The interim Director General of the Health Service Executive has said individuals will be held to account for failings in the CervicalCheck programme if there is a requirement to do so.

Speaking at the Public Accounts Committee, John Connaghan said that public confidence in the programme had been "sadly undermined" by the failure to communicate the results of an audit of smear tests to women who had a cancer diagnosis.

He said: "The CervicalCheck Programme did not effectively close out the issues that were subsequently encountered regarding the breakdown in the process of treating clinicians discussing audit findings with their patients.

"Indeed, it is not clear to me that the staff within the programme were aware of the scale of the difficulty in terms of the proportion of women who had not been communicated with."

Mr Connaghan also acknowledged that briefing documents circulated among the HSE and the Department of Health in relation to the issue featured language that was "very functional and somewhat lacking in empathy for the women who were to be communicated to".

On the issue of accountability, he said there was "an obligation for an organisation or individual to account for its activities, accept responsibility for them and to disclose the results in a transparent manner".

Mr Connaghan said the "collective failure" of the HSE and CervicalCheck was on ensuring effective follow through on good intentions.

He said: "In common parlance we did not 'close the loop'. While the results of the audit were communicated to the relevant clinicians the arrangements thereafter appear to have broken down.

"The outcome was that a large proportion of women were not told about either the audit itself or the results for them as individuals.

"The impact of this failure has been profound both for every single woman affected and their families. It has also undoubtedly caused significant levels of fear and anxiety for the wider population of women in Ireland."

Mr Connaghan added that "it has sadly undermined public confidence in the CervicalCheck programme".

He told the committee that if there was a requirement to hold individuals to account on a personal basis the organisation would do so.

Committee sees document on response to CervicalCheck audit

The committee has been shown a document that indicates that doctors and health managers who attended a meeting about the CervicalCheck audit last September reached a general consensus that CervicalCheck should let women know the outcome of an audit of their smear tests.

The information is contained in the minutes of a meeting of the Lead Colposcopist's Group, which included clinicians who were treating women with cervical cancer.

It states that while there was general agreement that it was a stressful area "where women were unaware of the (audit) process and the possibility of an outcome".

It was suggested that women's knowledge about the benefits and limitations of cervical screening, particularly that all cancers cannot be prevented, should be increased.

The minutes state: "A perception that putting the onus on the clinicians to initiate the conversation was not correct and caused a deal of concern and negative feelings towards the programme from clinicians."

Another point noted in the minutes says that "a general consensus that CervicalCheck should let women know prospectively about the process around the time of diagnosis and if appropriate communicate directly to the women when the outcome was available".

Sinn Féin TD David Cullinane said it was bizarre that the outcome of this meeting was to produce a new information leaflet for women with cervical cancer.

There were tense exchanges between Mr Cullinane and Jim Breslin, the Secretary General of the Department of Health.

When he asked why the Minister for Health was not told of issues related to the cervical audit process, Mr Cullinane said he was "angry" and was "not going to be given waffle".

Mr Breslin said memos circulated in the Department of Health in 2016 did not relate to the widespread non-disclosure to the women affected.

Mr Cullinane said he welcomed a commitment that people would be held to account for failings, but he said some of the people who should be held to account were sitting in the room before him.

Labour's Alan Kelly echoed calls for accountability, saying what has gone on to date was "a*** covering".

The committee chairman Sean Fleming asked why legislation enacted last year, which would set out a framework for open disclosure in the event of medical mistakes, had not been implemented.

Mr Breslin said regulations and a commencement order for the legislation would be signed by the minister next month.

HSE response to audit discussed

The committee was told that a draft press release and notes were prepared on the audit of cervical smears to address negative publicity about the screening programme in the aftermath of possible litigation.

However, a national director of the HSE said this was done on the basis that women had been informed.

Stephanie O'Keeffe said that what was prepared was a series of documents to respond to risk to the programme.

"The shocking and horrendous thing here is that it happened and we didn't realise that actually the issue was that the women weren't informed. All of those documents were prepared on the basis that the women would have been informed," Ms O'Keeffe said.

However, Sinn Féin TD Jonathan O'Brien said he disagreed with this because there was no intention to inform families of women who had passed away.

The committee has requested a copy of the press releases.

Ms O'Keeffe also said she had no knowledge that women were not being informed of their screening results.

She said that she asked repeatedly about the audit, and was told all was going well.

"I did not think there was anything going wrong, perhaps I should have, but I didn't", she said.

Meanwhile, a senior manager at CervicalCheck told the Public Accounts Committee that he should have checked with clinicians to ensure that women were being told the results of a screening audit. 

John Gleeson, CervicalCheck programme manager of the National Screening Service, was asked if it was his responsibility to ensure that clinicians followed up on what was being asked of them. 

"I didn't take it to be so at the time" he said, but added "Yes I should have checked at the opposite end".

"I didn't know it was my responsibility to check, I'm not certain" he said. 

Official defends decision not to inform minister

The Chief Medical Officer at the Department of Health has defended his decision not to inform the minister for health of potential adverse publicity in the wake of the CervicalCheck audit.

At the committee meeting, Sinn Féin's David Cullinane asked Dr Tony Holohan whether his decision not to escalate the matter was "a failing" on his part.

Dr Holohan said: "It was not a failing on my part. It was a judgement, I think it was a fair and reasonable judgement, it was made based on the circumstances at the time, we didn't have information of the kind that's come out now".