Sandwich and a cancer check: Put NHS screening units near offices, say experts

NHS screening units should be set up near offices and shops so workers can have checks for breast and bowel cancer in their lunch breaks, the head of a national review has said.

Prof Sir Mike Richards also said patients must be able to book smear tests and mammograms on their smartphones as easily as buying a train ticket.

The former cancer tsar said Britain could not tackle its poor survival rates from cancer - languishing at the bottom of international league tables - without a radical overhaul of the way services are run.

Sir Mike has been commissioned by health officials to lead a review of screening programmes following a series of scandals and growing concern about a decline in uptake of the checks.

In an interview with The Daily Telegraph, he signalled that it will call for sweeping reforms of the way services are accessed, and an upgrade of “woefully poor” diagnostic services.

“One of the things we really need to do is promote convenience; offering more out of hours appointments - places you can get your screening done at 8pm - and services nearer to where people work so that they can do it in their lunch break,” he said.

Take-up of cervical screening is now the lowest it has been for 21 years, while uptake of mammograms has reached a decade low.

Sir Mike said his review, which will publish an interim report next month, found that around half of patients who do not attend screening had intended to have such checks.

The oncologist said it was crucial that the health service follows modern businesses, in providing patients with reminder messages, and simple ways to book slots at convenient times.

“In all the other branches of life we have moved to convenience,” said Sir Mike, who retired as NHS chief inspector of hospitals in 2017. “I am not a ‘techy’ person but even I book my train tickets and plane tickets online.”

“Everybody could be booking these services through an app,” he said. “This is the way we should be looking forward. This is what is happening in the rest of people’s lives and this is what should be happening in screening.”

Sir Mike, who previously spent 15 years as national cancer director, last week told a conference that the NHS has “woefully poor diagnostics in hospitals,” warning that budgets which should have been spent on scanners have been continually raided to balance the books.

He told The Telegraph: “We haven’t got enough staff and we haven’t got enough equipment. The OECD [Organisation for Economic Cooperation and Development] figures show that both for CT scanners and MRI scanners we are so close to the bottom of a large league table,” he said.

“We haven’t got enough diagnosticians -  the radiologists, the radiographers, the colonoscopists - so we do need to look at that,” he said.

The statistics also show Britain is lagging behind most OECD nations in cancer survival, with 11th worst mortality rates among all 35 countries, with rates similar to the Czech Republic and Lithuania.

“Our survival has gone up but with the exception of breast cancer we haven’t yet narrowed the gap,” Sir Mike said. “That’s why early diagnosis matters so much.”

Last week, NHS figures showed the worst performance against current cancer targets in a decade, with almost one in four waiting more than two months for treatment.

Sir Mike said a “significant” expansion in equipment and staff would be needed to meet a new Government commitment, to ensure that by 2020, patients given an urgent referral for suspected cancer receive a diagnosis or all-clear within a month.

The long-term plan for the NHS, published earlier this year also pledges to increase early diagnosis rates from 1 in 2 patients to 3 in 4 patients, by 2028.

“That is a very bold objective. It’s the right objective but having optimal screening services will be key to that,” he said.

Uptake of breast cancer screening among women aged 50 to 70 is now down to just 70.5 per cent, the lowest for a decade, while takeup of cervical screening is at 71.4 per cent - the worst since records began 21 years ago.

Sir Mike said his review is also likely to call for a major upgrade of technology and the use of more modern scanning techniques.

“We do need better equipment to do the best tests,” he said, citing the example of multiparametric MRI scans for prostate cancer. The technique is used by just half of NHS hospitals, although research suggests it is twice as good as standard scans at detecting aggressive tumours.

And he said his review will also examine the use of genomics to find “high risk” patients, who might need to be screened at a younger age, and the use of artificial intelligence in screening services.

“Artificial intelligence may - at some point down the line - be valuable in dealing with some of the workforce issues,” he said. “With mammography you always have to two different people reading every mammogram. If we could replace one of them with artificial intelligence that would be a great help.”

Sir Mike also warned of “very outdated IT” in screening services, with the technology supporting programmes for breast and cervical cancer now 30 years old.

The national review follows an inquiry which found almost half a million women were forced to endure needless anxiety about cancer blunders which actually affected around 5,000.

Last year then Health Secretary Jeremy Hunt told the Commons that a mistake by the national cancer programme meant around 450,000 women had missed out on checks, but it took months for officials to establish that the accurate figures were likely to be far lower.

The damning review found health officials did not understand their own programme, criticising a lack of clarity about which women should be summoned for mammograms. Separate blunders saw nearly 50,000 women miss results and screening reminders for cervical cancer.