Updated 21.00

A memo to the HSE in 2016 showed that Cervical Check had prepared a response for media stories about screenings not diagnosing cancer.

The three documents were drawn up for the executive during the audit process.

The 'briefing note' - which went through three iterations between March and July 2016 - has been released by the Public Accounts Committee (PAC).

HSE boss Tony O'Brien had earlier told the committee he was advised in 2016 "that the audit had not thrown by any issues of concern" - but the newly released documents have led to fresh calls from the opposition and one Government minister for Mr O'Brien to resign or be removed from his role.

Fianna Fáil said it will back Sinn Féin's motion of no confidence in the HSE Director General next week.

We've recently had sight of next week's motion, calling on Minister Harris to remove the HSE Director General. Fianna Fáil will support this motion, and reiterate that we call on the DG to step down immediately.

— Stephen Donnelly (@DonnellyStephen) May 10, 2018

Independent Minister Katherine Zappone, meanwhile, became the first member of Cabinet to publicly call for him to step aside this evening.

She's described the latest revelations regarding Cervical Check as a "game changer"

Separately, the Department of Health has said the memo was not brought to the attention of either Health Minister Simon Harris or his predecessor Leo Varadkar.

‘Screening did not diagnose my cancer’

In the earliest version of the Cervical Check memo, the authors wrote: "There is always the risk that in communicating individual case reports to clinicians of an individual patient reacting by contacting the media if they feel that ‘screening did not diagnose my cancer’. This is a risk that is inherent in having a clinical audit process as part of the national programme."

That version also included suggested next steps - advising recipients to pause all letters, await solicitors' advice, and to "continue to prepare reactive communications response for a media headline that 'screening did not diagnose my cancer'".

"Individual cases could appear in the public domain"

In the latest version of the briefing note - sent in July 2016 - John Gleeson, Cervical Check Programme Manager, wrote that more than 200 letters about the results of an audit had been sent or would be sent to doctors.

It states: "To date, a total of 86 letters have been issued to treating clinicians for cases where cytology was reviewed and a further approximately 200 letters will issue during July/August 2016 where cytology was reviewed.

"Given the volume of letters that will be issuing over the coming weeks, it is possible that individual cases could appear in the public domain."

The memo adds: "All international screening programmes will have encountered a media headline that ‘screening did not diagnose my cancer’.

"The Cervical Check Programme has prepared communications materials to ensure transparent, effective and robust communications processes are in place so as to provide clear information for the media and the public where appropriate on the Cervical Check Clinical audit process and results."

Discussing the results of the audit to that point, the note says that the majority of cancers were detected as early as possible - but adds that "not all cancers were prevented".

It also says that a ‘communications protocol’ had been prepared for consulting clinicians to address any questions.

Political response

Tomorrow's Cabinet meeting has been moved from Monaghan to Dublin so ministers can continue to deal with the Cervical Check fallout. 

They will discuss whether anything more should be done on top of investigations already announced.

In a statement, the Department of Health said they are currently examining their records related to Cervical Check.

The department said: "The HSE shared a number of documents in relation to the Cervical Check clinical audit with the Department, including the memos made available to the PAC today. However, nothing so far has been identified that changes our basic assertion that the fact of clinical audit being undertaken and arrangements being made to disclose to patients in this regard were positive features of Cervical Check.  

"Accordingly these documents were not shared outside the [Chief Medical Office] and Acute Hospitals Divisions and were not brought to the attention of any Minister for Health."

The memo has sparked fresh calls this evening for Tony O'Brien's resignation from the HSE after the release of the briefing notes.

HSE Director-General Tony O'Brien speaking in 2017 | Image: Sasko Lazarov/Photocall Ireland

Stephen Donnelly TD, Fianna Fáil Spokesperson on Health, said: "I said last week that the Director General of the HSE should step down, without prejudice, with immediate effect. I put that to him directly this week at committee, and in light of the memos released today, I am repeating that call.

“The Government must clarify whether it has confidence in the Director General, something they have studiously avoided doing to date. They have other questions to answer too."

People Before Profit TD Brid Smith, meanwhile, said Mr O'Brien's position has 'gone past its sell by date'.

She argued: "The fact that he read the 2016 memo warning of women going to the media about their screenings not diagnosing cancer confirms he is unfit to lead the HSE.

“There are now glaring and urgent questions that the Taoiseach Leo Varadkar must answer in the Dáil about his knowledge of the memo because he was Minister for Health in 2016."

Solidarity's Ruth Coppinger stated: "Tony O'Brien has defended his actions for the last couple of weeks, but his position is completely untenable - the Taoiseach must sack him immediately."

'Not thrown up any issues of concern'

Earlier, HSE boss Tony O'Brien told the PAC what he was informed of in 2016.

He observed: "I was advised that the audit had not thrown up any issues of concern.

"I was advised that the audit would be communicated to the individuals who were the subject of that audit. I was provided with quite some detail as to how it would be done... I was never subsequently told that any issues had arisen, or anything had happened to disrupt that plan."

The HSE has said audits in the cases of 209 women showed their screening test 'could have provided a different result'.

The executive says it is working to contact all the women affected, yesterday saying they have already been in touch with 201 women or families.

Additional reporting by Sean Defoe