Why is it an issue?
Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition, helping to manage or prevent further ill health.
A screening programme sifts through a healthy population to detect those that are more likely to have the condition/disease in question. Those that are more likely to have the disease i.e. are at higher risk, will go on to have a more definitive test – a diagnostic test, to determine whether they have the disease.
In the case of Chlamydia, for example, the primary screening test is actually also a diagnostic test. However, for breast, bowel and cervical cancer, the primary test may suggest the presence of abnormal cells but a secondary test is needed to diagnose cancer. For example, the primary test for bowel cancer is the faecal occult blood test and the secondary, diagnostic test, is a colonoscopy.
Where the boundary lies between a screening programme and a disease management programme is usually dependent on the organisational structures involved rather than any theoretical distinction.
What’s the local picture and how do we compare?
The bulk of this section is directly taken from the recent and comprehensive review of screening programmes, published in December 2010. It concluded that where targets and national comparisons are available on uptake and coverage of the screening programmes NHS Wakefield District compares well, with a few exceptions, which are highlighted below. However, even where NHS Wakefield District significantly exceeds the national average for coverage there is room for improvement.
It is further intended that future reports on screening programmes are produced on an annual basis and will include a balanced scorecard of screening indicators with some outcome measures and user feedback.
Rather than reproducing the document here, we link to this excellent review below. However, key actions arising from this review are as follows:
What are we doing to improve things?
Newborn Blood Spot Screening
- Audit standard 6 of Newborn Blood Spot Screening Programme to provide evidence of the timely receipt of repeat/second blood spot samples.
- Review 2009/10 data in relation to the timeliness of identifying untested babies (standard 8).
Diabetic Retinopathy Screening
Agree a future course of action for out of area patients within the DRS programme.
Abdominal Aortic Aneurism Screening
AAA screening programme to be commissioned by April 2013.
Breast Cancer Screening
- Take forward negotiations with NHS Leeds to replace one of the mobile units with another static unit.
- Review breast screening data on normal result turnaround when new data become available. The data from the first quarter of 2010/2011 suggest that NHSWD were not meeting their target, however this may be because the static service in Wakefield had only just been established.
- A health equity audit needs to take place to see if uptake of Breast Screening Services in those of South Asian ethnicity has improved since the introduction of the static unit in Wakefield.
What can we do differently?
All screening programmes
NHS Wakefield District recognises the need to provide equity in access to all population groups targeted by the screening programmes. This includes ethnic groups as mentioned above, but also people with learning disabilities, who, according to national research, are less likely to access cancer screening programmes. Monitoring equity in access is often hampered by lack of adequate data collected on these groups. It is therefore recommended that, in future, screening programmes should include the collection of this data so that equity in access can be monitored and addressed where appropriate.
Cervical Cancer Screening
New strategies to encourage screening in population groups not currently accessing screening needs to be developed.
Bowel Cancer Screening
The Bowel Cancer Screening Programme is relatively new and is soon to be extended to include men and women up to 75. Therefore it is particularly important to monitor the uptake and to ensure there is equity in uptake.
NHS Health Checks
- The Health Equity Audit only included SystmOne practices, therefore EMIS practices should be contacted to see whether they can complete a similar audit.
- NHS Wakefield should liaise with GP Consortia and individual practices to see why the performance of individual practices varies considerably in screening eligible patients. This could involve qualitative research on reasons for non attendance. This could inform guidance on best practice.
- Progress towards screening the eligible population should continue to be monitored through the PMS contract.