By Dr Alan Smith, Consultant in Public Health Medicine, National Screening Service
The Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 is legislation aimed at enhancing transparency and accountability across healthcare in Ireland. The Act establishes a requirement for the notification of 13 patient safety incidents, ensuring people are informed about their care and what has happened.
What has this Act got to do with cancer screening in Ireland?
Under Part 5 of the Patient Safety Act 2023, people can request a review of their screening should they develop a cancer after taking part in a population screening programme - BowelScreen, BreastCheck or CervicalCheck.
Screening programmes must continually balance the benefits and harms that are a recognised part of population-based screening. Screening will benefit most people in the eligible population. However, the screening process is not perfect, and it is an accepted reality, no matter how good the quality, that not every individual screened will benefit.
Achieving zero-errors in cancer screening in Ireland or any other country is impossible. False positive and false negative results are inevitable. In short, screening will not pick up every sign that could develop into cancer, and cancer can develop between screening tests.
When this happens, some people may want to know more about why it happened and can request a review of their screening.
How will Part 5 of the Patient Safety Act work in practice?
We will tell you about your right to request a review. This information will be in the leaflets we send you when we invite you for screening and when we send you your screening results. We also have information about screening reviews on our programme websites: BowelScreen, BreastCheck and CervicalCheck.
When a review is completed, we will share the findings with you in a meeting, generally held in person. Throughout the entire review you will have a dedicated contact person to keep you up to date and to answer any questions you might have. We’ll also give you a written summary after the meeting.
Are these types of screening reviews new?
No. Our BreastCheck programme has been responding to review requests for many years, and our CervicalCheck programme has been offering cervical screening reviews since April 2023.
Our cervical screening reviews were carefully developed with input from women who participated in screening and subsequently received a diagnosis of cervical cancer. The stand-out recommendation from patient representatives was that reviews should be a patient-centred, non-legal process, where patients could share their story in a compassionate and supportive environment and seek answers to their questions.
Will the commencement of the Act change existing screening reviews?
Yes and No. The new Act does place new mandatory obligations on us, mostly around documentation, timing and record keeping. From a patient perspective, no. Our review processes are patient-centred and aligned with the requirements of the Act.
Our experience has confirmed the key requirements for a successful patient requested review process. Firstly, they must be conducted in an environment that is non-legal, non-adversarial, compassionate and patient focused. And secondly, patient requested reviews must be conducted in a manner that adheres to ‘Good Medical Practice’ as defined by the Medical Council of Ireland.