The IT underpinning health screening programmes in England has been unfit for purpose since 2011, and there are no immediate replacement plans, a Public Accounts Committee (PAC) report has found.
Ageing systems used to identify the population eligible for screening have been underperforming but have not been replaced, resulting in thousands of people having potentially life-threatening illnesses undetected.
The PAC took evidence on the management of four of the 11 health screening programmes operating in England – bowel, breast and cervical cancers and abdominal aortic aneurism – and found that none met their targets because of specific barriers including IT.
National health bodies therefore run “a constant risk of not knowing if all the people who should have been identified for screening have been identified” due to the long-term failure of the systems, the report said.
Screenings rely on what has been defined as “a complex and ageing IT system” to identify who to invite for screening, namely the National Health Application and Infrastructure Services (NHAIS). Responsibility for these systems is sometimes local, while some are owned by Public Health England (PHE) and others by NHS Digital.
NHAIS was due to be replaced in 2017 by a new IT system with Capita contracted to undertake the work, according to the report. However, NHS England put the project on hold because it did not have confidence in Capita’s ability to deliver the change safely.
Work around the replacement of the system was then brought back in-house and is not due to be completed until 2020. This translates to an estimated cost of £14m for maintaining NHAIS in the meantime and a continued risk that more people will not be invited for screening when they should be.
The report also noted that national health bodies have been “too slow to recognise and respond to the problems caused, including sufficiently holding local screening providers to account”.
Issues in the breast screening invitation system emerged a year ago, causing several thousand women to miss their screenings, some of whom “had their lives shortened” as a result, it said.
Specifically on the breast screening system, inherited by PHE in 2013, the committee heard that an update had been made in 2015 and a new system, Breast Screening Select, had been rolled out in 2016. However, the report noted that the breast screening programme relies on 79 individual local IT systems that do not talk to each other.
The PAC added that PHE accepted it “did not have a sufficient understanding of the programme’s data as, even with this improved IT, it still took four months to understand the failure of the programme that emerged in 2018”.
However, the report said, the number of women who may have missed a breast screening appointment because of the “woeful inadequacy” of breast screening IT is also incorrect, and the true figure is closer to 122,000 rather than the 450,000 potentially affected patients quoted by then health secretary Jeremy Hunt last year.
The cervical screening programme is also hampered by complicated and old IT systems, the PAC found. The platform relies on about 360 applications, some of which are 30 years old, making it impossible for the cervical screening operating model to work effectively.
Mike Richards, who was the NHS’s first cancer director and the former Care Quality Commission chief inspector of hospitals, is leading the review of adult cancer screening, with full findings expected this summer.
Richards noted that there was an argument for a single end-to-end system for screening programmes, but NHS England did not know what size of IT systems reduction was needed to drive efficiency and reduce risk in the cervical screening programme.
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The PAC said it is “extremely doubtful” that NHS England will be able to bring the failing cervical screening system back in-house successfully, remove the backlog of samples waiting to be tested, and roll out a new testing regime in just six months.
It said a clear plan should be set out by NHS England to deliver the “inherently risky project” on time and without further disruption to patients undergoing screening.
The PAC’s recommendations in the report included that PHE and NHS England should develop a more integrated approach to their IT systems to ensure the myriad systems underpinning screening can connect and talk to each other. The report said the integration should also include “a single owner who is responsible for making sure the IT works as intended”.
In response to the PAC report, the Department of Health and Social Care (DHSC) said that under the Long Term Plan for the NHS, “patients with suspected cancer are beginning to receive a diagnosis or the all-clear within 28 days”, and that NHS England is investing £200m to fund “new ways to rapidly detect and treat cancer”.
“Although we await further recommendations from the Sir Mike Richards Review of national screening programmes, we are pushing ahead with important changes to help detect as many cancers as early as possible,” a DHSC spokesperson said.
The DHSC pledged to overhaul its IT systems in March in a response to an independent report into high-profile problems around breast and cervical screening that included recommendations such as NHS Digital reaching manual data input and duplication and to simplify the user interface of the screening systems.
The department then said it recognised that manual data entry and overly complex user interfaces could lead to women missing screenings and that it was “determined to take steps to minimise this potential for user error”.
It added that a cross-health service group, led by PHE and involving breast screening unit staff, would aim to reduce manual data entry and improve system usability, with recommendations due next month.
Unused system features have been identified and work has begun on streamlining the screening platform, the DHSC said at the time.
Introducing a new IT system for the breast screening programme would be a longer-term solution to address the issues, the department said, which would minimise the need for manual entry and deliver more effective access to performance data. A business case for future capital investment is being prepared for that purpose, it added.
The DHSC said a review of screening IT would be carried out within the context of a cross-system digital transformation plan and in partnership with PHE, NHS England and NHS Digital, under the auspices of the recently announced NHS X.