Scope of the inquiry
Health screening is a way of identifying 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. There are currently 11 national screening programmes in England. Examples include aortic aneurysm, bowel cancer, breast cancer and cervical cancer. There are three main players: the Department of Health and Social Care has overall responsibility for health screening, NHS England commissions screening services and holds providers to account, and Public Health England provides expert advice and monitors quality of programmes.
In 2018, there were two events which heightened
public concern about the management of screening programmes:
- May 2018: the Secretary of State announced in Parliament that between 2009 and 2018, an estimated 450,000 women were not invited for their final breast screening. This was later revised down to 122,000 women following an independent review.
- November 2018: it was announced that between January and June 2018, 43,220 women did not receive letters inviting them for a cervical screening and a further 4,508 women were not sent results letters. Of these, 182 needed follow-up treatment.
A recent National Audit Office (NAO) report has found major flaws in the management of screening programmes: none of the screening programmes it investigated met the Department’s target for the percentage of eligible population screened in 2017/18. The cervical programme also did not meet the Department’s “lower threshold” target, achieving coverage of 72% against a standard target of 80% and a lower threshold of 75%. Also, levels of coverage are inconsistent across Clinical Commissioning Groups in England, and are particularly low in London.
The report also discovered that all screening programmes rely on the system of patient registrations at GP practices (National Health and Application Infrastructure Services (NHAIS)), which the Department itself described as “not fit for purpose” in 2011. NHS England intended to replace the system in 2017, but work has been delayed and NHS Digital estimates that it will cost £13.9 million to maintain the system up to 2020-21.
On 20 March, the Public Accounts Committee will challenge the Department and NHS England’s performance on screening programmes and examine how they plan to improve governance and management arrangements. The Committee will also hear from Professor Sir Mike Richards, who is leading an independent review of national screening programmes, to explore the main challenges to delivering future changes in health screening.