The impact of administrative pressures on cervical screening

Posted: 14/06/2019

In this third article to help promote cervical screening awareness week, 10-16 June 2019, Penningtons Manches explains some of the administrative issues that have plagued cervical screening in recent years. These difficulties have been widely reported in the media and it is important that these problems do not deter women from attending their own screening test.

What are the administrative pressures on cervical screening?

At a time when the uptake for cervical screening has reached a 21-year low, and the numbers of cervical cancer diagnoses are increasing, it is vital that the process of cervical screening is as streamlined as possible to encourage women to undergo testing.

Unfortunately, there have been a number of reported administrative failures in recent years. It is evident that any delay in offering appointments or confirming test results could cause further anxiety to the women undergoing screening. This has led to concern that women may lose faith in the process and be even less inclined to attend their screening appointments.

Problems with Capita

One of the most widely reported problems in recent years has been the failure by Capita, the company contracted by NHS England to send cervical screening invitations, reminders and results.

In November 2018, it was announced that a system error between January 2018 and June 2018 resulted in 43,220 women not receiving invitations or reminder letters for cervical screening. A further 4,508 women were not sent results letters, of which 182 women needed follow up treatment for abnormal test results.

When this error was identified, letters were sent to all women who had experienced a delay in receiving cervical screening correspondence and an independent audit was carried out. The National Audit Office (NAO) and Public Accounts Committee (PAC) found serious flaws in screening programmes, with cervical screening not even meeting the lower threshold target for the percentage of the eligible population to be screened in 2017/2018.

The National Audit Office published a press release in February 2019 setting out the results of its investigation.

The cervical screening target was 80% of the eligible population, with a lower threshold of 75%. In 2017/2018 only 72% were tested. As well as failing to send cervical screening letters to almost 50,000 women, the audit found that Capita had also incorrectly notified 87 women that they were no longer part of the cervical screening programme. 

The report by the Public Accounts Committee found that the cervical screening programme is “not fit for purpose” due to its ageing IT system. As a result of the significant errors by Capita, NHS England is removing the screening programme contract from Capita and will be taking these services back in-house from June 2019.

Closure of laboratories

At the same time that Public Health England is running a campaign to encourage women to undergo cervical screening, it has been revealed that there have been problems with the laboratories used to test cervical screening samples.

Later this year, the NHS plans to move towards HPV testing and this will result in a reduction in the number of laboratories required. The laboratory services have been put out to private tender to reduce the existing 46 laboratories to just nine.

An unfortunate outcome of this proposed privatisation is that many biomedical scientists have already left their roles, leaving labs hugely understaffed when the number of samples are still increasing because of the Public Health England campaign.

Standard screening letters sent to patients confirm that results should be sent out within 14 days but it has been suggested that, due to staff shortages, there is already a backlog of several months for cervical smear test results. Any delay in receiving test results inevitably increases a patient’s anxiety and, more importantly, could potentially delay treatment for women whose results are abnormal.

Alison Cropper, the chairwoman of the British Association for Cytopathology, described cervical cancer screening as being “in meltdown” and suggested that the “poorly thought-out timing could leave women frustrated and less likely to engage with screening in the future”.

Charities, including Jo’s Cervical Cancer Trust, have long been campaigning for investment to improve the cervical screening programme, particularly modernising the out-dated IT systems and changing testing methods, including promoting self-testing kits which are already popular in Australia. In recent years, Australia’s vaccination and screening rates have improved so much that their annual cervical cancer rate is about half the global average, at only seven in 100,000 people.

The UK’s cervical screening programme is currently not fit for purpose and it is imperative that urgent action is taken not only to encourage women to attend but also to ensure that when they do attend, they are not let down by the system. Women should be able to access cervical screening and have confidence that their results will be reported accurately and within a reasonable time. 

However, at a time where there are so many difficulties, it is important that women do as much as they can to protect themselves, by attending their screening appointments when invited, chasing their appointments if they believe they are due, and following up on any outstanding test results.

Penningtons Manches has joined charities such as Jo’s Cervical Cancer Trust in the campaign to help women to understand the importance of cervical screening.  We will continue to release further articles on cervical cancer in the coming weeks and months.

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