• Auditors investigating four national screening programmes for adults
  • NAO apparently paying particular attention to breast cancer programme
  • The investigation comes amid independent inquiry into breast screening

The National Audit Office has started an investigation into the four adult health screening programmes in England, HSJ has learned.

Auditors have held preliminary meetings with officials at Public Health England and sent the agency a detailed list of data and information they need to investigate the screening programmes.

The NAO inquiry concerns the breast, cervical and bowel cancer programmes, and the abdominal aortic aneurysm screening programme.

The investigations are at an early stage and will be working on “a tight timetable” according to an email sent in early October to PHE officials from a member of the NAO’s investigation team.

The documents were necessary for the investigation, the email said. It is not “an exhaustive list, but we hope it will capture the majority of what we will need.”

It includes screening data, such as the total number of people invited to screen and the total who were screened, as well as risk registers, budgets, and specifications sent to external IT contractors.

Most of the 47 requested records concern at least two of the screening programmes. However, 20 concern the breast screening programme alone. No other programme was singled out in this way.

The email also included a “process walkthrough” for how investigators planned to conduct their inquiries into each of the screening programmes. It also included an “interview schedule” to help investigators establish “the facts around the breast screening incident and the response to it”.

The breast screening incident saw former health secretary Jeremy Hunt apologise to MPs for “a computer algorithm failure dating back to 2009” that meant up to 450,000 women had not been called for their final breast screen.

It is the subject of an internal inquiry by PHE officials and an independent inquiry chaired by Lynda Thomas, the chief executive of the Macmillan cancer charity.

Both inquiries are expected to be completed before the end of the year though in September HSJ obtained a copy of an internal review of the breast screening programme compiled by management consultants PwC as part of PHE’s internal inquiry.

PwC found that the algorithm was not responsible for the error. It said a misunderstanding about how the breast screening programme operates, dating back to 2013, combined with poor governance and a loss of “corporate memory” at PHE lay behind the incident.

The NAO is mandated to make inquiries of departments and agencies, or individual projects or programmes, ensuring they use their resources “efficiently, effectively, and with economy”. It carries out investigations “to establish the underlying facts” when “concerns have been raised by others or observed through our wider work”.

However, an NAO spokeswoman would not confirm or deny whether the NAO was carrying out an investigation into the screening programme, let alone if the investigation had been precipitated by the breast screening incident.

She told HSJ: “We continually review our programme of work and are considering this topic alongside other wider issues and causes for concern. At this stage, we cannot confirm if we will be doing anything.”

At first, PHE denied any investigation was going on, telling HSJ: “PHE is committed to working with our partners to continually ensure the quality and effectiveness of screening programmes. We will fully cooperate with the NAO if they decide to carry out this piece of work.”

It altered its statement when presented with evidence from documents compiled by the NAO, sent to PHE, and seen by HSJ.

Yesterday a spokeswoman told HSJ: “PHE is committed to working with our partners to continually ensure the quality and effectiveness of screening programmes. We will work with the NAO and they will decide on the next steps.”