NHS health screening hampered by ‘complex and ageing IT’

Written by Sam Trendall on 5 February 2019 in News
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National Audit Office report finds that programmes are impacted by outdated tech

Credit: Peter Byrne/PA Wire/PA Images

NHS health-screening programmes are being hampered by a “complex and ageing IT system”, a report from the National Audit Office has found.

Health screening is designed to ascertain a healthy individual’s risk of developing a condition in the future. NHS England currently oversees 11 national screening programmes for various conditions, of the which NAO has examined four, covering bowel, breast, and cervical cancer, and abdominal aortic aneurysms.

It emerged in May 2018 that issues with an algorithm used to determine which women should be offered breast screening had, over a nine-year period, resulted in a failure to invite 122,000 women between the ages of 68 and 71. The computer problems, which began in 2009, may have caused the early deaths of up to 270 women, the government said last year.

The NAO report said that the four screening programmes under examination are all blighted by an IT set-up that the Department for Health and Social Care acknowledges is “not fit for purpose”.


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“A legacy database of GP registrations, known as National Health Application and Infrastructure Services (NHAIS), is used to identify the eligible population for each screening programme,” the NAO said. “Information is held in 83 separate databases, making it hard to track screening histories when people move across geographical boundaries. NHS England intended to replace NHAIS in 2017, but this has now been delayed, causing additional cost and greater risk that screening services cannot reliably identify and invite eligible populations for screening.”

It added: “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 DHSC sets annual coverage targets for the percentage of the eligible population it expects each programme to have screened. In 2017/18, three of the four programmes audited by the NAO met their target for “the lowest level of performance that programmes are expected to attain”. Only the cervical cancer programme fell short, achieving a 72% coverage rate, against a minimum target of 75%.

None of the four schemes achieved their ‘standard’ target, which is set by the department at “the level at which programmes are likely to be running optimally”.

Responding to the NAO report, Meg Hillier, chair of the House of Commons Public Accounts Committee, said: “It is worrying that not everyone who is eligible to take part in screening programmes is doing so, and the proportion of eligible people taking part varies across England. Those responsible for screening programmes are not always capable of picking up when people are not invited for a screening appointment, or ensuring that people receive their test results on time. 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.”

A DHSC spokesperson said: "We have committed an initial £1.8m to identify and design an immediate replacement for the breast screening IT system. A further £12m will be available to implement the final version. We will also spend £487m on healthcare technology as part of the NHS Long Term Plan to improve patient care and reduce workload on staff.”

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Sam Trendall is editor of PublicTechnology

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