Department of Health considers overhaul of screening IT

In a response to a review of high-profile problems with breast and cervical screening, the Department of Health and Social Care (DHSC) is considering an IT systems overhaul.

The pledge is part of a response to an independent review of failures in the breast screening invitation system that emerged last May, which caused 450,000 women to miss their screenings, some of whom “had their lives shortened” as a result.

Recommendations set out in the report include an immediate review to be conducted by Public Health England (PHE) and NHS England to represent system users, and NHS Digital to reduce manual data input and duplication and to simplify the user interface of the screening systems.

In its response, the DHSC said it recognised that manual data entry and overly complex user interfaces could lead to women missing screenings and that it was “determined to take steps to minimise this potential for user error”.

It added that a cross-health service group, led by PHE and involving breast screening unit staff, would aim to reduce manual data entry and improve system usability, with recommendations due by June.

Unused system features have been identified and work on streamlining the screening platform has begun, according to the response from DHSC.

Introducing a new IT system for the breast screening programme would be a longer-term solution to address the issues, the department said, which would minimise the need for manual entry and deliver more effective access to performance data. According to the response, a business case for future capital investment is being prepared for that purpose.

The review of screening IT, the DHSC response pointed out, would be carried out within the context of a cross-system digital transformation plan and in partnership with PHE, NHS England and NHS Digital, under the auspices of the recently announced NHS X.

A separate report by the National Audit Office (NAO), which looked into a number of screening programmes in England, concluded that they all relied on “a complex and ageing IT system to identify who to invite for screening”, namely the National Health Application and Infrastructure Services (NHAIS).

Responsibility for these systems is sometimes local, while some are PHE-owned and others are owned by NHS Digital. The independent review recommended that the structure for overseeing the IT systems, and other screening programmes that rely on the same IT, such as NHAIS, should be reassessed.

The DHSC said changes in screening IT and the new governance structure would be informed by the review of adult cancer screening programmes at NHS England, currently being carried out by professor Mike Richards, who was the NHS’s first cancer director and the former Care Quality Commission chief inspector of hospitals. An interim report will be published next month, with the full findings due in the summer.

According to the independent review, the breast screening incident was primarily caused by a discrepancy between the upper age limit, as set out by the National Service Specification since 2013, and the way the current screening programme has been run since it was created.

The DHSC said that following confirmation that the upper age limit for breast screening should remain at 70 years and 364 days, PHE was working with NHS Digital and supplier Hitachi Data Systems to change the systems accordingly.

It added that PHE had hardcoded into the IT system the age parameters used to ensure that all screening services identify women who are aged between 52 years and 364 days and 70 years and 364 days who have not been screened in the previous 36 months.