UTV sees evidence which raises more questions about the cervical smear programme

By Carol Jordan and Deborah McAleese

In November, a damning report into the Southern Trust's cervical smear programme told of a prolonged history of screener underperformance and a failure to manage it appropriately.A review was conducted, the results of which are expected in the coming days after 17,500 slides were included in that review.However, UTV has now seen evidence of long-term underperformance in another trust, the Belfast Trust.

An extract from an unannounced inspection into that lab in October 2023, conducted by UKAS, the United Kingdom Accreditation Services, found that it suspended its accreditation in October 2023.

In that report, it pointed to a long term trend of screener underperformance going back as far as 2013.In the extract seen by UTV, it says that having reviewed the screener sensitivity data from 2013 to 2022, it found that there had been a number of staff not meeting the 95% for high-grade abnormalities and/or the 90% for all abnormalities.

One screener had not met either standard for six consecutive years. One had not met either standard for four consecutive years while in a twelve month period between 2016 and 2017, nine out of fifteen screeners failed to meet one or both targets.

Finally, UKAS said that in the years 2021-2023, four screeners were not meeting targets.So why does this matter? Well, missing these targets calls into question the integrity of the screening programme.

When it comes to the failings in the Southern Trust, UTV has previously spoken to Erin Harbison who died earlier this year after three smear tests were misread.

Lynsey Courtney died in 2018 aged only 30 after her test was misread and several other women have approached UTV after they developed cancer or warning signs after their tests were also misread.

So missing these targets can have real life implications.UTV has been asking for the screener sensitivity data for the cytology labs from the Northern, Western and Belfast/SE Trusts since August.

The Southern data is already publicly available. Despite repeated FOI requests to individual trusts and the PHA, we have not been able to obtain that data with a variety of reasons offered as to why that is not the case.For the Courtney's, hearing of our findings raised alarm bells.

Sandra Courtney, Lynsey's Mum, has criticized the lack of transparency around the review. She says she has to fight for every scrap of information about what happened with Lynsey's test, a fight she says will never end.The way we screen smears has now changed. From earlier this year HPV testing has been introduced and the screening is being centralised through one lab. But after hearing of our evidence, Diane Dodds MLA and member of the Health Committee has raised her concerns.

Why? The new centralized lab is being run by the Belfast lab. She insists the Minister is going to have to work out a way of moving forward and investigating the issue thoroughly.She raised the issue of the Belfast Trust in the Chamber on Tuesday and the Minister pledged to ask the right questions about it.The PHA oversees the cervical screening programme and it was responsible for awarding the contract to the Belfast Trust for the new centralized lab. It vehemently refutes any thought of concern.

It tells UTV: "At the time of the award of the contract for the new reconfigured laboratory service, UKAS had reinstated the accreditation for cytology in Belfast Trust.

"The process undertaken by UKAS is rigorous and this reinstatement indicated that they were satisfied with the evidence provided by the Trust. In addition, the process to award the contract was robust and involved senior representatives from a number of organisations as well as an external independent expert.

"The process appropriately took account of a range of factors in the ability of the trust to deliver this regional service, including service capacity, service delivery, quality and governance, sustainable staffing, business continuity and value for money. The PHA has no concerns about this contract."The Belfast Trust also refuted any issue with taking on the new service saying: "Since November 2024, Belfast Health and Social Care Trust has provided the regional centralised cervical screening laboratory.

"UKAS fully reinstated accreditation of the Belfast Trust laboratory in June 2024 and in October 2024, a further successful UKAS surveillance assessment was undertaken. Belfast Trust’s regional cervical screening laboratory continues to function normally."When pressed about the issue of underperformance and what was done to manage it, the Trust told UTV: "UKAS made an unannounced inspection to Belfast Trust cervical cytology laboratory following the suspension of accreditation of the Southern Trust cervical screening service."Following this visit UKAS suspended our accreditation on two counts. The first related to documentation not being in place which was corrected as a matter of urgency.

"The second related to a single statistic used to assess screener performance over a number of years, and we challenged the interpretation of this statistic as part of the appeal process. During the period in question the laboratory had been assessed by UKAS on several occasions and no concern was raised by those assessments."UKAS recommended reinstating accreditation in March 2024 and we were formally notified of the reinstatement in June 2024. As part of a normal accreditation cycle, we were visited by UKAS again in October 2024 in which we successfully retained our accreditation."Despite the questions over these potential issues within the labs cervical screening is still the most effective way that cervical cancer can be predicted or diagnosed and gives women the best chance of a positive outcome.The PHA says: "The HPV method of testing will help drive down rates of cervical cancer in Northern Ireland further, along with the ongoing delivery of the HPV vaccination programme. The HPV model is more agile and focused and enables results to be delivered for most women much more quickly. We continue to strongly urge women to attend forcervical screening when invited as it could be life-saving."However it has also told UTV that the way it monitors and quality assures the cervical smear programme will be reviewed by NHS England."NHS England has agreed to undertake a peer evaluation of the PHA’s quality assurance activities for cervical screening.

"The details of this are being finalised and it is anticipated that the work will get under way in the new year. As the model of cervical screening has changed quite significantly with the introduction of primary HPV testing into the cervical screening pathway and the move to a single lab undertaking cytology as part of the programme, this is a timely opportunity to review quality assurance as part of the ongoing evolution of cervical screening in Northern Ireland, which continues to save lives every year."Campaign group Ladies with Letters and families that UTV has spoken to say the only way forward is to hold a statutory public inquiry.

For them, they say there are too many unanswered questions. But they are only the ones who know that they or their loved ones' tests were misread.

The question is are there more?

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.