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Nurses 'overwhelmed' by demand after misguided breast screening warning

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Frontline NHS nurses were left “overwhelmed” and placed under needless added pressure after tens of thousands of women were wrongly told they had missed a routine breast cancer screening, an independent review has today found. 

In May 2018, then health secretary Jeremy Hunt announced that up to 450,000 women between the ages of 68 and 71 had not received an invitation to their final examination.

“The protection of the public’s health has been, and remains, the paramount consideration”

Steve Brine

The review into the incident found there had been long-standing misunderstanding over the age range for the national breast screening programme, which was first launched in the 1980s and offers older women routine tests every three years. 

Policy documents were rewritten in 2013 in an attempt to clarify the scope of the programme, but this resulted in the age limit being increased “in error” from 70 to 71.

The review (see PDF attached) found that all three organisations involved in the scheme – NHS England, Public Health England and the Department of Health and Social Care – did not know how this was signed off. 

Jeremy hunt new website

Jeremy hunt new website

Jeremy Hunt

The new upper age limit of 71 was then repeated in annual iterations of the policy but breast screening units were never officially informed about the change and IT systems were not adjusted.

Advice given to Mr Hunt about the scale of the blunder was based on an “incomplete understanding of what had happened”, the review found.

It concluded that Mr Hunt “made the right decision” in announcing the incident to the House of Commons based on the information he was given.

“Frontline staff were overwhelmed by the announcement”

Report 

In his initial statement, Mr Hunt said nearly half a million women might have been affected.

However, the review found that even this figure was an estimate based on data from just 30% of screening centres because NHS Digital was not able to obtain the full statistics fast enough.

In the end around 196,000 women were contacted by PHE to inform them that they may have missed a screening and that they were entitled to a catch-up one.

Breast screening units were not given prior warning about the incident before the public announcement, meaning they were “not able to prepare for the public reaction in advance”, the report found.

Following the revelation, units were asked to ensure they had capacity in place to deal with the additional screenings but they were not given timely information about the women affected in their area. 

The report said: “Although NHS England and Public Health England provided units with the information they needed to respond appropriately to the patient notification exercise, the timing of the information to units meant that at times they were operating with little advice and did not have the information needed to respond to queries from women.

“The review’s survey of women shows that the announcement made some women anxious and as a result they contacted local screening units to alleviate their fears, however frontline staff were overwhelmed by the announcement and the resource pressures associated with putting in place the subsequent arrangements for screening additional women,” it added.

PHE had already admitted that around 74,000 of the 196,000 women contacted had been wrongly included in the list.

However, the review found out of the 122,000 remaining women, only 5,000 had definitely missed a screening they were entitled to down to issues using the “unwieldy” IT system. 

“It is completely unacceptable that there was confusion about the breast screening programme”

 Lynda Thomas

A further 62,000 could be considered as having missed out on an invite if following the the rules wrongly set out in the 2013 rewrite of the policy, it added.

The review concluded that 129,000 of the 196,000 women contacted by PHE were “incorrectly” told they may had missed their final screening.

Based on the findings of the review, PHE estimates that up to 34 women who did miss out of their final screening could have had their lives shortened as a result.

The review praised the “dedicated” breast screening staff who gave their views as part of the investigation and who went above and beyond to support the women affected despite the difficult circumstances.

“We visited 10 units – from Bolton to Bristol – and found that the staff working there were skilled, experienced and worked very hard to make sure the women in their care received the best possible service,” it said. 

“When the incident was declared, they worked overtime during evenings and weekends to make sure every woman who was thought to have missed an appointment was contacted and screened quickly,” it added.

The national cancer screenings programmes are currently undergoing a major overhaul in light of a series of recent blunders including this one.

The independent review has made recommendations to inform this work, including:

  • Clarifying the age when women should stop being invited to screenings;
  • Updating public information so that it is clear to women what they should expect from the breast screening programme;
  • Reviewing the governance of all national cancer screening programmes;
  • Reviewing incident response protocols to ensure they are appropriate to the nature of the incident;
  • Making the IT systems simpler for breast screening units to use.

Macmillan Cancer Support chief executive, Lynda Thomas, who co-chaired the independent review team, said: “It is completely unacceptable that there was confusion about what the breast screening programme should have been delivering.

Macmillan Cancer Support

Cancer nursing charity appoints new chief executive

Lynda Thomas

“There needs to be clarity, and importantly women need clear information about what they should be able to expect,” she added.

Steve Brine, minister for public health and primary care, said the government would consider the recommendations of the review and provide a response in the new year.

He said a “new, fit-for-purpose specification” for the national breast screening service would be agreed and implemented, including proper clarification of the age range.

“The protection of the public’s health has been, and remains, the paramount consideration when responding to this incident,” he said.

Duncan Selbie, chief executive at PHE, said: “Women can be completely confident in the future of the breast screening service as a consequence of this review.”

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