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Health screening is the process of testing a defined population for one of a range of serious diseases or conditions. Usually, its aim is to detect disease among apparently healthy people so that it can be treated at an early stage. Like any medical intervention, screening has its limitations and carries both benefits and risks for participants. These will vary according to the screening programme. Potential benefits include increasing the likelihood of curing, preventing, or delaying the progression of disease; possible risks range from the physical and psychological effects of receiving a false result (either positive or negative) to harms arising from invasive follow-up tests.
Screening is a widely accepted intervention in the UK. Throughout this inquiry we heard that the public perception of health screening was generally positive and expectations of what it could deliver were high. However, such attitudes can make it challenging to convey the types and degrees of harm that may be incurred through screening and much more needs to be done to ensure that both the benefits and risks are clearly, and even-handedly, communicated.
The recently revised breast cancer screening leaflet for the 50-70 age group—with its more explicit focus on helping women to make an 'informed choice' about whether, or not, screening is right for them—is an important first step in this process. However, the principles followed to revise this leaflet have not been applied to all the communications developed by other NHS screening programmes. There is also no mechanism in place to ensure that best communication practice is shared across these programmes, potentially leading to inconsistencies in the quality of information materials available to screening participants.
Providing balanced, high-quality information to all potential participants must be a well-resourced and nationally supported priority, not an afterthought undertaken on an ad-hoc basis. We therefore recommend the implementation of a standard process for producing information that facilitates an informed choice to be made about participating in a screening programme. To ensure that valuable health resources are not wasted, we also recommend that the NHS Health Check programme be scrutinised by the UK National Screening Committee, retrospectively, to ascertain its value.
Since 1996, it has been the responsibility of the UK National Screening Committee (UK NSC) to ensure that screening programmes are only offered where there is robust, high-quality evidence that they will do more good than harm, and at a reasonable cost to the NHS. The UK NSC deservedly enjoys an international reputation for excellence and there have been success stories under its watch. If the UK NSC's decisions are to remain authoritative in the face of demands to introduce new screening programmes, improvements to the transparency and rigour of its processes for reviewing the evidence base are urgently required. In particular, there is a pressing need for the UK NSC to draw on established protocols to standardise the systematic reviews of screening programmes. As the UK NSC approaches its twentieth anniversary, it is also essential that it looks ahead to the next twenty years and sets out how it will adapt to the rapidly changing landscape of screening while continuing to pursue an evidence-based approach.
Finally, we are concerned that while the UK NSC performs many of the functions of a scientific advisory committee, it is not classified as such. Instead, its formal status, the principles by which it is governed, and its relationship to Public Health England, are all ambiguous. We consider this status quo to be potentially damaging to the UK NSC's independence and therefore make a number of recommendations aimed at formalising the operation of the UK NSC to ensure that it can consistently deliver independent, evidence-based advice to Government.
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