Health department rapped over NHS cancer-screening failings

MPs find millions miss out on potentially life-saving checks against backdrop of underperformance and out-of-date IT

Meg Hillier Credit: CSW

By Jim Dunton

10 May 2019

The Department of Health and Social Care is “losing its grip” on health-screening programmes designed to identify some of the biggest killer diseases at the earliest – and most treatable – stages, a new report has warned.

Members of parliament’s Public Accounts Committee said their study of four of the 11 health screening programmes operating in England – bowel, breast and cervical cancers, along with abdominal aortic aneurism – found none met targets for checking eligible members of the public.

MPs said the DHSC and its NHS England and Public Health England bodies were not doing enough to make sure everyone eligible to take part in screening was doing so, and did not know if everyone who should be invited for screening was being invited.


The committee said that the continued use of the NHAIS IT system that had been “unfit for purpose for screening programmes since 2011”, but which had not been replaced, meant health bodies had to carry the “constant risk” that target candidates for checks were being missed.

Members said national oversight of screening programmes had failed patients, resulting in thousands of women not being invited for breast and cerv ical screenings or waiting too long for their cervical screening results.

National health bodies had also been too slow to recognise and respond to the problems caused, and had failed to hold local screening providers to account for long-term failure, they said.

The report, which looked at 2017-18 screening results for the four programmes, identified that the period had marked a 21-year low for numbers of women screened for cervical cancer. The number of screenings for the year was 3.2m, which represented 71.7% of the eligible population – meaning that 1.2m women had missed out. The screening target is 80%.

MPs also found disparity across the nation in terms of the reach of screening programmes, with areas in the north east “consistently” outperforming parts of London.

PAC chair Meg Hillier said the benefits of screening could not be underestimated because treatment could be significantly more effective if killer diseases were found at an early stage. 

“Millions of people are not being screened for serious illnesses like bowel, breast and cervical cancer,” she said.

“Our inquiry has exposed a health service that is losing its grip on health screening programmes.

“Many individuals waiting for delayed results will suffer avoidable anxiety, stress and uncertainty. Those delays also stretch far beyond the department’s target waiting periods.

“The government’s understanding of variation across the country and the barriers facing different demographics of the population is patchy at best, which constrains their capacity to act.

“Ultimately, this is a question of health equality. The government has a duty to ensure that everyone has access to health screening.”

Hillier said the committee was calling on the department and NHS England to set out a plan of action to better hold local screening providers to account, overhaul governance arrangements and develop an IT system that worked properly. 

The report concluded that there was an “overwhelming lack of understanding” about local variation on screening levels that meant the national health bodies were unable to address the health inequalities that existed. 

It also noted that existing arrangements for oversight and monitoring of screening programmes failed to identify that thousands of women had not been invited for breast and cervical screenings, and that in the case of breast screening, the failure had gone undetected for more than five years. 

The report said the division of roles and responsibilities between the national bodies, between individual programmes, and between national and local bodies was accepted by DHSC and the NHS as “fragmentation” in the system.

It added that the “woeful inadequacy” of the IT supporting breast screening has played a fundamental role in the failure of the screening programme. It said DHSC accepted that the pan-service suite of software – known as NHAIS, short for National Health Application and Infrastructure Services – was “not fit for purpose” as far back as 2011 but was not due for replacement until 2020, three years later than planned.

The report said NHS England had decided that it could no longer work with Capita, its original partner, on the project and that NHS Digital would take on responsibility for replacing NHAIS.

It warned that until the system was replaced a risk remained that that more people would not be invited for screening when they should be. 

A DHSC spokesperson said 11m people a year benefited from the NHS’s world-class screening programmes and record numbers of people were receiving life-saving NHS treatment.

“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,” they said.

“Under the Long Term Plan for the NHS – backed by an extra £33.9bn a year by 2023-24 – patients with suspected cancer are beginning to receive a diagnosis or the all clear within 28 days, and the NHS in England is investing £200m to fund new ways to rapidly detect and treat cancer.”

DHSC said it expected results Richards’ review to be available this summer. 


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