13.All of the screening programmes rely on an IT system, known as NHAIS, to identify who is eligible for screening. NHAIS consists of 83 separate databases that contain the details of patients who have registered with a GP practice. NHS England is responsible for ensuring NHAIS operates as it should. Each screening programme also has its own separate IT systems that are used to send invites, reminders and test results to patients. Public Health England is responsible for the IT systems that support the breast, bowel and abdominal aortic aneurism screening programmes, whilst NHS England is responsible for the IT systems on the cervical screening programme.
14.NHS England told us that a key weakness within its screening services is the reliance on NHAIS. The Department of Health & Social Care concluded in 2011 that NHAIS “was not fit for purpose” for screening programmes because it was hard to track a person’s screening history if they moved across geographical boundaries. This meant that the national health bodies cannot be certain that everyone who is eligible for screening is being identified. NHAIS was due to be replaced in 2017 by a new IT system with Capita contracted to undertake the work. However, NHS England admitted that it had put the project on hold because it did not have confidence in Capita’s ability to deliver the change safely. NHS England has since decided to bring the new IT system back-in house and told us that it expected to replace NHAIS during 2020. NHS England would not tell us how much introducing the new system would cost, but confirmed that the cost of maintaining NHAIS during this delay is estimated to be £14 million.
15.Public Health England admitted to us that the “IT was hopeless”. Public Health England inherited the IT system that supports the breast screening programme in 2013. Public Health England told us that it updated the breast screening IT system in 2015 and introduced a new system, Breast Screening Select, in 2016. The breast screening programme relies on 79 individual local IT systems that do not talk to each other. Public Health England told us it had made some improvements to these 79 systems in 2015. It also asserted that introducing Breast Screening Select in 2016 had improved its ability to conduct analysis on the breast screening programme. Public Health England told us that the new system allowed it to see for the first time that there were women in their 70th year who were not being called for a screen. However, Public Health England accepted that 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 on the programme that emerged in 2018. Subsequently, the then Secretary of State for Health & Social Care made a statement to the House of Commons about a serious failure involving 450,000 women who may have missed a breast screening appointment, when in fact the true number was closer to 122,000.
16.NHS England is currently undertaking major changes to the cervical screening programme whilst also trying to manage significant levels of poor performance as the programmes have not met their targets since 2015. Capita is responsible for sending invites, reminders and test result letters to women on the cervical screening programme. Capita took full responsibility for the serious incident in November 2018 when it became clear that 43,220 women had not received their invitations or reminders to attend a screening, and a further 4,508 women did not receive their results. NHS England told us that it was not satisfied with Capita’s performance on the programme and would terminate Capita’s contract for the cervical screening programme in June 2019, with a phased transition of the service to bring it back ‘in-house’ throughout the rest of the year.
17.NHS England is preparing the cervical screening programme to switch to primary HPV test by December 2019. The HPV virus is present in 99.7% of cervical cancers. This change to how analysis is conducted will mean that women will be tested for the HPV virus first to identify those women whose samples would benefit from further testing. The change to HPV represents a significant change to how the cervical screening programme is run. NHS England described it as a “dramatic and fast” change to how it manged the programme and told us that it expected the change to result in around an 85 per cent reduction in the workload at the laboratories that analyse the screening samples. It expects this to mean that fewer staff will be needed and the process should be more efficient. Given that this change was announced in 2016 but is not expected to come into effect until December 2019, laboratory staff have “voted with their feet”. As a result it has become increasingly difficult for NHS England to recruit and retain staff leading to the difficulties in getting results to women within 14 days. NHS England confirmed that it was currently dealing with 98,000 samples that are waiting to be tested, but asserted that samples could be kept for six weeks before being tested, and preserved for longer with the addition of extra chemicals. We asked whether this number was likely to increase if the recent national campaign to encourage women to attend cervical screenings succeeds. Public Health England told us that the advertising campaign had been running for three weeks and was expected to run for a further five weeks and it was expecting a 5 per cent increase in the number of women attending a screening appointment as a result of the campaign.
18.The cervical screening programme is also hampered by complicated and old IT systems. The programme relies on around 360 IT systems in total including: the 83 separate databases included in NHAIS which identify who is eligible for screening; and a further 270 IT systems that deal with invites, reminders, analysis and test results. Some of these systems are 30 years old. NHS England accepted that it was not possible for the operating model for cervical screening to work effectively with so many IT systems in place. It recognised the need to move to what it described as “a unified cervical screening system”. Professor Sir Mike Richards similarly noted that there was an argument for a single end-to-end system for screening programmes. However, NHS England did not know what size of reduction was needed within the IT systems to create a more effective operating model and ultimately make the cervical screening programme less risky.
27 C&AG’s Report, para 1.10
28 Q 81
29 Q 127
30 C&AG’s Report, para 1.11
31 Qq 128–29, 141
32 Qq 132, 139–144
33 Qq 74, 81, 83
34 Qq 84–86, 94, 103
35 Qq 102–103
36 Q86, C&AG’s Report, paras 3.10 and 3.13
37 C&AG’s Report, paras 3.13 and 3.14
38 Q 81
39 Qq 19, C&AG’s Report, paras 4.5–4.7
40 Qq 19, 54, 56
42 Qq 64, 65
43 Q 67
44 C&AG’s Report, para 1.12
45 Qq 111–118, 121–127
Published: 10 May 2019