The latest CervicalCheck crisis can be confusing, not least because of the pace at which new details have been emerging.
The main problem about 856 women not getting their test results, due to an IT glitch was only made public last Thursday evening.
The HSE has clarified that the number of women affected by the IT problem is 856.
Last Thursday, in its statement to RTÉ News, the HSE put the figure at "approximately 800 women".
Women, their families and patient advocates have been left in disbelief and confidence in the system has been damaged.
The frustration and annoyance this has caused is palpable. And it was all so unnecessary, if matters had been handled better.
The rapid review being chaired by an external chairperson, Professor Brian MacCraith, has begun its work and it will hopefully explain who knew what when and how events led to where we are now.
Prof MacCraith has emphasised that the review is being carried out solely by him, otherwise he would not have agreed to take the role.
It is also welcome that he has already commenced discussions with patient representatives, including Stephen Teap, Lorraine Walsh, and he has spoken to 'Sharon' who helped bring the whole issue to light in the first place on RTÉ News.
The 6 June letter from the private secretary to the Minister for Health to 'Sharon', does not show that either the department, or the Health Minister were aware then of the IT issue.
But the correspondence, which was started by 'Sharon' in early April with the department, indicates that red flags were being raised and gives us a sense of timelines.
The department also said it would investigate the delay in test results
We can see that it took around 34 days for the Department of Health to find out, in the end, that more than 800 women were affected by the IT glitch and that test results had not issued.
Both patients and GPs were left in the dark. And the test results dated back in some cases to last October.
Since the story became public, I have received emails from patients, with stories of how they only got results after chasing them up, or still have not got their test results.
Is that good enough, given that CervicalCheck has been the biggest crisis in health in recent memory?
We have heard from Dr Colm Henry, Chief Clinical Officer at the HSE, that the overall clinical risk to 800 women is low.
Hopefully that reassurance will help.
Checks are now being made by the HSE, with the GPs of 52 women, whose retest showed up HPV positive, to make sure that information was conveyed to them.
It may be next week before all GPs and patients in this deeply upsetting affair have been contacted.
Minister for Health, Simon Harris has said he would like to have been notified before last Wednesday evening about the IT glitch and that more than 800 women were affected.
Patient advocates should also have been told earlier.
Once again, communication failures at the heart of the CervicalCheck programme have been exposed.
It raises questions about the oversight by the HSE and the Department of Health of one of the most sensitive issues of recent times.
This controversy over the IT failure was different in a key way to the original one exposed in April last year, about the failure to disclose the ten-year audits of smear slides.
The issue this past week involved the delayed notification of actual clinical results to women.
It may be by the stroke of luck that there appears to be minimal clinical negative outcome. But we do not have all the facts before us yet.
After two major reports by Dr Gabriel Scally, one would have thought the health system would be awake, every second, to any potential issue and ready to act - putting the patient first, as it is supposed to do.
Now the country is facing yet another CervicalCheck investigation - who is responsible for this situation?