UTV investigation uncovers serious failings in cancer screenings in Northern Ireland

A special UTV News investigation has uncovered a scandal finding serious failings in cancer care which saw people wrongly given 'all-clear' screening results and left with the incurable disease.

Families have been left devastated knowing their loved ones conditions could have been treated, prolonging their lives.

The trust at the centre of the scandal - the Southern Trust - apologised for its lack of action on underperforming test staff between 2008 and 2021 when it called a major review.

Our investigation has found authorities knew of the extent of the problem for years while those screeners who had been identified as producing incorrect results continued their work.

UTV journalists Carol Jordan, Sarah Clarke and Deborah McAleese have trawled through documents, spoken with heartbroken families and campaigners of those directly affected by the scandal which saw some women wrongly given the all-clear for cancer, only to later find out the disease was too far advanced for treatment.

Campaigners have told UTV only a public inquiry will uncover the complete extent of the issue.

Families have said they are considering legal action. Not for financial compensation, they say, but to shine a light on the subject and force health authorities to reveal all they know.

Health authorities have issued reviews and said it is important to await their results before determining their results. They urge people to attend screenings, stressing they do save lives.

UTV has been following the story since mother-of-four Erin Harbinson first raised concerns in April.

The 44-year-old had three cervical cancer screenings over the course of a decade giving her the all-clear.

Those were wrong.

It was not until she collapsed in serious pain in 2021 her cancer was revealed.

Had her condition been caught at one of her previous tests, doctors told her, it could have helped treat her sooner and possibly have helped save her.

Speaking to UTV, Erin said she was told to think of her disease as 'one of those things' and not her fault or anyone else's.

But when she realised she could have been diagnosed with the disease much earlier, she said: "This is someone's fault... they killed me... they've taken my life away..."

Erin died in August. Her family described her as a "a fearless and determined woman" and "a loving and caring mother".

The Southern Trust apologised for failures in her care.

Erin's case was one which led to a review of thousands in the Southern Health Trust. The trust undertook one of the biggest reviews of test results in UK medical history. In total 17,500 cases were reviewed.

UTV obtained information under Freedom of Information which shows a lack of scrutiny around ongoing screener underperformance across all Northern Ireland health trusts over several years.

Evidence and correspondence suggests several red flags and opportunities for action were missed not just by the Southern Trust but by the Public Health Agency which acts as quality control for Northern Ireland's cervical smear programme.

Documents also reveal that earlier this year health officials advised only those women who raised concerns should have their cases examined.

In July 2022, senior laboratory staff notified the Southern Trust's management team of concerns of underperformance within the screening team leading to an independent report by the Royal College of Pathologists.

The report examining the performance history of two screeners was published in April 2023. As a result, the Southern Trust launched its ongoing review of the records of around 17,500 women.

The family of one young woman who passed away from cervical cancer after a misread smear test approached the Southern Trust to understand the circumstances surrounding her death.

In a meeting in February 2019, Lynsey Courtney's family asked if screeners' work should be re-checked.

In the minutes of that meeting, senior doctors admitted nothing had been re-examined and questioned why such action would be taken.

Doctors at the Southern Trust also failed to inform the family of the history of underperformance in the lab dating back to 2007.

In July 2024, the Southern Trust admitted screener underperformance - when abnormalities which could develop into cancer were missed had been an ongoing problem. In correspondence sent to Lynsey's parents, the Southern Trust said: "There is evidence that the performance of the screener was not in line with cervical screening performance quality assurance standards for the best part of a decade."The trend of screening too fast is likely the primary cause of that screener's underperformance, which has been identified at several points over a number of years.

"Despite the checking of performance happening regularly, identified issues were not acted upon."

The Southern Trust also admitted: "There is an increased likelihood that women screened by this screener may have had an abnormality missed."

When Lynsey Courtney's family asked for the Serious Adverse Incident report into her death which they assumed would be done automatically given the failures involved, they were told it was never undertaken.

That correspondence referred to only one screener.

When the Southern Trust commissioned the 2023 report, the Royal College of Pathologists provided them with a table of screener performance dating back to 2007.

The report highlighted:

• Screeners are expected to hit 90% or more detection rate for any abnormality in a smear test

• Several screeners were not hitting this target in multiple years

• In some years, around 50% of staff failed to meet their targets

The ongoing review undertaken by the Southern Trust only covers the work of two screeners.

That's despite information provided by the Royal College suggesting more screeners who handled smear tests were also failing to meet their targets.

These screeners are not part of this review which raises questions about its effectiveness. Leona is another of the women failed by the Southern Trust. She spoke with UTV on condition we only use her first name.

She has shared a Serious Adverse Incident report which was compiled after she had to be treated for cancer after two of her smear tests were misread. The first as far back as 2011 was conducted by the Southern Trust. Two others were later carried out by the Western Trust. The Public Health Agency provides the quality insurance for the cervical smear programme.

The body is tasked with checking the data and performance of trusts as well as ensuring that the programme is safe for women in Northern Ireland.

UTV submitted Freedom of Information requests to the PHA asking for the reports associated with quality assurance visits from 2013 to 2023.The PHA should be conducting full formal visits every three years. In one trust, it had not visited in a decade.

In almost every report across all the trusts over many years underperformance of screeners is mentioned but there appears no questions from the PHA into why this was happening. The people leading the quality control on behalf of the PHA came from the health trusts presenting a possible conflict of interest. After a visit to the Western Trust in 2018, it was noted that in the three other health trusts, screeners were not meeting the target of 90% for detection of abnormalities. The PHA asked the Southern Trust to consider the position of one of the under performing screeners in 2019 but nothing happened. The screener remained in place for two more years until 2021.Leona said: "This is an absolute mess. It is chaos. There are so many screeners and a management system and a quality monitoring system that is fundamentally flawed.

"That screener was identified by management as underperforming and they assessed all those slides that that screener had done in 2012. So they knew that there were false negatives there but there was no recall of any women at all in the Southern Trust at that time.

"If it had been read correctly, I would have been referred for a colposcopy and that would mean that I would have been treated for pre-cancerous cells as opposed to being treated for cancer.

"I really want things to change for young women going forward. I have a daughter, I have nieces. My own sisters are still attending for their smear tests. That needs to change and they need to feel safe."Those impacted have told UTV that it is the lack of openness that adds to their distress. Since 2019, women across Northern Ireland have been entitled to learn about the audit into their past smears if they develop cervical cancer but failures in the Southern Trust appear to reach back much earlier.

A document from the PHA to the Department of Health in May 2024, appears to put the onus on concerned women to make the first move.

The document, which UTV has seen, said its advice was to run an awareness campaign around the issue but to let women who are concerned that their cancer could have been prevented to approach the PHA first, a decision they say which has been made with all trust medical directors.

UTV approached the Department of Health, Southern Trust and Public Health Agency for comment. None provided a spokesperson, instead they provided statements.

A Southern Health and Social Care Trust statement said: “The performance of any screener can fluctuate for a range of reasons. There are systems in place to pick this up and screeners are given annual training to keep their skills up.

"During the period 2008 - 2021, some of our screeners performance did fall below the recognised standard. The underperformance was identified by us at the time and actions were taken to deliver improvement.

"However, in some years, the performance of some screeners did not reach the required standard despite having had the required update training and support. This was not recognised and we apologise for this. In 2021 we took action to address screener underperformance including some of our staff ceasing screening duties."

The Southern Trust said senior laboratory staff notified its management team that they had concerns about performance in some steps of their laboratory’s screening system.

"To fully investigate these concerns, we brought in The Royal College of Pathologists (RCPath) to undertake an independent assessment of our cervical screening services and then we published their report on our website.

"The report found that for some screeners, the number of times performance dropped during the period 2008 to 2021 was a concern and they were not satisfied that the actions taken by the Trust were sufficiently robust.

"The RCPath Report contained recommendations and we have worked with the PHA to implement them in full."

The trust said its major review of tests for 17,500 women with the PHA in October 2023 was undertaken as a precautionary measure.

Its statement continued: "We assessed all women’s cervical smear histories in the Southern Trust since 2008 and identified the women who are affected and were to be included in the review.

"The Cervical Screening review will be completed within days and nearly all the women will have received an outcome at this stage. The results confirm that the vast majority of previous smear results are unchanged and have been confirmed as normal."

It said women with a diagnosis of cervical cancer were not part of The Cervical Screening Review.

"These women with a confirmed diagnosis of cervical cancer have their screening history reviewed through an audit of invasive cancer for learning and improvement purposes. No Cervical Cancers have been identified to date in the Cervical Review.

"The Cervical Cytology Review is due to conclude this month, after which a factual report will be produced before a detailed analysis of all findings will be undertaken. The Health Minister has advised that he will await the outcome of these processes before determining any next steps."

The trust said the Belfast Trust will provide the regional one-site Laboratory service for the NI Cervical Screening Programme.

"It is essential that women keep coming forward for their cervical testing when invited to do so,” the trust said.

The Public Health Agency said it recognised the 'serious shortcomings' identified in the RCPath Consulting report. It also acknowledged the 'distress and uncertainty' this has caused for many women.

"It is important that lessons are learnt," the PHA statement said.

"The cervical screening programme in Northern Ireland is very effective at detecting early cell abnormalities which, when treated, can prevent cancer and save lives. Together with the HPV vaccination programme, which began in 2008, it is reducing the incidence of the disease here.

"It is essential that women come forward for their cervical smear test when invited to do so. This will continue to save lives.

"The Northern Ireland Cervical Screening Programme introduced primary HPV testing into the cervical screening pathway in December 2023, which has increased the ability to detect early cell changes that could lead to cancer. Nearly all cervical cancers are caused by persistent infection with high risk types of human papillomavirus, known as HPV.

"A diagnosis of cervical cancer is devastating and our thoughts are with those who have been diagnosed with cancer and their loved ones.

"Screening by cytology, which was the previous model, is only expected to pick up 75% of abnormalities, so the screening history of all cases of cervical cancer are reviewed for learning and improvement purposes as standard practice. A good screening programme will find most, but not all, abnormalities.

"Following receipt of the report by RCPath Consulting, a review of historical slides in SHSCT was commenced, and this is due to conclude shortly. The findings of the review will be analysed in detail and a report produced. It will be important to consider the findings of this and identify any learning. We recognise that the slide review in the SHSCT has caused upset and concern for many women."Our cervical screening programme is essential in reducing the incidence of cancer and saving lives, but it can only work if women attend for screening when invited.

"Northern Ireland has an excellent cervical screening programme, and the number of cervical cancers in women who are eligible for screening has decreased significantly since 1988, when the screening programme was launched. We anticipate that this will improve further with the move to primary HPV screening and continued high uptake of HPV vaccination."

The Department of Health said the findings of the RCPath report were 'clearly unacceptable'.

“It is essential that we understand and learn the lessons from what has happened within the Southern Health and Social Care Trust," a statement from Health Minister Mike Nesbitt said.

“The Cervical Cytology Review (a review of laboratory slides) is due to conclude later this month, after which a factual report will be produced before a detailed analysis of all findings will be undertaken. This analysis will be supported by the appropriate independence. It is important that we await the outcome of these processes as they will help determine our next steps.

“As health minister I remain committed to finding the most appropriate method to understand what happened and to learn lessons, to ensure that our screening programmes deliver on behalf of our population.”

Catch up with the latest UTV Live on ITVX

Want a quick and expert briefing on the biggest news stories? Listen to our latest podcasts to find out What You Need To Know.