National Health Screening - Science and Technology Committee Contents

2  Background

National health screening in the UK

7. The process of devolution has effectively created, in administrative terms, four National Health Services within the NHS and provided the National Assembly for Wales, the Scottish Government, and the Northern Ireland Assembly with greater power over health services and public health in their territories.[15] Despite this devolved structure, policy recommendations on screening programmes are made at a UK-wide level by the UK National Screening Committee (UK NSC). Established in 1996, the UK NSC's remit is to "call on sound evidence to inform its advice and recommendations" to Ministers and the NHS in the four UK administrations about all aspects of health screening. [16] This includes evaluating:

a)  "The case for implementing new population screening programmes not presently provided by the NHS within each of the countries in the UK;

b)  Screening technologies of proven effectiveness but which require controlled and well-managed introduction;

c)  The case for continuing, modifying or withdrawing existing population screening programmes. In particular, programmes inadequately evaluated or of doubtful effectiveness, quality, or value; and

d)  Generic issues relating to screening programmes and policy".[17]

The UK NSC is chaired by Professor David Walker, the Deputy Chief Medical Officer for England. Each screening programme also has an advisory committee or group that examines the performance of the programme, suggests improvements or developments, and produces reports for Ministers and the UK NSC.[18]

From local to national oversight

8. Prior to 1996, UK-wide screening policy covered: breast and cervical cancer in women; phenylketonuria, congenital hypothyroidism and the physical examination of newborns; and testing for HIV antibodies in all women receiving antenatal care. Individual Health Authorities (as they were then known) also took decisions to introduce screening programmes for additional diseases and conditions "for the benefit of their local populations" and each had its own arrangements and protocols.[19] Speaking in 1994, the former Chief Medical Officer, and first UK NSC Chair, Sir Kenneth Calman, expressed concern that, in the absence of national co-ordination, different "screening tests" had been implemented across the NHS in an "ad-hoc fashion" and "without the basis of solid research evidence, leading to variations in local practice".[20]

9. The establishment of the UK NSC was intended to move screening policy away from a localised, piecemeal approach: in its first annual report, the UK NSC stated that "no further screening programmes should be introduced except where high quality research is used to demonstrate clinical effectiveness".[21] Between 1996 and 2014, the UK NSC made over 100 policy recommendations and began a process of bringing the management and organisation of screening under national control. This included providing support for the implementation of its recommendations and, in England, overseeing the introduction, and monitoring the effectiveness and quality, of the non-cancer screening programmes.[22] Responsibility for delivering programmes relating to cancer rests with the NHS Cancer Screening Programmes.[23] Table 1 outlines the screening programmes currently recommended by the UK NSC and offered across the UK. Under the NHS Constitution for England, the NHS has committed "to provide screening programmes as recommended by the UK National Screening Committee".[24]

Table 1: Overview of the screening programmes currently offered across the UK[25]
England Northern Ireland Scotland Wales
Antenatal & newborn
Down's syndromeYes NoYes Yes*
Fetal anomaly ultrasound scan YesYes* YesYes
Infectious diseases in pregnancy YesYes YesYes
Antenatal Sickle Cell and Thalassaemia YesNo YesYes
Newborn and Infant Physical Examination YesYes YesYes
Newborn Blood Spot YesYes* YesYes*
Newborn Hearing Screening YesYes YesYes
Young person & adult
Abdominal Aortic Aneurysm YesNo** No**Yes
Diabetic Retinopathy YesYes YesYes
Breast CancerYes YesYes Yes
Cervical CancerYes YesYes Yes
Bowel cancerYes YesYes Yes
* There are some variations in what is offered by these programmes in each country. ** These programmes are currently in preparatory stages.

10. Warwick Medical School[26] reported that in "only two other countries" (the Netherlands and New Zealand) do screening organisations like the UK NSC have "national responsibility to make and oversee the implementation of screening decisions for all their citizens".[27] Dr Sian Taylor-Phillips, Warwick Medical School, added that screening in the UK is "very well respected internationally", with other countries looking "to the National Screening Committee processes to inform their own processes".[28] Several witnesses expressed their support for screening delivered via the NHS and nationally managed and quality assured by the UK NSC. The Royal College of Radiologists stated that "NHS-funded screening" provided "a controlled and accessible package available to all", something that, according to the Academy of Medical Sciences, "few countries achieve", while the PHG Foundation suggested that this "controlled" approach also helped to ensure "structure and consistency" in UK screening.[29]

11. Some witnesses, however, told us that the UK NSC's role inhibited the implementation of new screening programmes. Owen Sharp, Prostate Cancer UK, described the UK NSC as presenting a "barrier" that a screening programme had "to get over" before it could be implemented while Children Living with Inherited Metabolic Diseases (Climb) questioned if the UK NSC was, in fact, "a world-leader at assessing the evidence" since it did not take "the opportunity to screen for many more metabolic diseases".[30] Other witnesses indicated that, despite the establishment of the UK NSC and its focus on evidence-based screening, it may be "politically difficult" to stop a screening programme in response to new evidence about its effectiveness.[31] Professor Susan Bewley, King's College, London, stated that the breast cancer screening programme—established in 1988, prior to the creation of the UK NSC—was "supported by political, rather than medical, imperatives"[32] while others indicated that screening had become, and remains, a very "emotive" issue. [33]

12. Health screening policy and practice provokes strong reactions among those who argue that the UK should screen for more conditions and in those who question the operation of, and evidence base for, current programmes. Since its establishment, the UK National Screening Committee has discouraged the haphazard growth of localised, unplanned programmes that are not grounded in high-quality evidence and has presented a barrier to entry. We agree that all screening programmes should be grounded in robust evidence and, given the difficulty of withdrawing a programme, support the idea that the evidential barrier to entry should remain high.

15   Parliament passed 3 devolution Acts: the Scotland Act 1998; the Northern Ireland Act 1998; and the Government of Wales Act 1998 Back

16   UK National Screening Committee, 'About Us', accessed 7 July 2014 Back

17   UK National Screening Committee, 'About Us', accessed 7 July 2014 Back

18   Public Health England and NHS England, Immunisation & Screening National Delivery Framework & Local Operating Model, (May 2013), para 2.2.4 Back

19   UK National Screening Committee, First Report of the National Screening Committee, (April 1998), p 39 Back

20   R Smith, "Government revamps screening policy", British Medical Journal, 5 February 1994, BMJ1994;308:357 Back

21   UK National Screening Committee, First Report of the National Screening Committee, (April 1998), p 39 Back

22   NHS0040 [Public Health England] Back

23   NHS Cancer Screening Programmes, 'Homepage', accessed 2 September 2014 Back

24   Department of Health, The NHS Constitution for England, (March 2013), p 8 Back

25   UK National Screening Committee, 'Programmes', accessed 15 August 2014 (table last updated June 2012)  Back

26   Evidence was jointly submitted by four academics from Warwick Medical School: Ms Farah Seedat, Dr Saverio Stranges, Dr Ngianga-Bakwin Kandala and Dr Sian Taylor-Phillips Back

27   NHS0025 [Warwick Medical School, University of Warwick] para 7 Back

28   Q4 [Dr Taylor-Phillips] Back

29   NHS0007 [The Royal College of Radiologists]; NHS0018 [Academy of Medical Sciences] para 21; NHS0034 [PHG Foundation] para 2.8 Back

30   Q169 [Owen Sharp]; NHS0013 [Climb]; see also NHS0026 [Muscular Dystrophy Campaign] Back

31   NHS0029 [Institute of Biomedical Science] para 2 Back

32   NHS008 [Professor Bewley] para 7 Back

33   NHS0013 [Climb]; NHS0025 [Warwick Medical School];NHS0029 [Institute of Biomedical Science] para 3 Back

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Prepared 29 October 2014