NHS screening programmes plagued by ‘not fit for purpose’ IT

The successful delivery of NHS screening programmes is suffering due to poor and outdated IT, a National Audit Office (NAO) report has found.

The report comes after it was made public in May last year that an algorithm error in the breast cancer screening invitation IT system has caused a huge number of women to miss their screenings, which led to an independent review of the breast screening programme.

Originally, the then health secretary Jeremy Hunt told the House of Commons it had affected 450,000 women, who had failed to be contacted for their screening. However, the review found that around 196,000 women were initially contacted, being told they had been missed, and of these, 122,000 women are now believed to have been affected, the NAO report said.

Following this, the NAO has looked into a number of screening programmes in England, and concluded that they all rely on “a complex and ageing IT system to identify who to invite for screening”, namely the National Health Application and Infrastructure Services (NHAIS).

The screening programmes covered by the NAO report include the cervical cancer, breast cancer, bowel cancer and abdominal aneurysm programmes, all conditions where early discovery is key.

The NHAIS is a legacy database which holds GP registrations, but is based on information held in 83 different databases, causing difficulties in tracking screening histories when people move from one area to another.

“Each screening programme also relies on its own IT systems to send invites, and to process and send results. These vary in their age and complexity from more than 30 years old on the cervical programme to less than 10 years old on the abdominal aortic aneurysm programme,” the NAO report said.

There is a huge plethora of systems, the responsibility for which are sometimes owned locally, some are owned by NHS Digital, some by Public Health England.

The cervical screening programme, for instance, relies on a huge number of different IT systems, “with some bodies estimating there are some 350 different systems supporting the various stages of the screening process,” the report added.

“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’.”

Commenting on the NAO report, Public Accounts Committee chair Meg Hillier said: “It is unacceptable that these important screening programmes are being let down by complex and ageing IT. The Department of Health and Social Care, NHS England and Public Health England need to get this fixed.”

Eight years ago, in 2011, the DHSC found that the NHAIS system was not suitable for screening programmes, and set out plans to replace the system by March 2017.

However, the project is currently running 22 months behind schedule. “NHS Digital has estimated it will cost £13.9m to maintain NHAIS up to 2020-21,” the NAO report added.