• Ageing IT systems an underlying cause of national screening incident, finds official review obtained by HSJ
  • Primary cause a “mismatch” between policy governing screening programme and how it operated in reality
  • “Lack of clarity” about how the system functioned stretched back to inception in 1988
  • Responsibility for oversight shared between DHSC, NHS England and PHE, says review

England’s breast screening programme is running on IT systems with “multiple practical issues and risk associated with their operation”, according to an official investigation report obtained by HSJ. 

The IT systems “require replacement to allow for better functionality and performance”, according to the internal investigation carried out by Public Health England in response to major concerns about a failure of the programme, which surfaced in the spring.

The “complexity in the operation of ageing IT legacy systems” was one of three underlying causes of the incident, according to a copy of the investigation obtained by HSJ.

In May 2018, the then health and social care secretary Jeremy Hunt told parliament “a computer algorithm failure dating back to 2009” meant up to 450,000 women had not received their final breast screening test. He subsequently told MPs up to 174,000 women had been affected.

PHE’s report, authored by its medical director Professor Paul Cosford, said 120,000 women were not invited to their final screen in the three years before their 71st birthday, as required by the screening programme’s national specification.

The principal cause was a “mismatch” between how the national specification defined the age women should receive their final screen and how the breast screening programme worked, the investigation said.

Women were being told they would be invited for their final round of tests within 36 months of their 71st birthday. In practice, the programme was sending out invitations to some women while they were aged 67, though in the calendar year they would turn 68.

PHE launched its internal investigation in the summer in response to the incident. It has run in parallel to an independent investigation announced by Mr Hunt in June, which is being led by external experts. It is expected to release its final report before Christmas.

The internal investigation said there had been a “lack of clarity” about when women were supposed to receive their final screen since the breast screening programme began in 1988. This was compounded by a loss of corporate memory in PHE’s screening team, according to an independent review of the breast screening programme for the internal investigation by management consultant PwC.

Misunderstanding became a divergence between policy and operations in 2013 when, following the Lansley NHS reorganisation, the first national specification for the programme was drafted.

The PHE investigation has also sought to define PHE and NHS England’s oversight responsibilities for the programme. It said oversight of “most screening issues”, including the age mismatch, was “for assurance” through an “oversight group” chaired by the Department of Health and Social Care with representation from NHS England and PHE. It is meant to provide the “arrangements for accountability” for the “Section 7A agreement” which governs the programme.

IT problems have dogged national screening programmes this year. The cervical screening programme sparked a national incident last month when it emerged problems with the Primary Care Support England service provided by Capita meant 40,000 women had not received invitations to be screened or their results letters.

The National Audit Office is investigating all four national screening programmes as a result of the reported problems with breast screening’s IT systems, while Sir Mike Richards – the former national clinical director for cancer – is leading an NHS England and PHE review of all cancer screening programmes, including IT systems.

PHE’s chief executive Duncan Selbie told HSJ: “We have provided the independent review team with our understanding of what went wrong and why and look forward to receiving their report when ready. Commenting in advance would not be appropriate.”