Breast screening scandal: Can the NHS handle the bigger picture?
Paste BN' health correspondent Paul Kelso questions whether the NHS is sacrificing long-term goals for short-term wins.
Thursday 3 May 2018 13:59, UK
At the heart of the breast cancer screening shambles is a bitter irony.
The failure may, in part, have been caused by a trial intended to extend life-saving screening to even more women.
The IT error that led to 450,000 women not receiving their invitation for a final routine mammogram occurred in 2009, following the introduction of a trial called AgeX.
AgeX was designed to examine whether screening should be extended from the current age range of 50-70 to include those aged between 47 and 49, and between 71 and 73.
Women from 65 screening centres across England were selected for the trial, with half of those in the older group invited to be screened beyond their 70th birthday, and the other half unscreened.
According to officials from Public Health England, when the AgeX system selected the older women it appears to have cancelled their automatic invitation for a final routine triennial scan.
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Researchers involved in the AgeX trial have challenged that account, saying Public Health England inadvertently included women who were not part of the trial.
Health Secretary Jeremy Hunt told Parliament that women aged between 67 and 70 were affected, but Paste BN understands those not invited were overwhelmingly aged 70 at the time they were due to be scanned.
Mr Hunt said the issue first came to light in January, but Paste BN understands the full scale of the failure only became clear in the last few days.
Staff from two agencies, NHS Digital and Public Health England, have been working through data sets to try and establish the scale of the error.
Sources have told Paste BN that last week officials thought the issue was confined to between 30,000 and 40,000 people.
This week the number rose sharply, with about 100,000 women identified on Monday. By yesterday evening, this had risen to 300,000 and today Mr Hunt announced 450,000 people may have been affected.
Perhaps the gravest IT error in the history of the health service, it raises questions about the NHS's past and future.
It should be said that breast cancer screening is an NHS success story. Four out of every five women can expect to survive, thanks in part to early diagnosis under the national screening program.
But the IT systems implicated in this case are also part of that legacy.
When the National Breast Screening Service was launched in 2009, new IT was bolted on to an existing system dating back to 1988. It was then upgraded in 2016.
The review may want to ask how the issue was not identified when it was introduced.
Public Health England insists that the system is now fixed and that they are confident that screening programs for bowel and cervical cancer are robust.
But with a fundamental error undetected for almost a decade, faith in the architecture of those systems, and other areas of NHS screening, cannot help but be affected.
There will be questions too about the level of oversight of such programmes. The entire NHS is stretched as perhaps never before. With less time for everything, staff are focused on the day-to-day, but is that at the price of the bigger picture?
In the NHS's 70th year, technology is repeatedly cited as a solution to its myriad challenges.
Once again the health service is being asked to demonstrate that it can manage the ones it has got.
Most of all however it will have to reassure women affected - and with so many potential cases, the worst of this story may yet be to come.