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Screening programmes inconsistent

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National Audit Office, report, screening porgrammes, targets, cervical screening, breast screening, IT failures, HPVAnd all four of the screening programmes investigated failed to meet the ‘standard’ target.

The National Audit Office (NAO) has found that the proportion of eligible adults receiving health screening is inconsistent across different areas in England and that services are not operating to the ‘agreed standards’.

Health screening is a way of identifying apparently healthy people who may have a higher risk of developing a particular condition, so that they can be offered treatment or management techniques at an earlier stage where this may make a difference to the outcome.

In 2018, two events – on the breast and cervical screening programmes – raised concerns about the management and understanding of screening programmes.

There are currently 11 national screening programmes in operation in England. The National Audit Office investigated the four health screening programmes that offer screening based on a person’s age rather than because they have a particular condition or are pregnant.

These are abdominal aortic aneurysm screening (AAA screening), bowel cancer screening, breast cancer screening and cervical screening.

In 2017-18 over 7.9 million people were screened by the programmes covered in this investigation.

But all four of the screening programmes investigated failed to meet the ‘standard’ target for the percentage of eligible people attending screening appointments in 2017-18.

However, the bowel screening programme nearly achieved the target with coverage of 59.6 per cent against a standard target of 60 per cent.

For the first time, in 2017-18, the Department for Health and Social Care also set a ‘lower threshold’ target, which all, except for the cervical programme, met.

The cervical programme achieved coverage of 72 per cent against a standard target of 80 per cent and a lower threshold of 75 per cent.

There is considerable variation in the percentage of people screened between different local areas.

The National Audit Office’s analysis shows that levels of coverage across the four screening programmes are inconsistent, with much of the lowest performance in London.

Two recent incidents with breast and cervical screening have raised concerns about oversight of screening programmes.

The Department of Health and Social Care’s governance arrangements assume that all those eligible have been invited for screening.

However, NHS England has admitted that omissions on the scale of the breast screening and cervical screening events are unlikely to be identified through the national level performance data that is used to monitor the programmes.

NHS England has concluded that the cervical screening incident has raised questions about the effectiveness of governance arrangements in place to prevent such issues.

NHS England has delegated responsibility for managing the performance of screening providers to its regional and local teams, and where providers fail to perform they can, as a last resort, terminate a contract.

All of the screening programmes the National Audit Office looked at rely on a national database of GP registrations to identify those who are eligible for screening – which the Department considers is not fit for that purpose and increases the risk that some people may not receive invitations for screening.

The Department for Health and Social Care intended to replace the old system, known as National Health Application and Infrastructure Services (NHAIS), in 2017, but this was delayed.

Once individuals are identified as eligible for screening, each screening programme relies on its own IT systems to send invitations to screeneing, and to process tests and send results, with the number and age of the systems varying by programme.

For example, the cervical screening programme relies on a large number of different IT systems, with some bodies estimating there are some 350 different systems supporting the various stages of the screening process.

Breast screening operates with 78 versions of the same system in place across England, and the Independent Breast Screening Review concluded that this IT is ‘dated and unwieldy’.

Around 5,000 women were not invited for their breast screening because of errors in using “two separate and complicated systems, despite the best efforts of staff”.

Many patients are also experiencing delays in getting their results after screening.

With cervical screening, the Department expects 98 per cent of women to receive test results within 14 days. This target has not been achieved at a national level since November 2015.

In March 2018 a third of women (33 per cent) received their results on time. Performance improved in December 2018 to just over half (55 per cent) of women getting their test results within 14 days.

In October last year, the number of samples waiting to be tested stood at 97,628.

A change in the way tests are carried out, which was announced in 2016 and is not expected to be completed until December 2019, is partly responsible.

The roll-out of primary HPV testing was announced in 2016 and is not expected to be fully introduced until December 2019. This change will mean that samples collected from women will be tested for HPV first, to identify those which would benefit from further testing.

The changes will reduce the number of laboratories needed to analyse results from 48 to 9. Some staff have left the laboratories since the announcement was made, resulting in a backlog of 97,628 samples awaiting analysis.

To read the full report, click here.

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