Review makes multiple criticisms over screening failures

The long awaited review has levelled criticism at PHE for its handling of the incident earlier this year.

It said the agency – working with the Department of Health and Care, NHS England and NHS Digital – provided ministers with incorrect information based on a misunderstanding of how the screening programme operated against what it assumed was its guiding policy.

It also found PHE was too slow in informing ministers of what it had decided was a major incident.

The review was commissioned by Mr Hunt, who was then health and social care secretary. It was chaired by Lynda Thomas, chief executive of Macmillan Cancer Support, and Martin Gore, a consultant oncologist at the Royal Marsden Foundation Trust.

It follows a review by PwC, commissioned by PHE, which identified problems around governance and a loss of corporate memory.

The independent review found the problems stemmed from the construction of a nationwide system specification for the programme in November 2013 – the first national specification for what had been a collection of regionally operated screening initiatives.

The Department of Health and NHS England drew up the specification. It was based on an incorrect understanding of how the screening programme worked. Neither body nor PHE have been able to say “how this document was signed-off”.

“What is clear is that it was not implemented properly,” the review said. “This was a failure of governance.”

The review found the specific age range during which women should be invited to routine screening was not clearly understood “for many years”.

The review found PHE first noticed there was a problem with the NHS’ breast screening programme in 2016. In January 2018 PHE realised it was dealing with a major incident.

The review also found there was a three-month gap “between the initial realisation that an incident had occurred and the secretary of state being advised to make a statement to Parliament”.

“The process in understanding the issues had taken too long and by then PHE should have understood what was causing women to miss their screenings,” the review found. “It is unclear what caused this process to be so delayed.”

The review also found: “The initial handling of the incident was not sufficiently gripped within PHE.”

In May, Mr Hunt told Parliament 450,000 women missed their final breast screen and between 135 and 270 had their lives shortened. He blamed a failure in an algorithm in the AgeX trial to extend the age bracket for screening.

The review found Mr Hunt overstated the scale of the incident to Parliament and misstated the cause, but it also found he was right to make the announcement, “based on the advice he was given”.

“However, we believe that in the rush to announce and correct the issue, assumptions were made about policy and operations which were not sufficiently challenged,” the review authors added. “We have not found that any one person is to blame for this confusion, but it is unacceptable for there to be confusion about what women should expect from the breast screening programme.”

The agency and NHS England will now review all women who may have suffered harm, junior minister Steve Brine today told Parliament. He added PHE now estimates up to 34 women have had their lives shortened as a result of not being invited for their final breast screen.

The review made several recommendations about the governance of the screening programmes and IT infrastructure, and DHSC has made £1.8m available to improve systems.

The review found NHS England, which commissions local breast screening providers, “failed to hold breast screening units to account for delivering against the contracts”. It recommended NHS England “should improve its contract management processes to ensure providers are delivering the service as set out in Service Specifications,” which will be redrafted.

 “Women can be completely confident in the future of the breast screening service as a consequence of this review,” PHE’s chief executive Duncan Selbie told HSJ.

The DHSC said improvements have been made to “ensure this can never happen again”, and the report will be fully considered and responded to.

NHS England said Sir Mike Richards is conducting a wider review of cancer screening which will take forward the lessons from the report.

Updated 11.30am on 14 December to state that the 2013 specification was not drawn up by PHE, and to include some more information about other agencies’ role.