresses. It is likely the number of actions will grow.

We have 86 actions to put in place. We have assigned or jointly assigned senior staff for each recommendation.

Some of these actions are directly related to the:

  • National Screening Service
  • CervicalCheck programme
  • wider Health Service

More than 70% of the actions will have begun being implemented before the end of 2018.

Patients Voice

We are committed to keeping patients and service users at the centre of this process. We have been communicating with patient representatives throughout the development of this plan.

Engagement structures are already in place for implementing Dr Scally’s interim recommendations. We are now building on these. These include the public patient involvement (PPI).

Progress to date

There are 86 actions assigned to the HSE. More than 70% of these will have started by the end of 2018.

We have 86 actions to put in place. We have assigned or jointly assigned senior staff for each recommendation.

The HSE has appointed an implementation lead for this project.

Our plan includes working to key milestones and deadlines.

We will publish interim updates on the status of actions within our remit on

Members of the HSE Implementation Oversight Group

Anne O’Connor - Deputy Director General, Chief Operations Officer
Dr Colm Henry - Chief Clinical Officer

Damien McCallion - National Director, National Screening Service
John Swords - Head of Procurement
Michele Tait - HSE Implementation Lead
Stephen Horan - Implementation Plan PMO HSE
David Walsh - Interim National Director, Community Operations
Paul Connors - National Director of Communications
Dr Kevin Kelleher, National Director of Public Health.
Liam Woods, National Director Acute Hospitals
Dr Peter McKenna, Clinical Lead Women& Infants Health Programme HSE & Interim Clinical Lead Cervical Check Programme

Scoping Inquiry Report

The HSE welcomed the publication of the final report of the Scoping Inquiry by Dr Gabriel Scally and his team. We would like to acknowledge the focus and commitment of Dr Scally and his team and the patient-centred approach that they have taken in this regard.

We are re-iterating our deepest apology to all those women and those families affected.   At the centre of this issue was our failure to communicate with the women who were the subject of the audit.  As Dr Scally noted, and with which we agree, these women should have been informed.   The impact of this failure has been profound both for every single woman and all family members affected.   We further accept that the manner in which women were told was inconsistent and in many instances ill-judged and poorly handled.

The priority for the HSE over the past number of months has been to support the women and families involved and continue to stabilise the cervical screening programme.  Designated liaison officers throughout the country are in ongoing contact with the women and families directly affected. 

We welcome confirmation by Dr Scally that the current laboratories have and continue to provide services in a quality assured manner.

We are now moving swiftly to implement all 50 recommendations and are continuing to thoroughly examine the findings.

Latest updates

An independent Expert Panel Review has been set up by the Minister for Health. The Royal College of Obstetricians and Gynaecologists (RCOG) will lead this review panel of UK experts. The British Society for Colposcopy and Cervical Pathology will also provide input. The review will take at least 6 months to complete. You can read more about the purpose of the review and the consent process here. We will be writing to all relevant healthcare professionals separately to inform them of the review.

1.1 What has happened to date?

Approximately 3,000 women have been diagnosed with cervical cancer since 2008. Approximately half of these cases were notified to CervicalCheck. The audit looked at the 1,482 cases which we were notified of.  A clinical audit is used to test and assure the standard of work that is being done by a health service or facility.

The audit initially found that 209 women could have been provided with a different result and recommended earlier follow-up following their screening test.

A further 12 women have since been identified. Their screening test could also have provided a different result and recommended earlier follow-up.

Importantly, this audit was undertaken after the women were diagnosed. CervicalCheck did not withhold information from any woman that delayed their cancer diagnosis. The audit of their previous smears was undertaken in response to CervicalCheck learning of their diagnosis.

A HSE Serious Incident Management Team (SIMT) has been working to respond to and clarify the details of what occurred, and this will continue as the situation evolves.

It is clear that there has been a very serious breakdown in communicating to the women concerned. They should have been told that this audit was happening and of the outcomes of the audit, but in many cases they were not. We are now doing this.

You can find out more information about the audit in this statement. This statement was published on 1st May 2018, when we knew of 208 cases where women could have been provided with a different result.

1.2 Information and Support for Women      

Women in Ireland have been understandably worried following the failures in communication about this audit. An information line was provided from April 28th and women were offered the facility to receive a call-back from a member of our clinical staff. This information line, Freephone 1800 45 45 55 (+353 21 4217612 from outside Ireland), continues to be in operation.

Calls have been returned to women following a careful exercise of checking records, data quality and assigning calls to health professionals. The call backs take a period of time as, in those cases where the person has a history of referral for colposcopy treatment or a history of cancer, we are providing a telephone consultation with a healthcare professional.

We are working hard to ensure that everyone who requested a call-back is responded to as soon as possible.

Key points:

  • CervicalCheck apologises unreservedly to you for any concerns or distress encountered as a result of this incident. 
  • Since 2008 over 3 million tests that have been taken in CervicalCheck, 221 of these tests were found to be inaccurate in this current review.  
  • Like all screening tests, cervical screening cannot unfortunately prevent all cancers. While it can detect pre-cancerous changes, it cannot always detect these changes or the presence of cancer if it has already developed.
  • The clinical advice is that women who have had normal test results in the past can continue to participate in the cervical screening programme according to their normal schedule. We are working to provide information to women across a range of channels to assist those whose query can be answered without the need for them to call the CervicalCheck information line.
  • Regular cervical screening is still one of the best ways to prevent cervical cancer.  To date, CervicalCheck has detected over 50,000 pre-cancerous changes in women, reducing their cancer risk by more than 90%.
  • CervicalCheck ensures that the laboratory analysis of our screenings is of the highest possible standard. All our screening tests are analysed in laboratories in Ireland and the US which have reached the highest standards of accreditation by national authorities. The laboratories have robust quality assurance and two screeners examine every test.

1.3 Most frequently asked questions

1.3.1 About the Audit

CervicalCheck carried out an audit of women who had been diagnosed with cervical cancer over the last 10 years. The audit happened after their cancer was notified to CervicalCheck. Not all of these women were told about the audit or that, in some cases, the audit found their screening test could have provided a different result and recommended earlier follow-up.

Contact with women directly affected

We have contacted most of the 221 women affected.

To date, we have either met with or arranged meetings with 208 of the initial 209 women affected or their families. The remaining woman lives outside the country and extensive efforts have been made to contact her.

We are also contacting the 12 additional women recently identified as also affected.

*Women diagnosed with cancer but not notified to CervicalCheck

The HSE is working with the National Cancer Registry of Ireland (NCRI) and the Department of Health to identify any other women who had cervical cancer during this time, who may also have had a CervicalCheck test.  Reconciliation of data on relevant cases is currently ongoing between CervicalCheck and NCRI.

1.3.2 I am concerned regarding my cervical screening results – what should I do?

Women who have had normal screening results do not need a repeat smear test.  We have received a large number of calls from people with normal smear test results. We understand people are very worried and need reassurance.

The HSE Serious Incident Management Team has reviewed the overall screening process and how it is affected by this audit. Women who have had normal screening results do not clinically require an urgent smear test.

If you are still concerned you should visit your GP and discuss those concerns with them and you can request a repeat screening test free of charge if you or your GP remain concerned.

1.3.3 For women who have had their smear test in the last three months

The best advice is for you to continue with your cervical screening as scheduled.

You should wait three months before having another smear test. As your results were normal you do not urgently need a repeat but if you are still concerned or are experiencing any symptoms you should talk to your GP who can organise a repeat test for you. The screening and consultation will be free of charge.

1.3.4 Request for previous screening test to be reviewed/re-examined

We are recommending that you carry on with your next cervical screening as scheduled since your last smear test was normal.

If you are concerned or are experiencing any symptoms such as vaginal bleeding in between periods, abnormal discharge or pelvic pain you should visit your GP and you can request a repeat screening test. The screening and consultation will be free of charge.

Please note a gap of at least 3 months is necessary for a rescreen as there will not be enough cells to test.

1.3.5 Can you reassure me that the programme is safe?

We would again like to apologise for any concerns or distress encountered as a result of this issue.

There is no evidence to suggest the clinical elements of the screening programme are faulty. The quality of smear-taking by doctors and nurses is not in question. All of contracted laboratories which currently look for abnormalities in smears have passed all quality control tests and are operating to international standards.

Cervical screening is for women with no symptoms and in the vast majority of cases, results show no abnormalities.  Every test is examined by two trained medical scientists in all of the labs that provide screening service to CervicalCheck.

1.3.6 If asked where their test have been screened/sent to or will be sent to?

CervicalCheck currently uses three laboratories to analyse cervical screening tests. It used other laboratories in the past. All laboratories meet CervicalCheck’s quality assurance guidelines and are certified by the relevant national authorities to an international standard. The laboratories have robust quality assurance and two screeners examine every test.

The laboratories currently used are

Quest Diagnostics, Teterboro, New Jersey, USA;
MedLab Pathology, Dublin;
Coombe Women and Infant’s Hospital, Dublin.

If the woman wants to know where her screening was carried out

This information is available on the cytology report.

1.3.7 Explanation of Screening - Limitations

The aim of cervical screening is to determine the presence or absence of pre-cervical cancerous changes. Like all screening programs, the results of cervical screening can never be 100% accurate. Cervical screening is not diagnostic and cannot always detect pre-cancerous changes. Despite its limitations, cervical screening is still one of the most effective ways to reduce your risk of developing cervical cancer.

To date, CervicalCheck has detected over 50,000 pre-cancerous changes in women, reducing their cancer risk by more than 90%.

1.3.8 Concerns from women currently in the care of Colposcopy.

The colposcopy clinics conform to a high set of standards, any queries regarding your specific case should be discussed with your colposcopy clinician.

1.3.9 What is a cervical screening test?

This is a screening test for well women and the vast majority of results show no abnormality. Screening tests are not diagnostic tests but can identify individuals who should have additional tests to determine the presence or absence of disease. Cervical screening does not prevent all cases of cervical cancer. Cervical screening tests, like other screening tests, are not 100% accurate.

1.3.10 Women who have had a hysterectomy

If you have had a radical hysterectomy then there is no need for you to have a smear test. If however you have had a partial hysterectomy then you should participate in the CervicalCheck Programme. You can register online and if you are already registered you can also check the date of your next smear test online here.

Your doctor can advise you what type of hysterectomy you have had and whether you need to continue in the CervicalCheck programme.

If you have any concerns or you have signs or symptoms, such as irregular vaginal bleeding, abnormal vaginal discharge and pelvic pain you should discuss them with your GP.

1.3.11 Pregnancy and cervical screening

I am pregnant and have received a letter, what do I do?

If you are due your routine smear test and you are pregnant, then the smear test can be delayed until three months after you give birth. Simply call the CervicalCheck Freephone and indicate that you wish to defer your routine smear test.

I have had a baby; do I need a smear test?

You do not need a smear test after having a baby unless you are due to have a smear test.

My last result was not normal and now I am pregnant, what should I do?

A not normal result will not affect your pregnancy. If you have had a not normal result and a repeat smear test is due then you can discuss this with your doctor or nurse. If you have been recommended to attend colposcopy you should attend your appointment. You can discuss this with your doctor or nurse if more information is needed.

Can a smear test that is not normal affect my pregnancy?

A not normal smear test has no effect on pregnancy. Occasionally women may have slight bleeding after having a smear test in pregnancy, but a smear test will not increase the risk of miscarriage.

1.3.12 Open disclosure (sharing information)

The HSE supports open disclosure. Information should always be shared with patients relating to their care. It is not in keeping with our policy and is not acceptable to us, that this did not happen in many of these cases. An independent statutory review has now been established. It will look at why this happened and what we need to do to ensure that it doesn’t happen again.

1.3.13 Additional Smear

You can get an additional cervical screening consultation and smear test free of charge from your GP if you want one.

1.3.14 Can I get my result which was negative rechecked?

We are not recommending this. The reason is that while we’re happy to stand over the lab process, and as is stated on all cervicalcheck information letters, results letters and information leaflets, no screening process is 100% accurate. The value of screening tests, which are not the same as diagnostic tests, is to regularly check for a very slow-growing disease, at planned intervals.  Our advice, if people are concerned about their cervical health, after talking to their GP, is that they should book in for a free, new screening test.

1.3.15 What is the difference between HPV test and current cervical screening? When will it be introduced? Does it replace smear test?

Cervical smears examine a sample of the cells on the cervix under a microscope, by 2 different people, to check for any abnormalities that can be seen.  Later in 2018, we are adding a new test, where we’ll look at the cells as before, but also test for the presence of HPV virus in the sample. HPV is a sexually transmitted infection that is extremely common, and which causes about 70% of all cervical cancers.  This new screening process will be the same for you – you will visit their smear-taker, and the sample will be collected in the same way, but the testing for HPV will offer an additional level of accuracy and reassurance.

1.3.16 Will the figures for the individual labs be published?

We have published data from the 3 labs we currently use on the HSE website and this indicates that these labs are performing as they should, compared to international norms, and to each other.  The cervical screening programme is safe and effective, and we urge women, despite the poor communications process that has been seen during this audit, to remain within the programme, to continue attending for screening as per their normal schedule.

Other information

We appreciate a large volume of women have attended for repeat screening. The following resources may assist smeartakers:

CervicalCheck daily reports can be found here

Information for women concerned about their smear test results can be found here

Download a PDF version of these FAQs here

Update for smeartaker and partner organisations (pdf) - 4 May 2018

Letter to  CervicalCheck colposcopy services (pdf) - 3 May 2018

Letter to GPs and Smeartakers from HSE and CervicalCheck (pdf) - 2 May 2018

Is cuid den tSeirbhís Náisiúnta Scagthástála é CervicalCheck
Bosca Oifig Phoist 161, Luimneach
Saorghlao 1800 45 45 55
CervicalCheck is part of the National Cancer Screening Service
PO Box 161 Limerick
Freephone 1800 45 45 55

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Is cuid den Rannóg Sláinte agus Folláine i bhFeidhmeannacht na Seirbhíse Sláinte í an tSeirbhís Náisiúnta Scagthástála. Cuimsíonn sí BreastCheck – An Clár Náisiúnta Scagthástála Cíoch, CervicalCheck – An Clár Náisiúnta Scagthástála Ceirbheacs, BowelScreen – An Clár Náisiúnta Scagthástála Putóige agus Diabetic RetinaScreen – An Clár Náisiúnta Scagthástála Reitiní do Dhiaibéitigh.

The National Screening Service is part of the Health and Wellbeing Division of the Health Service Executive. It encompasses BreastCheck – The National Breast Screening Programme, CervicalCheck – The National Cervical Screening Programme, BowelScreen – The National Bowel Screening Programme and Diabetic RetinaScreen – The National Diabetic Retinal Screening Programme.