To ask the Minister of Health to outline the protocol for interaction between the Public Health Agency and the Health and Social Care Trusts when an issue arises from screening.

Mr Nesbitt (The Minister of Health)

Trusts are responsible for delivering the screening services that they provide. They have a statutory duty of quality. Each trust is responsible for maintaining internal structures to support quality improvement and local coordination of screening services. They are also charged with ensuring that their workforce is appropriately trained. The Public Health Agency provides oversight and external quality assurance for screening programmes. It is also responsible for maintaining structures to support quality improvement and coordination of the screening programmes across Northern Ireland. Screening programmes have a learning event protocol that sets out the arrangements between the trusts and the Public Health Agency to support a culture of shared learning in order to improve the quality and safety of the programmes. Any issue, regardless of its impact, including near misses, should be reported immediately by the trust to the relevant screening team in the PHA. The team will then work collaboratively with the trust to investigate, review and implement any actions recommended because of the investigation. For more serious incidents or if more than one trust is involved, an incident management team will be established with involvement from relevant stakeholders. Serious adverse incidents (SAIs) are notified under the regional procedure for the reporting and following up of SAIs. Individual learning events are discussed at regular meetings between the PHA and the trusts, and a summary of learning events is reviewed at regular regional quality assurance meetings with an emphasis on sharing lessons learned with other, unaffected trusts, identifying trends that require further investigation and agreeing mitigating actions to reduce the chance of recurrence. The learning event protocols are regularly reviewed and updated accordingly.

Mr Nesbitt

I thank the Member for her interest in the issue, which goes much broader than a protocol. I have no doubt that she was shocked, as was I, at the time that passed before there were the right interventions. The screening programme encompasses a range of services provided by the trusts, GPs and the Business Services Organisation (BSO). We have had a number of reports on what went wrong with the occurrences in the Southern Trust. I await some quality assurance reports, and I will then decide on the way forward. The point is that it does not matter what protocols are in place; it is whether they are effective and are followed. Clearly, something went badly wrong and affected a really large number of women. I am determined that we will get to the bottom of it. The questions that we must ask are, "What went wrong? Why did it go wrong? Who was responsible for it going wrong? What steps can we put in place to ensure that it never happens again or, at least, to minimise the chances of it happening again?".

Mrs Dillon

Minister, with regard to Mrs Guy's questions about the protocols, are you saying that something has changed and that something new has been implemented to ensure that the PHA has that overarching responsibility to ensure that what happens in the trusts' screening programmes is being done effectively and properly and that there are no issues? Also, will you give us some reassurance on the accreditation status of the HPV screening services in the Belfast Trust that are currently in place? I would encourage every woman to have her screening and smear test done.

Mr Nesbitt

I join the Member in encouraging women not to be shy and not to be put off going for screening because it is important that they do so. The issues about Belfast's accreditation I will characterise as more technical than real issues with regard to the quality of the screening, and that is being addressed. For the overall picture on screening, we follow the advice of the UK National Screening Committee, so I am satisfied that everything that should be done is being done to ensure the quality of screening operations in Health and Social Care (HSC) in Northern Ireland.

Mrs Dodds

Minister, I noticed that you did not answer the last question. The Belfast Trust has been given the contract for the regional cervical screening programme for Northern Ireland, despite the fact that it is not yet accredited for such screening. Is the Minister satisfied with the decision to award the contract to the Belfast Trust? During a recent Committee meeting in Daisy Hill Hospital, the PHA admitted that it was short-staffed and was having to send tests to Gateshead in Newcastle to clear a backlog of screening. In awarding the contract in that way, the Minister bypassed two trusts — the Northern Trust and the Western Trust — that are fully accredited.

Mr Speaker

Please get to your question, Mrs Dodds.

Mrs Dodds

The award of that contract resulted in the resignation of two senior members of the service.

Mr Nesbitt

I thank the Member for her remarks. The awarding of the contract was the appropriate and best way to go forward. I accept that there have been workforce issues. There has also been an issue with some equipment, but, as I said in my previous answer, any issues with accreditation are more about technical and administrative issues than with the quality of what is being done. It is, of course, a matter of regret that some of the tests had to be exported to get the results expedited, but we are moving in the right direction to providing that screening.

Mr Beattie

To tie this down and clarify, will the Minister advise who is ultimately responsible for the policy decisions in relation to the screening programme?

Mr Nesbitt

I thank my colleague for the question. The Department is guided, as I have said, by the UK National Screening Committee. It is an independent committee that advises Ministers and health services across the four UK countries on all aspects of screening. Its recommendations are evidence-based about whether to introduce, continue, change or withdraw screening programmes for a variety of conditions. In addition, there is a Northern Ireland screening committee that considers recommendations from the UK National Screening Committee. It is chaired by the Chief Medical Officer and provides policy advice to me and has a specific focus on implementation issues in Northern Ireland. I then consider and make my decision on screening policy in Northern Ireland on the basis of the advice, as I said, of the UK National Screening Committee and, indeed, the Northern Ireland committee.

Mr Durkan

With regard to bowel cancer screening, we still lag behind the other regions of the UK on the age range for screening. How and when will we see that disparity addressed?

Mr Nesbitt

I have been talking with officials with a view to expanding it, and that is part of the three-year plan that I published recently. It is dependent on budget and finance and on workforce. I would like to see it offered from the age of 50 upwards, and that is an ambition that I will work towards within the confines of budget and workforce.