Southern Health Trust: expert review ordered into cervical screening failures

Stormont's Health Minister Mike Nesbitt has ordered an expert review of all reports into cervical screening failures at the Southern Health Trust.

However, he stopped short of ordering a statutory public inquiry into a major recheck of smear test results in the Southern Health Trust, which had been requested by some campaigners.

Around 17,500 women in the trust area who were screened between 2008 and 2021 had to have their results rechecked after concerns were first raised in a report commissioned by the Royal College of Pathologists.

It emerged last year that the trust review showed eight women went on to develop cancer after their smears were misread.

Mr Nesbitt announced on Wednesday that three reports related to reviews of the failures had been published.

In a statement he said he has now asked Professor Sir Frank Atherton, previously the chief medical officer in Wales, to conduct an expert review of all the published reports to date.

Mr Nesbitt said the review findings were expected in 2026 and would be delivered directly to him "without any influence" from officials in the Southern Trust or the Public Health Agency (PHA).

The minister said: "From the outset, I have sought to understand what happened, who was responsible, why it happened and how can we prevent it happening again.

"It is clear there were significant issues with the Southern Trust's laboratory including the management processes in place at a trust level and the quality assurance of the Public Health Agency was inadequate.

"As to why it was allowed to continue for so long, it is evident that the method for reviewing individuals' performance within the trust was taken in isolation and that performance trends over several years were not monitored."

Mr Nesbitt said cervical screening is no longer undertaken in Southern Trust and has been centralised in Belfast Trust.

He added: "I acknowledge that this has been a difficult and challenging time for many people, particularly for the women who were part of the review and those impacted by cervical cancer, but I remain committed to understanding the circumstances and events which led to the precautionary review of cervical cytology in the Southern Trust."

The Ladies with Letters campaign group questioned why the minister had "chosen to ignore the calls from the many women and their families to establish a statutory public inquiry".

A spokesperson added: "The minister has said that the issues at hand are complex.

"He has said that he has commissioned a further expert report to identify any gaps in existing reports, prolonging this already drawn-out process and further adding to anger and frustration.

"Our view has always been that gaps will inevitably remain unless the minister listens to those who have suffered most and establishes an inquiry which is capable of 'looking behind' the data and statistics to establish what we suspect is a very human problem at the heart of these issues.

"An inquiry would also compel those involved, from the screeners to the management, to give an account of what went wrong so there is full transparency to enable us to understand why and how these failures were allowed to continue for a shocking 13-year period."

Meanwhile, Dr Stephen Austin, Medical Director at the Southern Trust, said:

“The Trust apologises once again to all women who have been impacted by the cervical screening review.

"We acknowledge the past performance issues in our laboratory and fully accept that the actions of the Trust at that time were not sufficiently robust and that this was an unacceptable breach of governance procedures.

“Although the review and analysis which informed these latest reports has been exhaustive, we nevertheless welcome the Minister’s announcement today that a further independent expert review of all the published reports to date will be carried out to establish if there are any gaps or areas that need to be explored further. The reports scrutinise complex technical screening methodology and operational issues, provide considered professional opinions and review historical issues which will benefit from further expert consideration.

“The Trust is committed to ensuring these failures do not happen again. We have examined in detail the findings in these latest reports and many measures have already been put in place to address past failings. In addition, we will be implementing remaining recommendations that have been made and are not already in place.

“Much improvement has been made throughout the course of the review and it is important to stress that the testing, screening and diagnostic pathway for the region was changed in December 2023 with the introduction of the primary HPV testing screening programme across Northern Ireland, which is the current screening standard in the rest of the UK.”

Dr Joanne McClean, Director of Public Health at the PHA, added:

“The PHA welcomes the publication of the three reports. Both the NHS England review of quality assurance processes and the summary learning report identify areas for improvement and make a range of recommendations. The PHA acknowledges that while our QA processes identified concerns in relation to the Southern Trust laboratory, there were gaps in how these were communicated and subsequently appropriately escalated to senior executives to ensure the Trust took appropriate action to address the performance issues. We are sorry for the failures in our governance model and our handling of these performance issues and apologise to all those adversely impacted by the previous poor performance in the Southern Trust laboratory and all those affected by the cervical cytology review carried out as a result of concerns about the performance in that laboratory. The PHA is committed to implementing all recommendations in the reports in full.

“The decision in 2023 to review the screening history of over 17,000 women was taken as a precautionary measure to verify results issued by the laboratory in the Southern Trust following the concerns about the performance of that laboratory. The independent expert report has concluded that the cervical cytology review was robust and that the vast majority of the reviewed cytology results issued by the Southern Trust laboratory were correct.

“Both the cervical cytology review and NHS England review span a long time period dating back to 2008. The service in place today is very different from that in place for most of that time period and major improvements have taken place since then. These include the implementation of primary HPV testing into the programme in December 2023. This is the screening pathway recommended by the UK National Screening Committee and is more sensitive at detecting abnormalities which may go on to develop into cancer. The reconfiguration of the laboratory service into one regional laboratory is another important improvement. These changes bring the Northern Ireland programme into line with other programmes in the UK.

“We would like to remind all women that cervical screening helps to protect their health and save lives and it is essential that women continue to attend when they are invited.

"Our screening programme is very effective and the improvements put in place will make the programme better at finding women with abnormalities which put them at greater risk of going on to develop cervical cancer.

"But we will only find these abnormalities in women who attend for screening. I ask all women who are invited to attend for cervical screening to please attend. It could save your life. I would also remind women who have symptoms that screening is for people without symptoms.

"If you have symptoms you need to seek medical advice even if your cervical screening result is negative.”

Sinn Fein MLA Linda Dillon said Mr Nesbitt's statement "creates more questions than answers".

She said: "Women deserve clear, honest communication and reassurance that lessons have truly been learned.

"The focus must be on speaking directly to women as well as the wider public to rebuild confidence in the screening system."

SDLP health spokesman Colin McGrath said another review will "delay justice".

He said: "While the publication of these reports and the Health Minister's engagement with affected families are positive steps, the decision to initiate yet another review falls far short of what's needed.

"Every additional review simply delays justice for the women who were failed and for the families who continue to live with the consequences."