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NHSX, the government’s digital unit for the national health service, has started working on improvements to the delivery of screening services.
Under a partnership with NHS Digital and Public Health England (PHE), NHSX has launched a discovery exercise to understand the challenges that patients and health professionals experience when it comes to screening.
Cervical screening is a priority of the programme. According to Hayley Sorrell, a product manager at NHSX, there are “many opportunities to improve” the service, and the digital unit expects the process “will uncover more opportunities than it is possible to cover in one alpha”.
Investigating the shortcomings of systems that underpin screening will be a key area of the discovery process. According to Sorrell, NHSX has observed that practice nurses have to enter the same user and clinical information into two different digital systems while the patient is in the room, which impacts on the delivery of care to patients.
“The average appointment time is 15 minutes,” she said. “We know that many nurses would like to use this time to speak to patients about other things, such as contraception or sexual health.”
Screenings currently rely on what has been defined as “a complex and ageing IT system” to identify patients that need to be invited. According to a Public Accounts Committee (PAC) report published in May 2019, the IT underpinning health screening programmes in England has been unfit for purpose since 2011.
Service design methods will be used by NHSX to identify areas in screening that need improvement, from a technology standpoint but also from a process point of view. Back-end processes involved in inviting people to screening, as well as how data collected in a GP surgery affects someone processing a sample in a lab, are areas that will be investigated, said Sorrell.
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The needs and context of people who take and analyse samples and the people who attend screening will also be analysed. User research in GP practices, sexual health clinics, cytology labs and face-to-face meetings with patients will be carried out, with the service mapped end to end from the moment patients are invited for screening, through to how they move into cancer care.
“This is a complex service,” said Sorrell. “It has various online and offline stages delivered by different parts of the NHS and private organisations. We’re making sure we map and understand the background processes.”
NHSX will also be looking into how screening services can “work for everyone”, speaking to patients attending their appointments, but also those who are eligible but haven’t attended – or groups that are statistically less likely to attend, such as disabled users or those from ethnic minority groups.
In response to a review of high-profile problems with breast and cervical screenings, the Department of Health and Social Care (DHSC) said in March 2019 that an IT systems overhaul for screening could be on the horizon and would be carried out in the context of a review to be led by NHSX.
The pledge was part of a response to an independent review of failures in the breast screening invitation system that emerged last May, which caused hundreds of thousands of women to miss their screenings, some of whom “had their lives shortened” as a result.