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HSE concerned by Minister’s cancer screening legal proposal

By Catherine Reilly - 02nd Sep 2022

occupational medicine

 The HSE has expressed concern about the Minister for Health’s proposal to designate all ‘discordances’ found in individual look-back reviews in cancer screening services as “notifiable incidents” under the Patient Safety (Notifiable Patient Safety Incidents) Bill 2019. 

The board of the HSE fears that the proposal would have “negative consequences” for cancer screening services. 

In March, Minister Stephen Donnelly stated his intent to introduce a “notifiable incident directly relating to cancer screening services”. 

Describing the proposal to the Oireachtas health committee, he said: “If we have an identified patient on an interval cancer where a look-back is done and a discordance has been found, regardless of whether that discordance subsequently happens to be a patient safety incident – it may or may not be – open disclosure is required under law.” 

A HSE spokesperson said there “has been no formal consultation” on the Minister’s proposal. However, the Chief Clinical Officer and National Screening Service (NSS) had advised that the amendment risks “continued misunderstanding of the role of screening”. 

The HSE’s spokesperson commented: “BreastCheck has provided a patient-requested review service for many years for women who develop an interval cancer between screening. CervicalCheck has been working closely with patient groups as we develop a similar process for women who come for cervical screening.” 

“At the request of any patient diagnosed with an interval cancer, we will offer a review of their screening history and provide them and/or their families with all factual information possible in relation to their diagnosis. This is best practice, and we are concerned about any proposal that would designate a review request of this nature as a notifiable patient safety incident. 

“The Bill says that regulations may provide for incidents to be prescribed as notifiable incidents where certain criteria are met, such as that ‘the incident was or would be an unanticipated and unintended outcome of the health service provided’. 

“The expert reference group interval cancer reports reiterate that interval cancers are a recognised  unavoidable and expected occurrence in all organised screening programmes. As such, an interval cancer very rarely indicates a patient safety incident – although it is acknowledged that a small number of interval cancers may also be patient safety incidents. It is anticipated that the vast majority of reviews will fall into the category of being new cancers and/or within the expected limitations of screening.” 

The proposal “risks legislating a misunderstanding of the reality of screening programmes that they do not and cannot diagnose all cancers”. 

A Department spokesperson said the NSS was consulted during drafting of the proposed amendment and the Minister’s Office “will be engaging” with the HSE Chairperson on foot of correspondence. 

The Bill will be progressed to Dáil report stage during the autumn session. 

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