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The systems underpinning the UK’s national health screening programmes need to be updated urgently to address a number of potential risks to patient safety, a major report has found.
The much-awaited review by Mike Richards, former chief inspector of hospitals at the Care Quality Commission and the first NHS cancer director, includes an investigation of the IT infrastructure supporting breast, cervical, bowel and other screening services – and has found a number of issues.
According to the report, screening programmes are based on an “over-complicated” systems set-up that has issues across the critical stages of identification, management and recording of outcomes.
It called for the urgent replacement of breast and cervical screening, but also found issues in the platforms supporting other types of programme. A Public Accounts Committee report had previously found that screening IT in general had been unfit for purpose since 2011.
“Although the IT systems for bowel and abdominal aortic aneurysm screening are more modern than those for the other adult screening programmes, none have the full functionality required now or for the future,” the Richards report said.
On identification, the report noted that multiple systems are in place to gather data from GPs or the National Health Application and Infrastructure Services (NHAIS) suite of systems, but information that could have been used to contact attendees more easily, such as mobile phones, has not been utilised.
On management of screening, bowel and abdominal aortic aneurysm screening run on a single platform that enables following patients as they change address, it said.
However, disparate, ageing systems covering breast and cervical cancer cause delays in transferring relevant patient data. Some breast screening management systems had not been updated following the Wannacry cyber attack of 2017, the report added.
Lack of interoperability is a key issue when investigating processes around recording outcomes, the report found. It noted that while work has been done by Public Health England (PHE), NHS England and NHS Digital to scope out and recommend changes for breast and cervical screening IT systems, issues around decision-making and funding across the bodies resulted in an incoherent approach, with efforts to improve systems duplicated, slowed or even stopped.
The review calls for intervention from NHSX to address the issues and recommends that the unit should set out a roadmap for the delivery of new targeted and population screening IT systems “as soon as possible”, starting with a focus on breast and cervical programmes.
It acknowledged the digital unit’s efforts to investigate the problems around the current system set-up for breast and cervical screening, which have now been completed and found “multiple inefficiencies, opportunities for error and corresponding benefits that will accrue from a new system”.
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Richards noted that NHSX is working alongside PHE, NHS England and NHS Digital to carry out alpha development for new screening systems which will last six to 12 weeks, to be followed by a beta stage.
The review said a single system should be able to integrate information to provide insights such as individuals who participate in other screening programmes and other relevant data, such as HPV (human papilloma virus) vaccination history for cervical cancer screening.
It also noted that patients should be able to book their own screenings and access their records – neither of which is currently available. It also said the aim should be to improve uptake, identification and invitation of people to be screened, as well as managing them through the system, analysing and reviewing the results.
The report welcomed developments around artificial intelligence (AI) as a means to improve screening, but noted that more fundamental changes are needed to allow for the benefits of emerging technology.
“Combined with growing evidence on new approaches for population and targeted screening, genomics and AI will provide many more opportunities to enhance the quality of people’s lives,” the report said. “Urgent change is needed if NHS screening programmes are to have any chance of realising this potential.”
In a parliamentary statement about the review, health secretary Matt Hancock said “there is a serious need to improve the existing arrangements”, adding that the findings of the review will be used to inform actions to improve screening.
Hancock also acknowledged the point about clarity and accountability for the various elements of screening. He announced that NHS England will become the single body responsible for the delivery of screening services.