The challenge
The NHS Cervical Screening Programme aims to reduce the number of women developing cervical cancer in England, by improving the uptake of cervical screening, enabling the early detection and treatment of disease to reduce mortality rates.
In October 2018, NHS England took the decision to move the Cervical Screening Administration Service (CSAS) back under NHS England control from a third party, following several high-profile incidents, supported closely by Midlands and Lancashire CSU.
Working with colleagues across the whole pathway, CSAS plays a pivotal role in the delivery of call/recall for the Cervical Screening Programme. CSAS is responsible for complex, high volume processes, sending invitations and reminders to eligible individuals who participate in the programme and result letters once they have been tested.
The CSAS team deals with administrative queries and requests from clinicians to cease, defer and reinstate individuals in the programme. The CSAS team also provides this service to Defence Medical Services (DMS) issuing result letters to their medical bases and managing queries for administration of their participants based around the world.
In addition, CSAS and NECS actively aid development of the Cervical Screening Programme to drive improvements in access and uptake, supporting projects such as Self Sampling and SMS messaging.
Our response
Our Programme and Operations teams worked collaboratively with third party stakeholders to scope and transition the service into NECS. This process included two key stages:
Phase 1 (December 2018 – August 2019): Maintaining service continuity as a priority and transferring service and staff into NECS who were operating from the third party’s offices in Leeds and Preston, whilst designing and implementing a new Customer Relationship Management (CRM) solution, which is the key driver for the service.
Phase 2 (From July 2020): Establishment of the service in new premises, switching over to the NECS ICT infrastructure, replacing the previous technology and processes with the provision of most supporting services by the NHS.
The Robotics Processing Automation (RPA) platform was introduced following several high-profile incidents and provided assurance that these issues would not reoccur.
In July 2020, we were given notice by the third party (who previously provided CSAS) that they would be switching off their robotics platform due to security risks associated with RPA software vulnerabilities. This necessitated the acceleration of the transition to NECS ICT infrastructure and robotics solution and moving CSAS staff to NECS premises in Leeds to ensure service continuity and patient safety.
To ensure we were ready to transition, our Programme Management Office (PMO) had to be confident that:
1. There was a robust plan in place for the transition incorporating recommendations from Deloitte in respect of planning, testing and controls.
2. Monitoring and escalation processes were in place in case any of any issues.
3. All necessary criteria to support the transition have been met.
4. Key risks have been identified and were adequately mitigated.
A number of robotics processes were established previously to operate key process steps, including producing management information (MI) and uploading letter files ready to be printed.
Deloitte undertook assurance work and evaluated our preparedness for the planned transition of technology arrangements. Industry best practice tools and templates shared by Deloitte were used to complement standard our project management materials.
Opportunities for improvement identified through the Deloitte assurance were addressed prior to transition. Some of these opportunities were strengthening programme governance, MI reporting and developing clear ‘Go / No Go’ decision criteria, IT controls required to operate the RPA and disaster recovery requirements. Extensive due diligence was applied to ensure risk was effectively managed and transparent to all parties, allowing informed decisions.
Outcomes
NECS successfully managed the transition from using the previous third party’s infrastructure to its own, with the aim to provide a like for like service. The transition ensured that there was no service disruption or impact to service users, with all processes being actioned, ensuring 100% of all invitation and results letters were sent during the transition period.
We successfully cleared more than 40,000 pieces of inherited backlogged work. We have achieved 90% of KPIs since the service transferred with 95% during 2021 and the average response time for queries has been reduced from 30 days to three days.
In addition, our multi-skilled team members provided the flexibility to support the variation in work volumes. During the Covid-19 pandemic, CSAS supported the continuation and recovery of the screening programme by proving information to support decision making for the programme. As the programme has seasonal variations, the volumes vary from month to month to year to year.
For the year 2020/21, the team processed:
- over 5.5 million invitations and over 3.5 million reminders sent
- over 35,000 result files from laboratories processed
- nearly 3 million result letters where no abnormalities were detected sent
- over 141,000 result letters where further examination was required by a colposcopy clinic
- approximately 100,000 administrative requests and queries.
“It’s thanks to colleagues at CSAS and NECS for the considerable amount of work they have undertaken during the transition phase, especially in light of the many challenges they have faced during this process, and for clearing the backlog log of outstanding queries.”