This is not beyond the wit of man, surely?

Breast cancer survivors have complained that screening letters are forcing them to relive the trauma of their battle.

Women who have had double mastectomies to remove the disease have said they are still receiving invitations for mammograms, even though they have do not need to be screened.

Now, charities are calling on the NHS to better link its IT systems in order to prevent the distress.

The NHS system automatically posts letters to British women between the ages of 50 and 70 who are registered to a GP to invite them for regular breast screenings, including the time and date of the appointment.

According to NHS Digital, Women in England are called and recalled for screening using an application called Breast Screening Select (BSS).

Using the application, doctors flag higher risk individuals as well as remove patients from the system.

However this is not always the case and women who have survived the disease and are living ‘“flat” – having had two mastectomies – are still being given screening appointments.

Running a database. Or even, making sure the information on one is correct. This is not beyond the wit of man. Although it does seem to be beyond the ability of a bureaucracy. Which is one good reason why perhaps we shouldn’t use bureaucracies to run things.

Or maybe it’s just Hayek’s pretence of knowledge. Either way, not hopeful for this method of doing things, is it?

31 thoughts on “This is not beyond the wit of man, surely?”

  1. It’s as simple as the GP or their staff removing them from the database. That’s it.


  2. The women should stop whining. The are still alive to receive stupid letters. Their lives have been saved and that is vastly more important than moaning about minor NHS incompetence. They should consider the poor sods that NHS failure polished off instead. Complain about the fates of the real victims of the NHS and campaign for its end instead of vapouring about nowt.

  3. Also Tim–once again a dearth of decent posts on here while Contins has plenty of topics with the usual 0-3 commenters. With all that’s going on –once again I suggest once again that you copy some of the Contins stuff over here for a real workout. Wait a couple of days for your vast commentary team over there to have their say and then post the pieces here.

    You know it makes sense.

  4. Eh, some of it is a matter of perspective, I suspect. Sure, it’s obvious and trivial to update the BSS database in this case. From the gp/surgeon’s perspective, it’s no doubt one item in a big pile of paperwork, that’s constantly threatening to crowd out actually treating people. And I wouldn’t be surprised if the system will only accept the surgeon’s word that all cancer-prone tissue was removed.
    Single (human) point of failure. Exponential complexity of documenting the consequences of actions, while maintaining privacy etc.
    Not an excuse, but it’s probably more complex in context. Like most jobs.

    Although I think Ecks does have a point (shudder) about it being a bit hysterical to ‘relive their battle’ off a redundant screening letter.

  5. Having been driven to considerable distraction in manufacturing by error riddled parts databases I’d be a fan of incentivising the operators and users of the database with carrots and sticks.

    The “computer it says” blind blundering is a modern curse.

  6. Running a database is harder than you assume.

    Especially if one false negative is worse than 100 false positives, and you already have 1000 other priorities to spend your money on.

    If were complaining about letters like this, then it’s a sign that the NHS is damn near perfect.

  7. “The women should stop whining. The are still alive to receive stupid letters. ”


    The bigger point here is that this isn’t that hard to do and is wasteful. Someone will have to receive their phone call cancelling the appointment. Or because the NHS is a wasteful bureaucracy, it took 2 calls.

    Giant bureaucracies are a bit of a pain in the arse to work for, but at least there should be a benefit of connected systems. You want to know the balance on your account with Nationwide, you can walk into any branch, do it on the phone or do it from an ATM.

    I flagged up for glaucoma with an optician (I don’t have glaucoma) and had to be referred. So, I got a letter about Choose and Book. I logged in with the login details. I was given a list of hospitals. Oh, the private one just down the road. So, I called the number. “I’d like to do it at that one please”. “We don’t do the glaucoma screening at that one”. “So, why did you put it on my list?” “Well, we just put all hospitals we do any treatment. So, basically a waste of fucking money. They could have said “call this number” or maybe built a system that matched the type of treatment to the hospital. So, I get a hospital and a date which is like 2 months away. “Really, I’d like to get this done sooner”. “Let me check the other regions near you”. So now, despite the fact that we have had software to do “find nearest” since the late 90s, someone has to click on each other region. She comes back “Oxford can be done in 2 weeks”. “Great, can you book that please”. “No, I can’t do that”. “Wha—. Why not?” “That’s not Wessex NHS”. “So, what do I do?” “I’ll give you a number to call”. So, I call Oxford. “I can’t book that for you.” “Why not?” “Wessex are holding it. You need to get Wessex to release it so that we then book it”. “Seriously? Your system can’t just tell theirs to do that.”. So I then call my local people to release it. Then I call Oxford to do the booking.

    They’ve just implemented e-referral. Instead of GPs sending fucking PAPER LETTERS to consultants, they can now do the process on a computer. Oh and bonus – the GP gets notes back electronically, so a typist doesn’t have to type it, only for another typist to type it again. I was implementing this sort of workflow shit in the private sector 15 years ago.

  8. I keep trying to point out to X that CT is an attempt to make me a living. Thus it does tend to gain some attention. We’re not there yet but we can see the pathway to it at least….

  9. Ted S–I, like the most of rest of the human race, rarely look at Contins. Are you one of the regular commenters there? The three of you won’t be needing to swap your telephone box meeting room for a TARDIS anytime soon–even tho’ one will be for sale by the time the BBC have finished.

    There is no question of freeloading. Contins is –or was?(I rarely keep up with it) free–the money comes from the advertisers so Tim has to kiss their CM a’feared arses. Hence the anodyne nature of Contins comments. Redolent of an opium den full of half-dead ether-sniffers dumped out of wheelbarrows.

    Which sums your comment up nicely.

  10. Bloke in North Dorset

    Its not as if breast cancer screening increases overall mortality and may even decrease it:

    Authors’ conclusions:
    If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings. To help ensure that the women are fully informed before they decide whether or not to attend screening, we have written an evidence-based leaflet for lay people that is available in several languages on Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening.

    Discussed on More or Less.

    Maintaining the integrity of such large and dispersed databases is a nightmare. You can’t just give everyone permission to go in and change data because of the likelihood of errors – imagine the outrage if a GP got it wrong and removed someone who missed a screening and then died of breast cancer? Its probably easier and cheaper to leave them alone than pay for the level of checking that would be needed to update these cases.

  11. I have no objection to you making a living Tim. But it hardly detracts from your operation over there if–after say a day or two’s delay–some of the meat is re-thrown to the crocs over here.

    Or maybe it does. Folk would likely much prefer we over here speaking our minds to weasel comments made at Contins with an eye to not frightening the CM horses pulling the advertisers coal-carts. And if the readers are over here for the fresh air they aren’t over there busily clicking on the suppository or whatever adds on Contins.

  12. I’m one of the few who comment there. I don’t tune my comments to the venue anywhere. Never been modded at Contin’s. It’s quite frequent at Guido’s, and often inexplicable. But we can’t all be Ecks.

  13. ‘Breast cancer survivors have complained that screening letters are forcing them to relive the trauma of their battle.’

    Give us some names.

    I don’t believe it. Campaigners are making this shi+ up.

    Women who have had double mastectomies are reminded every day they wake up. It’s something they would notice.

    There is economy in mass mailings. Trying to fine tune it will add to the cost, not reduce it. NHS Digital is trying to make more work for itself.

  14. In these interesting and troubled times, it would be good to have a few open threads here, Tim.

    Ecksy: I predict a very convenient run on sterling just before (and/or just after) May loses the vote on her crock of shit. Carney will trigger it with more negative remarks and his fellow globalists (Soros will be in there) will sell £s and UK stocks….

  15. ” at least there should be a benefit of connected systems”

    But there isn’t.

    Based on my experience in the NHS IT, each region, each hospital, even sometimes each GP practice, will have its very own system that they guard with dragons, which doesn’t talk to any of the others and will never be changed because “that’s they way we do it here” and nobody has overall authority to enforce standards.

    Never in all my life have I seen such disorganisation and general incompetence in IT.

    Good luck to Matt Hancock, he’s going to need it.

  16. TedS, yes it’s possible but unlikely provided a decent job of the mastectomy was done. Risk would be roughly the same with male breast cancer, i.e. exceptionally rare but not unheard-of.


    You’d really love German healthcare bureaucracy. Encountering that for the first serious time as a patient was a lesson in how creative people can be with forms. Get the wrong or wrong colour referral and some of the arsier specialists and hospital clinics will refuse to even see you, because they get paid more for a (correct) referral than if you walk in.

    Nationwide might be fine, but Natwest are just impossible. I made a change of address with them and still get letters constantly, churned out by the famous computer, sent to both addresses, insisting I fill them in and return with certified copies of ID and whatnot. I have refused thus far on the basis that they already accepted my instruction in person at one of their few remaining physical branches and obviously have no problem in writing to my new address.

  17. @NielsR
    From the gp/surgeon’s perspective, it’s no doubt one item in a big pile of paperwork
    That’s what medical secretaries are for, if they ever look up from reading the latest issue of Hello magazine.

  18. Theo–Phillip “Ratweazle” Hammond has already been mooting just that. Not really very smart of him to talk it up in advance then.

    Tories on the job.

  19. OnT (getting letters that don’t apply):

    Once or twice a month I get letters from financial experts who want to help me (sic) with my retirement. Will even give me free dinner at a nice restaurant if I will listen to their spiel.

    I’ve been retired 9 years. They are still working. And they are going to give ME advice? How rich is that?

  20. @Mr Ecks, December 2, 2018 at 10:34 am
    @NielsR, December 2, 2018 at 10:56 am @


    They “re-live the trauma” every time they see a woman breasts, or even a bra.

    Hmm: if what thou seest with thou’s eyes offends thee, plucketh them out.

  21. @Mr Ecks, December 2, 2018 at 10:45 am


    Maybe Tim is still under the illusion we’ll all register on Diqus and comment on CT

    @Tim W,

    Face reality – ain’t gonna happen. We’re not conformists. Allegedly, you’re a realist.

  22. @Tim W

    Bug-eye loon has a BA Economics and International Relations

    Why would she need a historian on International Relations? She ignores them.

    After all she rants about Palestine, Israel & Venezuela then when challenged says “I’m not an expert on Geo-Politics”

    Mongs voting for loons: both supporting “hate” and understanding nothing.

  23. Peter MacFarlane,

    “Good luck to Matt Hancock, he’s going to need it”

    Haha. He’s talking about apps, when they can’t even manage good data processing. Without the data, the app is worthless, shit for brains.

    Only answer to the NHS is privatising the shit out of it.

  24. @ Gamecock
    I even get them ‘phoning me (I am not quite as old but well past state pension age): most gave up when I pointed out that I was more qualified to give advice on the subject that they were, but *some did not*!
    The BT nuisance call blocker has been a very worth-while investment..

  25. “If were complaining about letters like this, then it’s a sign that the NHS is damn near perfect.”

    Its a sign that a significant number of middle aged women are so self absorbed that they can’t see that being around to get a letter asking them to go for a no longer required mammogram is in fact a reason to celebrate, not complain.

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