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National Audit Office Press Notice

The Performance of the NHS Cervical Screening Programme in England

Report by the Comptroller and Auditor General
HC 678 1997/98
22 April 1998
ISBN 010 294598 5
Price: £14.95

Sir John Bourn, head of the National Audit Office, reported to Parliament today that the NHS Cervical Screening Programme in England - which costs around £130 million a year - had achieved a great deal since his previous report in 1992. Research indicates that cervical screening prevents between 1,100 and 3,900 cases of invasive cancer each year; and death rates are falling by seven per cent a year. Sir John concluded, however, that considerable scope remained for improving the service women experience and receive.

Sir John pointed to the recently discovered serious cases of quality failings in smear screening and reporting which while small in number were, he concluded, a disturbing feature of the Programme. These failings have led to the deaths of some women wrongly told their smear was normal, and caused avoidable harm to others; and caused anxiety and inconvenience to women recalled for screening.

Sir John also found that:

• the Programme overall had exceeded its target to screen at least 80 per cent of eligible women in the last five years, but 13 health authorities failed to screen sufficient women to reach the target in 1996-97. Research suggests that some groups of women, including some from ethnic minorities, unskilled manual workers and those in poor economic circumstances, are underscreened;
• in 1996-97 around 450,000 unscheduled smears were taken from women, possibly causing inconvenience and anxiety for women. Recent guidance from the Cervical Screening Programme is that unscheduled smear taking is not justified. The number of unscheduled smears had however fallen from 684,000 the previous year;
• many women are waiting too long for their smear test results. And not all women receive their results in writing as recommended. There is scope for improving women’s understanding of the process and reducing anxiety, particularly when an abnormality is found;
• in March 1996, the Cervical Screening Programme issued guidance to secure an accurate and effective screening service. This guidance is being widely implemented and a considerable amount of change is in hand; and most of the laboratories are meeting most of the operating practice recommendations. But some important objectives are not being met, and this may be placing accuracy at risk. Until the end of 1997 participation in external accreditation was voluntary, and two thirds of screening laboratories had external accreditation. The NHS Executive has now made external accreditation mandatory;
• the achievement of waiting time targets for women referred onwards to colposcopy clinics for follow-up is generally poor; one in six colposcopy clinics has difficulty in measuring its performance; and quality targets for biopsies are being missed by a significant number of clinics; and
• there are wide variations in unit costs at screening laboratories and follow up clinics which are difficult to explain. A better understanding of cost variations could offer the possibility of ensuring better cost-effectiveness without diminishing the quality of services available to women.

In his report, Sir John:

• welcomes steps taken by the NHS Executive to respond promptly and across the Screening Programme to the recommendations of the enquiry into why serious failings occurred at Kent and Canterbury Hospitals NHS Trust;
• emphasises the need for steps to be taken to minimise errors, and for quality assurance to be improved, so that any remaining errors are detected at the earliest time;
• recommends improvements in inviting women for screening, taking smears, and in screening laboratory and follow up clinic performance; and
• notes that the national policy is that women should be screened at least every five years. In 1996-97, 60 per cent of health authorities invited women for screening every three years. Sir John recommends that health authorities consider the costs and benefits of the shorter interval, to ensure that their decisions on priorities are fully informed.

Notes for Editors

The Comptroller and Auditor General, Sir John Bourn, is the head of the National Audit Office employing some 750 staff. He and the NAO are totally independent of Government. He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.

Press Notice 34/98
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