NHS Health Screening System Unfit for Purpose: 6 steps to minimising project risk and maximising contract performance

By Allan Watton on

When you watch any of the multitude of medical TV shows, they will always wax lyrical about the need for early detection to minimise the impact of an illness or even to save a patient’s life. But a recent Public Accounts Committee (PAC) report found some very worrying shortcomings in 4 out of the 11 screening programmes operating in England.

None of the screenings for bowel, breast or cervical cancer and abdominal aortic aneurism has been meeting targets for appointments. This has been largely blamed on an IT system called NHAIS (National Health Application and Infrastructure Services) that is reported to have  been “unfit for purpose for screening programmes since 2011” but which is still being used because its replacement is not due to go live until 2020.

PAC chair Meg Hillier has reportedly gone so far as stating that the Department of Health and Social Care (DHSC) was “losing its grip on health screening programmes”.

Taking just one of those screening programmes, cervical cancer, the 2017-18 screening results reportedly showed that they were at a 21-year low and that up to 1.2m women may have missed out on their appointments. The other metric identified as worrying in the report was that there was no consistency across the country, with the north east of England outperforming London. It is argued that quality of care is becoming somewhat of a postcode lottery.

To make matters worse, not only were appointments down, but results were delayed, causing additional stress to all those waiting to hear whether they had a life-threatening condition, that time would only make worse.  

Minimising Project Risk and Maximiisng Contract Performance – Develop Your Own Early Warning System

Performance issues in any organisation can take obvious or subtle forms, but if you have the correct structures and processes in place, and individuals are following them, you should be able to identify when issues could start to develop into operational risks.

The PAC report has identified the risks to person and programme. You can develop your own early warning system on your projects to minimise risks and maximise contract performance if you follow these six steps.

Step 1: Set Clear Goals

If you want to determine the trajectory of your project, you need to identify with crystal clarity the outcomes you aim to achieve as a result of the efforts of the project. The business case you create should identify not only the quantifiable benefits of the project, but also the risks and challenges likely to be faced along the way or as a result of the project. This is not a motivational document, it is not a reflection of your optimism, or a best-case-scenario. Instead, it’s to be the real-world expectations of the project which you can then take out into the supplier market in order to test its early validity.

Step 2: Understand your service provider’s motivations

To know how to negotiate the best value (price and/or services) from your service provider while still encouraging the right behaviours that will drive performance and innovation, to know what inspires them and drives them to do their best each day, you need to understand your service provider.

These insights will help to drive how you develop your relationship with them, how you structure your contract with them, how you interact with them and who you choose to be on your internal ICF (Intelligent Client Function) team to work collaboratively with them and draw the best from them.

Step 3: Contract for clarity

Despite best intentions all round, please resist creating an ‘agreement to agree’. Most of the dispute situations we deal with are because the ‘agreement to agree’ never actually got…agreed. It won’t benefit you or the supplier. Your contract should be a real-world document with, where possible, clear and detailed language, understandable to all parties.

It should take into account what should happen in the event of challenges and failings as well as successes and rewards, and it should be developed in collaboration with your service provider during the pre-contractual stages, not afterwards.

This will ensure that they are motivated to do their best rather than feel locked into an agreement they wished they’d never signed – resulting in minimal effort, motivation and innovation.

Step 4: Effective client-side management

There are occasions where some clients diligently create their business cases and contracts then leave it to the service provider to manage themselves, not quite realising they are inadvertently abdicating their responsibility for the project to the third party.

However, the most successful relationships are ones where clients are involved in relationship building and project monitoring – where the in-house expertise in the project’s specialist arena is maintained and progress is carefully assessed on a regular basis. Micro-changes that could indicate project risks or performance issues can then be quickly identified.

This is the role of the ICF team, a multi-functional group of individuals, pulled from different departments, who work closely with their service provider colleagues and share the insights they learn so you can make more informed decisions on the management of your relationship.

Step 5: Thorough pre-contractual due diligence

If your service provider is an ‘expert’ in their field, utilise their knowledge and experience, go out into the market and ask them to critically analyse your business plan, to offer solutions, to let you know whether the outcomes you are aiming for are realistic or whether they under- or over-estimate what’s possible.

Remember, asking your service provider to act in more of a consultative fashion will provide you with much better advice. Separately, their expert advice comes with a duty of care that says they must validate to you completely and honestly, about what they can and cannot do, but also on the implications of what they cannot do on your project.

Step 6: Collaborative relationship building

Your contract should provide all sides with a roadmap to delivering the project, while mitigating risks and identifying and overcoming challenges in what may well be a long-term relationship you need to develop together. That means building trust, maintaining open lines of communication, realigning contractual aspirations at least once every six months and gaining a greater understanding of your strategic partner as time goes on so you are better positioned to deal with any issues that arise.


In an article on PublicTechnology.net, the Department of Health and Social Care is reported to be said to be awaiting “further recommendations from the Sir Mike Richards Review of national screening programmes”, but seems to be waiting for the additional funding it’s been promised by 2023-24 – “Under the Long Term Plan for the NHS – backed by an extra £33.9bn a year by 2023-24 – patients with suspected cancer are beginning to receive a diagnosis or the all clear within 28 days, and the NHS in England is investing £200m to fund new ways to rapidly detect and treat cancer.”

Most clients in major strategic relationships do not have the luxury of waiting for change to happen to them: they need to make the change happen themselves. Prevention through thorough planning, following the six steps above, would be a best course of action. However, if you are already beyond this point then early detection would be next best, having the right people in the right place to identify and address any risks and challenges quickly and decisively. This means turning to your ICF team.

Photo credit: i-stock

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