Decades old computer systems putting lives at risk

A letter from a leading cancer charity to health and social care secretary Matt Hancock, seen by HSJ, has asked ministers to urgently review the IT infrastructure amid “serious and growing concerns” about existing computer systems.

Plans to upgrade the IT system have stalled because of problems with the Primary Care Support contract between Capita and NHS England.

Experts have also told HSJ any delays to the roll out could cost the NHS £32m a year.

Robert Music, chief executive of Jo’s Cervical Cancer Trust, told Mr Hancock in the letter sent in September: “We are fortunate to have a fantastic cervical screening programme, which saves thousands of lives every year, but if action is not taken we will instead see lives at risk or even lost.”

His intervention comes as the NHS prepares to fundamentally change the national cervical screening programme. As of December 2019, all cervical cell samples will be tested for the presence of the cancer causing human papilloma virus rather than being analysed under a microscope for physical abnormalities.

But Mr Music said he was worried the new national programme will have to rely on 30 year old IT infrastructure that a Department of Health report in 2011 described as “not fit for purpose”.

There is no single database serving the cervical screening programme. It uses a constellation of different systems and databases that cover different parts of the country and provide various pieces of information to enable doctors to call women in for their tests.

It was meant to have been replaced by a single system as part of the Primary Care Support services contract between NHS England and outsourcing firm Capita. That process has stalled, Mr Music said, after it came under scrutiny and criticism from the public accounts committee and National Audit Office.

He asked for assurance from the secretary of state that the current system can support the change to primary HPV screening “with no risk to health”.

He believes there is “an urgent need for a review of the entire IT infrastructure to fully understand the systems in place, ensure it is clinically safe and that it meets the needs of the future screening programme and the population it serves.”

Primary HPV screening has been piloted in six areas around England since 2013. It was meant to be introduced across the country by April 2019, but the deadline has been pushed back to December.

In November, the NHS will start taking bids for up to 13 laboratory services to carry out the HPV screening across England. Meanwhile, NHS Improvement and NHS England have been working with current providers to allow those that “meet the quality criteria and have a robust risk mitigation plan” to switch to HPV screening while the procurement process runs its course.

This effort to streamline the introduction of HPV screening comes in light of a recent analysis published in the Journal of Medical Screening that estimated quality adjusted life years lost if HPV screeing was delayed by a year would reach at least £32m.

Peter Sasieni of Kings College London, one of the authors of the paper, told HSJ their research was not about pointing fingers of blame for the slow introduction of HPV screening. It’s “simply to point out that there is a cost to pay for being overly cautious.”

“Undoubtedly, more rapid introduction would have required additional investment,” Dr Sasieni added. “But it is staggering to think the saving in terms of years of life gained would amount to some £32m per year the introduction is delayed.”

“If it is true that no new IT system has been commissioned and that the plan is to roll out primary HPV testing using the existing 30 year old system, then it is truly depressing,” he continued. “The need for a new IT system was discussed at the Advisory Committee for Cervical Screening 14 years ago.”

The gradual switch to HPV screening has already caused disruption to the national screening programme. Checking samples for HPV requires fewer laboratory staff than analysing cells under a microscope. As staff move on, the labs are struggling to find replacements to fill roles that may not exist by the end of next year. This is causing a backlog and delays in getting test results to women.

A DHSC spokeswoman told the HSJ: “Cervical screening saves many lives every year in England – we are committed to offering women the best system and will take all necessary steps to ensure as many of them as possible continue to benefit from timely and accurate screening.”

“We have received the letter from Mr Music and will be responding in due course.”