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ITV News
27 minutes ago
- ITV News
'No scope for further pay rise', Health Secretary tells resident doctors ahead of five-day strike
Resident doctors, formerly known as junior doctors, are preparing for five consecutive days of industrial action.
ITV News
27 minutes ago
- ITV News
NHS bosses say Friday's doctors strike is a 'crushing blow' for patients
NHS bosses have branded Friday's doctors' strike as "irresponsible and reckless" and a "crushing blow" for patients and the NHS. Thousands of resident doctors will begin a five-day strike from 7 am on Friday, their 12th walkout since March 2023. The British Medical Association (BMA) said on Tuesday that talks with the government to avoid the strike had collapsed over the key issue of pay. Daniel Elkeles, chief executive of NHS Providers, told ITV News: "This is a crushing blow for patients and the NHS, and the strike is unnecessary and naturally, in my view, it's irresponsible and reckless. "The thing that they should do is call off the strike and get back around the negotiating table with the government." Professor Meghana Pandit, NHS England national medical director, said: 'There is no doubt this industrial action will take a toll on patients and NHS staff, and it is disappointing it is going ahead." Meanwhile, Dr Melissa Ryan, co-chair of the BMA UK Resident Doctors Committee, said she does not want to strike but needs more than 'vague promises' - she wants action to restore doctors' pay. "None of the strikes need to go ahead. If the government actually would negotiate on these things, we could have," she said. "We wrote to Mr Streeting in April and again in May. We told him of our plan last year, that we were going to expect the next part of the journey to pay restoration at any point in time. He could have come to the table and negotiated properly. "My request is simple: that we restore the pay. So I ask you, if somebody had taken £10 from you and then they'd given you £8 back, would you not want the extra £2? We've had 21% of our pay eroded since 2008. "All we're asking for is not a pay uplift, we're simply asking to have that returned to us because we're not worthless." She added: "I don't want to have to strike. What we need from the government, though, is more than just vague promises of talks. The time for talking was a while back. What we need from them is action. "They need to value the doctors in the NHS so that we'll stay and so that ultimately patients can see doctors in the future. " How will you be affected by the strike? The public is being urged to continue seeking NHS care during the strike. NHS England said GP surgeries will remain open, A&E and urgent care will still be available, and routine appointments should go ahead where safe to do so. Sir Jim Mackey, a NHS England boss, told hospital leaders on Thursday to cancel appointments or operations only if patient safety is at risk. The public is advised to use 111 online first for urgent but not life-threatening concerns. However, the BMA has said NHS England's plan to carry on with business as usual poses a risk to patients. Strikes by resident doctors in June 2024 led to 61,989 inpatient and outpatient appointments being rescheduled. Since the end of 2022, almost 1.5 million appointments have been rescheduled as a result of industrial action. A YouGov poll showed about half (52%) of people in the UK 'somewhat oppose' (20%) or 'strongly oppose' (32%) resident doctors going on strike over pay. A third (34%) of the 4,954 adults surveyed either 'somewhat support' (23%) or 'strongly support' (11%) doctor strikes. YouGov said the proportion supporting the strike over pay has dropped five points since it last asked the question in May, when 48% opposed the strikes and 39% supported them.
ITV News
27 minutes ago
- ITV News
Up Close: Questions about the management and scrutiny of Northern Ireland's cervical smear programme
The Royal College of Pathologists report into the cervical screener sensitivity rates in the Southern Trust from 2008 prompted a review of smear samples of over 17,500 women. The review showed that two women died after their tests were misread. At least eight others had developed cancer. An interview with one of the women who went on to lose her life after three of her samples were misread, Erin Harbinson, prompted a UTV team to wonder if the issues stopped at the Southern Trust or whether screener underperformance was something other trusts were dealing with. The Public Health Agency provides external quality assurance for Northern Ireland's cervical smear short they oversee the integrity of the programme and ensure it operates to industry standard. In the summer of 2024, UTV sent in an FOI request to the PHA asking for all quality assurance reports for all of the trusts over the period of 2008 - 2023. In almost all of those reports, although heavily redacted, screener underperformance was mentioned. It gave us an indicator that maybe this was an issue in other trusts too but in order to assess that, we needed to see the screener data for individual screeners from the Northern, Belfast and Western Trusts. That data for the Southern Trust was already in the public domain and though it felt like an innocuous table of information, this data would be key. But what is screening data and why is it important? There are two key benchmarks which those screening cervical smear samples should reach. The industry standard is that they should be able to detect 95% of what are called high grade abnormalities. They are expected to detect 90% of all abnormalities. And it does cervical smear scandal in the Republic of Ireland was caused by underperformance by screeners in a US laboratory. So far 18 women have died. The first FOI for the screener data from all trusts was submitted by UTV in August 2024. We sent the same requests to the individual trusts who produce the data. The trusts either declined to provide the data or directed us towards the PHA. The PHA also declined to supply the data saying that it would take too long to collate it. But there was another party to all of this, the organisation which accredited each lab, UKAS. Excerpts of reports produced by UKAS were seen by UTV in late 2024. In those documents, concerns about underperformance in both the Belfast and Northern Trust were raised. So UTV appealed to the PHA and the Belfast Trust against the decision not to release the info. In February 2025, the PHA again turned down the appeal but said in the interests of transparency, it would release the data, warning it would take longer than the standard FOI period of 20 days to produce it. Five months and a dozen emails In the meantime, the Belfast Trust again declined to release the data so UTV made an appeal to the Information Commissioner, saying we believed this info, which was already available for the Southern Trust, was of huge public interest given that this was an issue which had cost women their lives. The Commissioner upheld that appeal.. That ruling was brought up in July's meeting of the Health Committee with Diane Dodds, DUP MLA putting the difficulties around obtaining data to the Chief Exec of the PHA, Joanne McClean. Again she reiterated that the data would be available shortly. This may have been a turning point. It gave us the opportunity to look for the data yet again. And then it landed. But what does it show? As expected it showed some screeners in all trusts, some worse than others failed to reach their benchmarks. In one year, 2016 / 2017, the data showed that half of the screeners in the Belfast Trust failed to meet the 90% detection rate for all abnormalities. Underperformance was detected during ten annual periods in the Belfast Trust and at least in eight annual periods in the Northern Trust, screeners failed to reach the 95% detection rate for high grade abnormalities. The Western Trust also had identified underperformance but had conducted a small review in 2018/2019. Questions are now being asked by politicians and campaigners about whether the issues in the Southern Trust were evident in the other trusts too and if so what was done to correct them? In the course of this investigation UTV has seen other evidence which would suggest calls were being made for a regional-wide mechanism to monitor and manage screener underperformance. The Western Trust held a small review into the work of one under-performing screener in 2018. A Serious Adverse Incident report was compiled in 2019 focussing on this review. In that a series of regional recommendations were made to bring in a defined framework for the management of underperformance. UTV has seen another Serious Adverse Incident report from two years later where similar calls were made. When we asked the PHA about the Western Trust review and posed the question of whether other underperforming screeners in other trusts should have had their work examined, it said that it played an advisory role only in the process. Also, a matter of public record is the Belfast Trust's loss of UKAS accreditation in Oct 2023. UTV has previously reported on the contents of a report drafted by the UKAS at that point where they point to screener underperformance as a contributory factor to the suspension. That decision was appealed and accreditation was reinstated in June 2024. Campaigners Ladies With Letters say this adds to the case for a statutory public inquiry. When shown the data, Diane Dodds agrees. She says it's only with a statutory public inquiry that the public will ever be able to understand how pervasive the issue of screener underperformance was in the labs throughout Northern Ireland. Professor Gabriel Scally who led a review into underperformance in the Republic of Ireland also feels there are enough questions to warrant a full inquiry. It's worth noting that HPV screening has now been implemented with the Belfast lab now providing that service. The PHA say that this is a far more efficient and accurate methodology. And there's no cervical screening programme saves lives. In response to our findings, the Belfast Trust told UTV: "Belfast Trust cytology service remains an accredited UKAS service and we remain confident in our screening programme. The PHA is satisfied that the performance of screeners continues to be actively monitored and managed by the Trust and that the data does not demonstrate the need for a review. The apparent decrease in all abnormalities sensitivity is a well recognised statistical artefact across the entire Northern Ireland region. This was noted by PHA after the introduction of HPV triage in the Cervical Screening Programme. These individual sensitivities cannot be simply interpreted as underperformance in isolation without the wider context. Screener underperformance is not an infrequent occurrence within any National Cervical Screening Programme, therefore robust mechanisms are required to be in place to capture it. All episodes of persistent screener underperformance within the Belfast Trust were reviewed in line with established procedures and to the standard set by PHA and UKAS. Subsequent cervical cytology slides reviewed by an identified underperforming screener are further checked by another senior scientist before the report is issued, these quality control measures have been approved by both PHA and UKAS. Belfast Trust has not been required to report any screeners to the HCPC." When approached the Western Trust told UTV:"A Spokesperson for the Western Health and Social Care Trust (Western Trust) said: 'As part of the Northern Ireland Cervical Screening Programme, the Western Trust has maintained full confidence in its screening programme and procedures it has provided up until the new arrangements were put in place in late 2024 for the Belfast Trust to provide the Regional Laboratory services for the NI Cervical Screening Programme going forward. The public should be reassured that quality control and quality assurance systems were in place in the Trust and both formal quality assurance visits and data visits by the Public Health Agency were undertaken to ensure the Trust was meeting the standards set, which we did. It should be noted that any minor deviation in performance should not be considered in isolation and viewed in a wider context of the screening programme. The Western Trust's Cellular Pathology Department's Cervical Cytology service underwent robust routine and unannounced inspections by UKAS (The National Accreditation Body). Some of their post inspection comments include: The assessment team found an extremely dedicated and competent service, with a Quality Management System that is meticulously maintained. There were no concerns raised, which included no concerns surrounding the competency of the staff or management team and there no findings.' The Spokesperson continued: 'While contracted to provide services for the NICSP, the Western Trust had a robust management of underperformance procedures which feeds into the wider Trust governance teams. All regional and local guidance has been followed with corrective and preventative actions recorded throughout.' The Northern Trust told UTV:"We understand that the Public Health Agency (PHA) has provided performance data to UTV which utilised percentage based-metrics (ie performance rates) to gauge individual performance. While use of such a metric is frequently employed and offers a convenient summary, the data should not be read into without considering the wider surrounding context related to quality control, especially when a sample size is smaller. This position is also emphasised by the PHA in its report to the Health Committee which states 'in order to accurately interpret the data relating to cervical screening it is necessary to review it in the context of the wider parameters of the screening programme'. In addition, the PHA states: The Northern Trust emphasised the issue of data interpretation saying "Sensitivity is only one measure of the accuracy of the primary screening stage of the cytology pathway. It should be noted that all false negative slides at primary screening are still reported by the laboratory to the GP as having an abnormality. So while the primary screener called the slide normal the internal quality control measures in the laboratory worked as expected to identify the abnormality at the rapid review stage. High grade sensitivity statistics of individual screeners are based on very small numbers, so these should always be interpreted with caution. Sensitivity data can be impacted by data recording and quality control processes within a laboratory, so sensitivity data of individual screeners should not be considered in isolation. They represent a statistic at a single point in time. They are one indicator of performance and should be interpreted alongside other indicators for that individual and within the wider operating context of the laboratory in which they work. All organisations who participate in screening programmes must hold UKAS accreditation. Within the accreditation process there are clear protocols to be followed with regard to performance management of those involved with screening. UKAS review the action taken by accredited organisations where examples of potential underperformance are identified to ensure they are satisfied that quality control mechanisms are working effectively. Accreditation is withdrawn if this cannot be evidenced. The Northern Trust has continually held UKAS accreditation for the duration of its participation with the regional screening programme which evidences that the quality control process was robust and effective action was taken. In addition to UKAS accreditation, the PHA also quality assures the cervical screening programme and it did not raise any issues or concerns with regards the cytology screening service provided by the Northern Trust. The Northern Trust would therefore be confident that a review of all slides is not required. As highlighted above, high grade sensitivity statistics of individual screeners are based on very small numbers, so should be interpreted with caution ie: the volume of slides reviewed by each screener must be taken into consideration when reviewing the data as looking at percentages in isolation is misleading. For example a screener who 'misses' one high grade sensitivity case out of 5 will have a percentage of 80% whereas a screener who 'misses' one out of 45 cases will have a percentage of 97.8%. The Northern Trust is confident that any 'under calls' by primary screeners were picked up by the internal quality control processes in place as evidenced by the organisation's maintenance of UKAS accreditation and PHA quality assurance programme. Therefore, the Trust is of the view that referral to HCPC was not required. The Northern Trust would continue to encourage all women eligible for participation in the screening process to continue to avail of this opportunity. The Southern Trust said the latest on their review can be found here on their website. When asked about the findings and the governance of the cervical smear programme the PHA provided the following statement to UTV. "The Northern Ireland Cervical Screening Programme is a well-designed and effective programme which saves lives. It is essential that women attend for screening when invited. The data provided to UTV show sensitivity results for individual primary screeners for each year under consideration. These primary screening data can be impacted by data recording in the laboratory and the quality control processes in place, so sensitivity data for individuals should not be considered in isolation. They represent a statistic at a single point in time and are one indicator of performance that needs to be interpreted alongside the individual's work pattern and the wider operating context of the laboratory in which they work. As expected, there is some degree of variation across trusts, years and screeners, and some individual results are below the target sensitivities of 90% for all abnormalities and 95% of high-grade abnormalities. These individual sensitivities cannot be simply interpreted as underperformance in isolation without the wider context. Where any individual screener's sensitivity falls below the programme standards the trust will identify and take corrective action. There are other layers of quality control in place in the laboratories. As detailed in the report, sensitivity is a measure of the accuracy of the first level of cytology examination (primary screening). All cervical cytology samples are assessed as normal or abnormal at this initial stage of reporting. All samples then have at least one further level of assessment, with the final report issued by the laboratory either agreeing or disagreeing with the assessment made by the primary screener. In addition, it is important to note the small number of slides on which the statistics are based. Approximately 92% of screening samples taken at GP practices from women aged 25-64 have a negative result. This means that for every 1,000 screening slides assessed by an individual primary screener, approximately 80 will have abnormal cell changes and about nine of these will be considered high grade changes. To meet the sensitivity standards, the screener will need to correctly identify at least 72 out of 80 slides with abnormal cells (90%). For high grade abnormalities if eight out of nine are correctly identified the sensitivity falls to 88.9%. The data provided do not give any information about the numbers screened by each individual nor do they give other contextual information. It should not be used as a single measure of performance of a screener. The PHA is satisfied that the performance of screeners was actively monitored and managed by these trusts. There is nothing in this data that would suggest reviews of other trusts are required." When asked if it was concerned about the integrity of the Southern Trust review, the PHA said: "The data taken in isolation should not be interpreted to mean that Belfast Trust's cytology laboratory was underperforming. Trusts continually monitor the performance of their cytology laboratories and respond to any signals that performance has dipped. One aspect of this is screener sensitivity data. As well as being reviewed on an ongoing basis in the trust, there is an annual data review with the Public Health Agency (PHA). The PHA is reassured, based on this ongoing work and the overall laboratory performance statistics, that the laboratory element of the screening programme operated appropriately in Belfast Trust. Sensitivity data for individual screeners should not be considered in isolation. The data do not show persistent underperformance by individual screeners in Belfast HSC Trust, and all other measures indicate that the Belfast laboratory was operating within expected quality parameters and in line with national standards for performance. The cervical cytology review of slides from the Southern Trust commenced in October 2023 through to completion in early autumn 2024. The Northern, Western and Belfast HSC Trusts contributed to the review of these slides. As demonstrated in the data provided for Belfast HSC Trust for 2023/24, which coincides with the time of the review, all screeners met the 'all abnormalities' sensitivity threshold of 90% for samples received in that year. While two screeners did fall marginally below the 95% threshold for high grade sensitivity in 2023/24, as advised in the report, high grade sensitivity data are based on very small numbers and should be interpreted with caution and within the wider context for the individual and laboratory. There are no concerns about the integrity of the review." When asked why it took so long for UTV to get this data, the PHA had this "As indicated previously, collating and checking the range of data requested was a significant undertaking and required time to ensure it was complete and consistent." UTV also asked that given that the PHA supported a cervical review and recall of 86 women for retesting in the Western Trust in 2018 after an issue of screener underperformance where their rate had dipped to 92.3% and that this data shows other screeners in other trusts were also failing to meet the standard of 95% which became a mandatory standard in 2019, would they support a review into the work of those screeners? "The Western HSC Trust undertook a review of a small number of slides in 2018 in response to a concern the trust had identified with an individual screener. This action was based on the trust's assessment of the performance of that screener over a specific and limited period of time, and took account of all information they had available to them. The PHA had an advisory role on the review group only. Individual sensitivities cannot be simply interpreted as underperformance in isolation without the wider context of other data and information. Where any individual screener's sensitivity falls below expected programme standards, the trust will consider the significance of this in this wider context and take corrective action as needed." When questioned about an SAI report from 2019 after the recall which was conducted in the Western Trust about whether they ever actioned a series of regional actions points or recommendations around the identification and management of screener underperformance, the agency responded: "The PHA has consistently advised trusts that the national standard for all abnormalities and high grade abnormalities (calculated in line with the national definitions) is the benchmark and it would be inappropriate for Northern Ireland to develop alternative thresholds. As the circumstances may differ for any individual who does not meet the benchmark, trusts have a range of actions they can take which should be tailored to the individual case. This practice is in line with elsewhere in the UK." The accreditation body UKAS sent this statement to UTV: "The United Kingdom Accreditation Service (UKAS) is the national accreditation body for the UK. Its role is to assess the technical competence and impartiality of organisations that provide certification, inspection, testing, calibration, validation and verification services (collectively known as conformity assessment services) against the requirements of nationally and internationally agreed standards. UKAS is not a regulating, policing, monitoring or standards-defining body. As such, UKAS's remit is limited to the assessment of an organisation's competence and impartiality against relevant standards, the awarding of its accreditation and where necessary its sanctioning (either through suspension or withdrawal of accreditation). UKAS takes concerns about the performance of accredited organisations very seriously and will always act on any credible information that is brought to its attention. UKAS is not permitted to either disclose or comment on individual assessments/reports, however we can share the following: The process of accreditation assessment necessitates a sampling of an organisation's evidence of compliance with the relevant standard. Accreditation of cervical screening services at both the Southern Health and Social Care Trust and Belfast Health and Social Care Trust was suspended in October 2023. Imposed suspensions are applied when UKAS has identified that the organisation is unable to continue to meet the requirements of the standard for which they hold accreditation, in this case ISO 15189:2012 (the medical laboratories standard). Accreditation was reinstated for cervial screening services at the Southern Health and Social Care Trust in December 2023, and at the Belfast Health and Social Care Trust in June 2024. Accreditation is only reinstated when the organisation has demonstrated to UKAS that is able to meet the requirements of the relevant standard. Starting in November 2024, the accreditation of cervical screening services has since been voluntarily withdrawn by the Western, Northern and Southern Health and Social Care Trusts, as a result of cervical screening services for Northern Ireland being centralised at the Belfast Health and Social Care Trust. Accreditation for HPV screening services was awarded to the Belfast Health and Social Care Trust in June 2025. Accreditation is only awarded when the organisation has demonstrated to UKAS that it has the facilities, equipment, technically competent staff and quality control processes in place to enable it to meet the requirements of the relevant standard." Finally the Health Minister, Mike Nesbitt, declined an interview but did issue the following statement. "I am very conscious that at the heart of concerns with underperformance in cervical cytology screening (between 2008 – 21) in the Southern Trust are the women who have been impacted by the Cervical Cytology Review. I have given this matter my full attention and concern and have listened intently to those that have been affected the most. They remain the key focus for myself and my officials. I acknowledge that this has been a difficult and challenging time. This is a very complex area and that is why I and my officials have on several occasions, met women affected, and their families, and sought to share information on an open and transparent basis. I am encouraged that officials in the Southern Health and Social Care Trust (SHSCT) have adopted a similar approach. I remain committed to understanding the challenges and events which led to the precautionary cervical cytology review and importantly, to identifying the learning emerging and the improvements that have been and will continue to be made - to ensure we continue to have a high-quality population-based cervical screening programme in Northern Ireland. Regarding the screener data recently shared with UTV by the Public Health Agency (PHA), I have been advised that - based on assessment of this data along with information relating to laboratory performance, and on engagement with and feedback from the relevant trusts, the PHA and relevant trusts are content with how these laboratories were operating as part of the NI Cervical Screening Programme. The PHA has advised that it is reassured that the laboratory element of the screening programme operated appropriately and is satisfied that the performance of screeners was actively monitored and managed by the respective trusts. I must reinforce the key message to women across Northern Ireland that screening saves lives. Nearly all cervical cancers are caused by an infection from certain types of human papillomavirus (HPV). Cervical screening is estimated to save 4,500 lives in the UK each year. It is essential women in Northern Ireland continue to take up the offer of cervical screening when invited to do so." He outlined the next steps in the process: "Following completion of the Cervical Cytology Review (CCR), two factual reports were published by the PHA and the Southern Trust on 11 December 2024: CCR Activity and Outcomes Report and Cervical Cancers in SHSCT NI. A number of further reports have also been commissioned, including –an independent expert opinion on the above two factual reports, relating to the Cervical Cytology Review and the Cervical Cancer Epidemiology; o A report of NHS England's peer review visit to the Public Health Agency;and o A summary of the findings and learnings arising from SAI Learning Reviews undertaken by the Southern Trust I have requested that the above three reports are published at the same time, as they relate to the full screening pathway and need to be viewed in their entirety and in conjunction with the reports already published. I expect that publication of these additional reports will be in late August/September. Given the complexity of the issues at hand, and with the number of reports recently published or due to be published shortly, I have tasked officials with considering how best to provide an overall picture of the complex and detailed information set out in these reports before I determine what additional or other steps may be required. I have pledged to keep communication open with the women and their families whom I have previously met, and I will fulfil this pledge. We share the common aims of finding out exactly what happened, and of understanding why it happened and how learning has been identified which will be embedded in our healthcare systems - to ensure that we are offering the best service that we possibly can and that we continue to have a high quality population-based cervical screening programme across Northern Ireland."
