Agenda item

Steven Senior, Public Health Consultant and Shenna Paynter, Public Health Specialist to present the attached presentation.

Steven Senior – Consultant in Public Health and Shenna Paynter – Public Health Specialist attended the meeting to give an update on the screening programmes currently being carried out across Bury.

 

It was explained that screening is intuitively appealing. But all healthcare interventions involve risk, and no screening test is perfect. And since screening programmes involve apparently healthy people, they need to be carefully considered to avoid doing more harm than good. Informed consent is essential.

 

UK National Screening Committee defines screening as:

•      “the process of identifying apparently healthy people who may have an increased chance of a disease or condition.

•      The screening provider then offers information, further tests and treatment. This is to reduce associated problems or complications.”

Screening should always be a personal choice. Informed consent is essential

 

In the UK, the National Screening Committee (NSC) is responsible for making recommendations about which screening programmes are effective and cost-effective, according to established criteria. Decisions should not be taken locally.

 

Key considerations include:

•      The condition: Is the it a serious public health problem? Does it have a detectable early stage? Do we understand how it progresses? Is there an effective treatment? Does early treatment lead to better outcomes?

•      The test: Is there a good test? How many people will get wrong positive results? How many wrong negatives? Is the test acceptable to the population?

•      The programme: Is the treatment and the whole programme cost-effective? Are there sufficient resources (money, trained staff) available?

 

Screening programmes in England are commissioned by NHS England under section 7a of the NHS Act 2006. In Bury, programmes are commissioned by NHS GM at a GM level, not by locality NHS staff or by the Council public health team.

 

The Greater Manchester Screening and Immunisation Team is responsible for monitoring performance and inequalities and for working with local primary care commissioners to improve uptake and tackle poor performance from providers.

 

The local authority director of public health has a role in providing challenge to the commissioners and providers, and in advocating locally to improve access to screening and minimise inequalities.

 

In practice, the local public health team currently performs some of the functions of the Screening and Immunisations Team (monitoring data, promoting uptake, coordination and system leadership etc.)

 

Areas where Bury’s screening uptake appears good include:

•      Breast cancer screening; and

•      Chlamydia screening.

 

Areas where Bury’s screening uptake is poor include:

•      New-born hearing screening;

•      Abdominal aortic aneurysm screening;

•      Cervical cancer screening (particularly among women aged 50 to 64 years old); and

•      Bowel cancer screening uptake (specifically in Bury PCN).

 

 

Recent local priorities include:

•         Setting up a Screening Assurance Group to bring together NHS GM commissioners, local public health expertise, and local providers.

•         Understanding the impact of COVID-19 on local screening programmes and their recovery.

•         Reviewing local breast screening performance and making recommendations.

•         Reviewing local cervical screening performance (work in progress) and supporting plans to incentivise cervical screening by GP practices.

•         Seeking assurances from NHS GM commissioners that steps are being taken to improve Abdominal Aortic Aneurysm screening, new born hearing screening, and addressing issues with timeliness of sickle cell and thalassaemia screening (part of the antenatal screening programme).

 

Bowel Cancer Screening:

•         Bowel cancer screening uptake in East Neighbourhood is low. The PCN has chosen to focus on improving this.

•         BAME specific support materials produced e.g. local GP created a video to explain the screening kit in Punjabi.

•         Working with BCSP consultants at FGH who attended F2F session (and online) with health professionals to promote the programme and encourage their clients to take part.

•         Future plans:           

Bowel Cancer awareness month activity (April)

Review practice BCSP DNA policy (aim for unified policy)

            East practices to identify a BCSP Champion

            East PCN to employ a Cancer Co-ordinator

 

Breast Screening

•         PH Review (in context of COVID-19 recovery)

•         reduced coverage in Bury (average 11.8% decrease)

•         significant practice variation in screening uptake rates (prior to CV-19) that cannot be explained by deprivation alone

•         Limited socio-economic and demographic data is available for breast cancer screening uptake currently. However, both 3-year coverage and 6-month uptake after invitation shows a correlationbetween practice area deprivation and engagement with breast screening services.

•         BRCA screening in Jewish Community

•         BRCA 1/40 Jewish people, 1 in 300 in general population. BRCA 1 lifetime risk of Breast Cancer = 80%

•         Previous RCT. NHSE Cancer Prog and Genomics Unit are establishing a targeted programme. Acceptable, and has community support. But carries some risk of over-treatment.

•         NHSE estimate 26 BRCA carriers identified in Bury over 1 year. 

 

Targeted lung health checks (lung cancer screening)

•         Initially used in areas of very high smoking prevalence. Now being rolled out more widely.

•         Still some doubts on overall cost effectiveness and use of resources. Evidence strengthening though. Still needs to be targeted to areas of highest risk to ensure best balance of benefit vs harm is best.

•         With NHS GM Bury colleagues we worked with Health Innovation Manchester Utilisation Management to refresh small-area lung cancer incidence statistics.

 Self-referral to lung x-ray

•         Self-referral to lung x-ray ‘pilot’ ongoing. However, evidence from previous pilots suggests focus on patient and GP education may be a better approach.

 

Those present were given the opportunity to ask questions and the following points were raised:

 

It was asked what could be done to encourage uptake of screening across the borough?

 

It was explained that work was being done to promote uptake and continued engagement as well as identifying barriers.

 

Councillor Pilkington referred to a screening of TB that was carried out recently in Rochdale and asked whether this would be replicated in Bury.

 

It was explained that there were not enough cases of TB in Bury to justify screening. This was something that was constantly reviewed.

 

It was agreed:

 

That the update be noted.

 

That a further update report be brought to the Health and Wellbeing Board annually.

 

That Steven and Shenna be thanked for their comprehensive presentation.