Safety fears for England's screening services if national oversight is lost

Plans to devolve responsibility for the quality of England's 11 national screening services could result in significant safety risks, experts tell The BMJ in an exclusive report.

Assistant news editor Gareth Iacobucci explains that NHS England is currently discussing proposals to delegate some of the functions of the national Screening Quality Assurance Service (SQAS) from NHSE to regional Integrated Care Boards (ICBs).

But concerned experts warn that devolving responsibility to local organizations will spread resources more thinly, lead to a loss of expertise and independence, and compromise national oversight, making it harder to identify problems early and help improve screening pathways.

There are 11 national screening programs in England. Three cover cancer screening (breast, cervical and bowel), six cover antenatal and newborn screening, and two cover abdominal aortic aneurysm and diabetic eye screening.

Screening programs must report all safety incidents to the SQAS, and SQAS staff visit local sites to pick up urgent issues and make recommendations for improvements.

But talking to The BMJ under condition of anonymity, one individual involved in quality assurance visits warned that NHSE was cutting corners to save money.

They said cuts in recent years had already caused SQAS to drastically reduce the number of site inspections, meaning problems were not being picked up as early as they would have in the past. The BMJ understands that the SQAS headcount has reduced substantially since 2021 and the number of site visits across the country has fallen from around 140 a year to about 40.

The source also said they had seen "some really quite scary stuff" on visits and that the latest plans would exacerbate this.

Sue Cohen, former national lead of screening quality assurance at Public Health England, told The BMJ that devolving responsibility for SQAS to local organizations would be a "retrograde" step.

Highlighting scandals such as in Kent in the 1990s, where a lack of oversight of a cervical screening program led to women with cancer not being picked up, she said, "If you don't have a quality assurance service that is properly resourced and has that ability to keep a national view, you will simply not have the oversight of the system and there is a bigger risk of incidents going undetected."

Devolving this complex role to ICBs would also risk "diluting" expertise and undermining what the service was set up to do, while cutting costs is a "very short-sighted approach," she added.

Cohen also said she was concerned that these proposals would make it harder to maintain the service's independence: "If you don't have that separation, then you can have that conflict of interest of commissioners wanting to perhaps get a slightly cheaper service without understanding the quality consequences of doing that. It is really important that you separate out those functions, and we fought quite long and hard to maintain that."

Muir Gray, former director of the UK National Screening Committee, said he was skeptical that devolving responsibilities for screening quality assurance to ICBs would lead to any positive impact in terms of driving improvement.

However, an NHS England spokesperson said, "NHS screening helps to save thousands of lives every year across England. Discussions about the possible delegation of some screening functions from NHS England to ICBs in the future are ongoing but no formal proposals have yet been put forward. We will continue to ensure that NHS screening services meet the highest standards."