Debate contribution: Cervical Screening Scandal Inquiry

Debate contribution by Mr Mike Nesbitt on 3 November 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

3 November 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Cervical Screening Scandal Inquiry

Assembly identifier

Official Report component 5213654

Read the official Assembly record

Text

Deputy Speaker, thank you. If anybody was in any doubt that all healthcare is personal, this debate and this issue are the proof. I will begin by trying to assure Members that, right from the beginning, from taking up my post, I have given this matter my full focus. I have listened to those who have been affected and have met some of the women and some of their families, not just their spouses but their children. On several occasions, I have met the Ladies with Letters group. I have listened to their concerns, and I believe that I understand their frustration and anger. One thing that, I am sure, we all agree on is that the affected women must and will remain the key focus for all of us. With regard to information sharing, I have sought to be as open and transparent as possible right from the get-go. I recognise that it has now been more than two years since the publication of the Royal College of Pathologists' report on 9 October 2023, and so, of course, I regret the time that it has taken to reach this point. However, it is essential that we gather all the relevant information, because we have to fully understand the full picture of exactly what happened in the Southern Trust cytology laboratory. While I am conscious of the time that it has taken to reach this point, a significant amount of work has been undertaken in relation to the screening programme in the meantime.

Let me list a few points. All the recommendations contained in the royal college's report have been implemented. All cervical screening activity in the Southern Trust has been ceased. There has been the full implementation, since December 2023, of human papillomavirus, or HPV, testing, which is a better and more reliable automated test. Cytology is now used as a second line of testing, undertaken for screening samples that test positive for the presence of HPV. Since November of last year, a single regional laboratory service, managed by the Belfast Trust, has been established. I will return to Mrs Dodds's concerns about that later. Consequently, the cervical screening programme has been significantly improved over the past two years. As Members will be aware, a population-based cervical screening programme is a complicated process and involves a number of steps. The UK National Screening Committee states:

"It is important to have realistic expectations of what a screening test does and that it will not identify all cases of disease. It is not a diagnosis."

It is important to repeat that point: screening is not diagnosis. False negative and false positive tests occur in all screening programmes. The screening programme is aimed at healthy women with no symptoms. Its purpose is to reduce the incidence of cervical cancer and to prevent women from dying. Screening has been shown to be effective in helping reduce the risk of developing cervical cancer, and, like other Members, I urge all women to take up the offer of screening when invited to do so. The programme's effectiveness is reflected in comparative data across the UK for 2017-19, which shows that the European age-standardised incidence rate for cervical cancer in Northern Ireland is similar to the UK average. In Northern Ireland, it is 9·1 new cases per 100,000 females, while the UK average is 9·9. In the Republic of Ireland, the age-standardised incidence rate is 10·43 cases per 100,000 females for the period 2018-2022, which is just a year out from our own data. I urge Members to ensure that that message is not lost. I also remain committed to understanding what happened in the Southern Trust cervical screening programme. As Members may recall, the background is that, in 2021, the Southern Trust's senior management received internal notification that raised concerns of poor performance in the laboratory going back several years. That was formally raised with the Public Health Agency in February 2022, triggering a series of meetings that led to the royal college's being commissioned to undertake a desktop-based risk assessment. The pathologist's report was received in May 2023. It found that there was a significant performance issue with a number of screening staff. The report also found that the trust failed to take appropriate action to manage the underperformance. So, yes, it was management and screeners. The Southern Trust and the PHA considered the report's recommendations and, taking into account ethical considerations, decided to carry out a precautionary physical review of the records of over 17,000 women who had been screened during the period in question. The review became known as the cervical cytology review, or CCR. I fully acknowledge that the news of the review naturally caused a lot of worry and upset for the women who received letters. It was, however, a necessary and important step to help establish the facts, to check the accuracy of the original screening results and to check whether those who were screened were on the correct pathway. Although the Southern Trust laboratory played no role in it, the review took longer than was initially anticipated and was completed in the autumn of 2024. Following its completion, two factual reports were published on 11 December last year: the 'Cervical Cytology Review: Activity and Outcomes Report', for 2008-2021; and a separate, companion report, 'Cervical Cancers in the Southern Health and Social Care Trust Area: A Summary Report', for 2009-2023. The reports provided the factual information collated from the review and drew on data reported by the Northern Ireland Cancer Registry and the audits of the invasive cervical cancer process. As Members will recall, no cervical cancers were identified during the CCR. The cervical cytology review outcomes report noted that 96% of the women included had no change to their original smear test result on review and required no further follow-up. Therefore, while the review in itself did not provide all the answers that we needed, it went some way in reducing the concerns that were raised in the RCPath report, which stated:

"Whilst the majority of Negative results issued by this laboratory ... were correct, a significant number of women are likely to have had negative screening results on tests which would have been identified as abnormal in other ... laboratories".

As a result of the review, 64 women were invited to attend a colposcopy or gynaecology review. Of those, 56 attended their colposcopy appointment: 21 had a negative or normal result and therefore required no treatment and were discharged; 24 had evidence of precancerous changes to their cervix that did not require treatment; and 11 had precancerous changes to their cervix or another significant incidental finding that required treatment. Those women have either completed or are undergoing a treatment pathway. There is a second report, entitled 'Cervical Cancers in the Southern Health and Social Care Trust Area'. It is a comprehensive review of cancer rates in Northern Ireland from 1997 to 2021. That report concluded:

"When adjusted for the population, data from the registry show that there is no statistical difference between trusts in the number of cases of cervical cancer, the stage at which they have been diagnosed, deaths from cervical cancer or the number of cases of pre-cancerous changes of the cervix. The incidence of cervical cancer in Northern Ireland has also been reported as being similar to the UK average."

To ensure that we have a full understanding of the potential issues in the Southern Trust laboratory, several additional reports were commissioned. I advise Members that three separate reports are due to be published jointly by the Southern Trust and the Public Health Agency this Wednesday, 5 November. Let me emphasise that I am not publishing and the Department is not publishing; the three reports will be jointly published by the Southern Trust and the Public Health Agency. They are an independent expert's opinion on the factual reports that were published in December last year; an independent review by NHS England of the PHA's quality assurance arrangements for cervical screening in Northern Ireland; and a summary of the multi-patient serious adverse incident findings and learnings. I requested that those reports be published at the same time as they relate to the full cervical screening pathway and because they need to be viewed in their entirety and in conjunction with the reports previously published. I will make a written ministerial statement to coincide with their publication and to update Members.

I will give way to the Member, but I will say this: one report was ready to be published, but I asked for it to be held back so that all three could be published at once, which means that we will not have some sort of swinging effect of one publication's taking people to a certain conclusion and a second one's taking them to another.

I thank the Member for the intervention. I will certainly note that. I have a next step in mind. I will make clear in my written ministerial statement on Wednesday what that intention is. I take on board what the Member has asked to be included in my thinking. The senior management of the Southern Trust previously acknowledged that there was underperformance by some screeners in its laboratory and in its oversight system. It recognised that that was a completely unacceptable breach of governance procedures, and that it represented a system failure. Turning to the issue of the equipment in the regional laboratory, it is important to note that cervical screening and HPV testing are two separate processes, that cervical screening in the Belfast Trust has never been paused, that cervical cytology screening is the step that is undertaken after primary HPV testing, and that reporting for that step has continued on-site during the equipment downtime and remains unaffected. I confirm that, at this time, the HPV testing equipment is operational again in the regional laboratory. Trust staff are committed to having the service back to full operational capacity within the next short number of days. However, that machine, it seems to me, is nearing the end of its life. I have spoken to the permanent secretary about, as a matter of urgency, finding the capital to find a replacement piece of equipment, because there have been issues with the HPV testing equipment and it is reaching the end of its working life. However, all laboratories have contingency arrangements to deal with scenarios such as this, and since the Belfast Trust enacted its contingency plan for HPV testing with Gateshead, there has been no backlog in HPV testing. The plan will continue until technical issues are resolved. As of 31 October, around 13,522 samples have been sent to Gateshead, and the results are sent back within 21 days of samples being sent there. Let me emphasise that they are sent to GPs, and it is up to the general practitioner to pass them on to the patients. The vast majority of women who attend screening — approximately 90% — test negative for HPV. They will not have had any negative impact on their screening outcomes, as that report will return them to a three-yearly smear as part of the screening programme. For women who test positive for HPV, there will be minimal to no additional impact to their turnaround times. Those samples require secondary testing by cytology screening to determine the final report. That process is more complex and manual, and it requires additional time. As I have said, reporting for that step has continued on site during the equipment downtime and remains unaffected. In closing, I acknowledge again that this remains a difficult and challenging time for all who have been impacted on. I pledged to keep communication open with the women and families whom I previously met, and I will fulfil that pledge. I urge all Members to read the three screening-related reports due to be issued on Wednesday. Diane Dodds asked about how the contract was awarded to the Belfast Trust. It was open to any trust to pitch. Accreditation for HPV testing was one of the criteria scored, but the decision by the implementation project board to commission Belfast Trust was informed by a range of factors. I am told that the Belfast Trust scored highest in the process and was awarded the contract. The scoring was reviewed by an independent appeals panel on 3 July 2025, and it endorsed the original result. Linda Dillon asked for a women's action plan, and Sinéad McLaughlin said that I believed that an action plan was "sufficient". I have never said that. We do need a strategy. I am saying that, in the remainder of the mandate, what is practical is to deliver an action plan ahead of delivering a strategy in the next mandate.

If you can do it in 10 seconds, it is yours.

I understand that they will be given sight of the reports before they are made public, yes, by an hour or so.

2,160 words. Text as published by the Northern Ireland Assembly.

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