Screening Programmes Failed to Meet Targets 

Theresa Bebbington

February 01, 2019

Health screening programmes failed to meet targets, an official report has found. There was also a backlog of 98,000 cervical screenings samples waiting to be tested

There are currently 11 national screening programmes in England. After concerns raised in 2018 about two of these screening programmes, the National Audit Office (NAO) investigated four of the screening programmes that are based on a person's age: abdominal aortic aneurysm (AAA), bowel cancer, breast cancer, and cervical cancer. More than 7.9 million people were screened in these programmes in 2017–18.  

Outdated IT Systems

In 2018, concerns were raised about the two screening programmes for breast and cervical cancers. NHS England admitted that omissions on the scale of these two screening events were unlikely to be identified through the national level performance data used to monitor the programmes. NHS England has delegated responsibility for managing the performance of screening providers to regional and local teams.

The four screening programmes the NAO investigated rely on a national database of GP registrations, known as the National Health Application and Infrastructure Services (NHAIS), to identify those who are eligible for screening. The Department of Health does not consider the 'complex and aging' system of the NHAIS fit for purpose, because there is an increased risk that some people may not receive invitations for a screening. This system was due to be replaced in 2017 but this has been delayed.

Each screening programme also relies on its own IT systems to send invites, process tests, and send results, and these vary in number, age and complexity. For example, some estimates indicate there are 350 different systems supporting various stages of the cervical cancer screening pathway. The Independent Breast Screening Review found the breast screening IT systems 'dated and unwieldy'. Because of errors in these systems, around 5000 women were not invited to their final breast screening.

NHS England and Public Health England have implemented a new bowel scope screening, with all but one of its screening centres operational by the end of 2016–17. However, only 3162 of 7649 GP practices were linked to a screening centre, and by September 2018, only 33% of those entitled to a bowel scope screening had been invited to an appointment.

Failure to Meet Targets

The Department of Health has two performance levels for each screening programme: the ‘standard’ level at which a programme should be running optimally, and a 'lower threshold’, which is the lowest level of performance that a programme is expected to attain. The Department of Health introduced the lower threshold target for the first time in 2017–18.  In 2017-18, none of the screening programmes met its standard coverage target.

When the NAO looked at screenings in different local areas, it found that there was considerable variation in the percentage of people screened. Although nationally 60% of those eligible received bowel cancer screening, eight Clinical Commissioning Groups (CCGs) screened only 30–44% of eligible people. The levels of coverage across the four screening programmes were all inconsistent, with London having much of the lowest performance.

Many people also waited longer than the expected target days before receiving results of their screening. The expectation, for example, is that 98% of women will receive test results for cervical screenings within 14 days, but this target has not been reached since November 2015.

The NAO found:

  • All four screening programmes failed to meet the 'standard' target for percentage of eligible people attending screening appointments in 2017–18

  • Only the bowel cancer, breast cancer and AAA screenings attained their lower threshold target

  • The bowel cancer screening programme achieved 59.6% coverage, against its standard target of 60%

  • The cervical cancer screening programmed achieved 72% coverage, compared with a standard target of 80% and a lower threshold of 75%

  • In March 2018, only 33% of women received test results for cervical cancer screenings within 14 days; this improved to only 55% in December 2018

  • In October 2018, there was a backlog of 98,000 samples from cervical screenings waiting to be tested, reduced from almost 153,000 in March 2018

Waiting for Independent Review

Responding to the report in a statement a Department of Health and Social Care spokesperson said: "Our screening programmes are widely recognised as among the best in the world, and we are committed to making any improvements needed to keep our offer to patients world-class.

"We are already working closely with NHS England and Public Health England to address the issues this useful report highlights. An independent review announced by NHS England is looking at cancer screening services. We expect this to lead to an overhaul of the system so it meets the high standard NHS patients rightly expect."

The results of NHS England's independent review of all the three cancer screening services it is responsible for: breast, bowel, and cervical, is expected in the summer of 2019.

The Department of Health and Social Care is responsible for health screening in England, but it has delegated statutory responsibility to NHS England. It is NHS England's responsibility to commission screening services and hold providers accountable for delivering on the agreed contracts.

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