Scottish Screening Committee minutes: 1 March 2022

Attendees and apologies

Members:

• Jann Gardner, Chief Executive, Golden Jubilee Hospital (Chair)
• Gareth Brown, Scottish Director of Screening, NHS National Services Scotland
• Bob Steele, UK National Screening Committee
• Fraser Tweedie, Public Partner
• Susan Siegel, Public Partner
• Michael Kellet, Director of Population Health, Scottish Government   
• Janette Fraser, Head of Planning, NHS Forth Valley
• Lisa Cohen, Cancer Research UK Representative
• Graham Foster,  Director of Public Health, NHS Forth Valley
• Fiona Wardell, Deputising for Safia Qureshi, Director Of Public Health, Healthcare Improvement Scotland
• Sonya Scott, Deputising for Nicholas Phin, Director of Public Health Science and Medical Director, Public Health Scotland      

In attendence:

• Tasmin Sommerfield, National Clinical Advisor for Screening, NHS NSS
• Sinéad Power, Head of Health Protection, Population Health Directorate, Scottish Government
• Laura McGlynn, Committee Secretariat, Health Protection Division, Scottish Government
• Michael Kerr, Committee Secretariat, Health Protection Division, Scottish Government
• Susan Thompson, Committee Secretariat, Health Protection Division, Scottish Government
• Katie Cuthbertson, Associate National Director, Centre for Sustainable Delivery, NHS Scotland

Apologies:

• Nick Phin, Director of Public Health Science and Medical Director, Public Health Scotland
• Safia Qureshi, Director Of Public Health, Healthcare Improvement Scotland
• Scott Urquhart, Director Of Finance, NHS Forth Valley
• Jane Burns, Medical Director, NHS Lanarkshire

Items and actions

Welcome and apologies

• Jann Gardner (JG) welcomed attendees and introduced attendee Katie Cuthbertson
• apologies were received from Safia Qureshi (SQ), Scott Urquhart and Jane Burns. Fiona Wardell deputised for SQ
• JG confirmed that Nick Phin would be the new PHS representative, however as he was unable to attend this meeting Sonya Scott deputised
• minutes from the previous meeting were approved and will be published on the Scottish Government website

UK National Screening Committee (UK NSC)

Bob Steele (BS) provided an update on the UK NSC which last met on 4 November 2021.

• the UK NSC considered the use of AI in breast screening; screening for alcohol misuse; Congenital Adrenal Hypoplasia, and Duchenne Muscular Dystrophy
• the UK NSC agreed that a robust assessment of AI in breast screening would be required before it could be rolled out in the screening programme
• for alcohol misuse, it was agreed there is at present insufficient evidence for a national screening programme, but it may be considered as a targeted programme in the future
• for Congenital Adrenal Hypoplasia, there was considered to be insufficient evidence for a newborn screening programme at this time
• for Duchenne Muscular Dystrophy, it was agreed the volume and type of evidence was not sufficient to recommend a national screening programme
• the evaluated rollout of Non-Invasive Prenatal Testing (NIPT) and trisomy screening went live in England on 1 July 2021. An evaluation of new born blood spot screening of severe combined immuno-deficiency started on 6 September 2021

In addition, BS updated on planned changes to the UK NSC:

• the UK CMOs had undertaken a review and on completion agreed that the UK National Screening Committee (UK NSC) would be a more strategic, proactive committee driving innovation, looking at population, targeted and risk stratified screening
• there would be three new sub-groups: (i) Adult Reference Group; (ii) Fetal and Maternal Health Reference Group, and; (iii) a Research sub-group
• the UK NSC was recently transferred from Public Health England to the Department for Health and Social Care
• the UK NSC would be announcing a new Chair, replacing BS who would be chairing for the last time at the meeting on 7 March 2022

In the discussion, it was noted that a strength of the previous NSC was its UK-wide focus, and that it was essential that devolved nations continued to have the same representation on the committee to influence decision making. The committee thanked BS for his significant contribution to screening policy whilst Chair of the UK NSC.

Screening and the strategic landscape

Katie Cuthbertson (KC) and JG provided information to the Committee regarding the care and wellbeing programmes, and the evolving role for Centre for Sustainable Delivery. The care and wellbeing portfolio includes four programmes: Place and Wellbeing; Preventative and Proactive Care; Integrated Planned Care; and Integrated Urgent and Unscheduled Care. A summary and aims of each was provided.

GB queried if work is at individual board level, or if there were projects or interventions that involved scaling up beyond the board level to regional or national level. He highlighted that one challenge in screening, especially with staff, has been boundaries – resources could be in one part of the country and while there is not enough in another, and it is difficult to move them around. JC clarified there had been a mixture. She discussed about the consideration of trying to avoid fourteen versions of a service when each board introduced it, and remove some of the burden on boards. Information governance is always going to be a challenge but tried to make it easier for each board, and establish clinical protocols to help provide consistency across boards.  Individual boards will need to implement and there will be local variation, but it is important to share guidance and best practice so that each board doesn’t work from scratch.

Updates and challenges within the screening programmes

GB reminded the SSC of the conversation at the last meeting regarding the situation within screening, and advised that the situation is largely still the same.

Bowel screening

• the programme continues to operate in line with pre-COVID performance
• the uptake rate is slightly higher than before the pandemic
• there has been concern regarding colonoscopy waits, however, National Screening Oversight (NSO) have been advised that patients are typically not waiting very long for appointments
• four boards are currently using faecal immunochemical test (FIT) results when prioritising patients for appointments

Diabetic Eye Screening (DES)

• capacity continues to improve but the programme is not as yet meeting the performance targets, where there is also variance between health boards
• NSO has met with some health boards regarding their local challenges with the programme, and it is recognised that these are likely to remain due to the lasting impacts of the pandemic

Breast screening

• the breast screening programme capacity was reduced over the winter period, due to staff vacancies and the challenges posed by COVID-19. However uptake remains high
• the programme board would be discussing an options paper on restarting self-referrals for those aged 71 and over. Any decisions around this would need to avoid unduly impacting on screening of the recommended age range of 50-70

Cervical

• sample taking for the programme was currently at a slightly higher level than was predicted
• some boards are not currently meeting colposcopy targets; however, there is ongoing work to increase capacity including through the additional funding from the Scottish Government provided to a selection of health boards where delays were most pronounced

Abdominal Aortic Aneurysm (AAA)

• AAA screening is operating as normal in most health boards; there is some variation on performance levels across the boards
• performance in January 2022 exceeded that of January 2021, with uptake reported to be only slightly less than January 2020

Pregnancy and newborn

• the pregnancy and newborn programmes were not paused due to the COVID-19 pandemic and therefore do not have the same backlogs and capacity issues found in the adult programmes
• the programmes are operating as normal, however some boards have adjusted their criteria after it was determined safe to do so

Other key points

• it is not anticipated that there will be any further pause to the screening programmes
• the performance of DES and breast screening programmes were most concerning of all, whereas the bowel screening programme performance is more reassuring than previously
• the performance of the programmes will continue to be monitored, with any significant concerns escalated when it is considered appropriate

In addition, GB advised that the NSO are at the latter stages of its strategic planning.

GB then welcomed questions and comments from the Committee.

It was noted that the improvement seen in the bowel screening programme’s recovery was important progress. It was queried if there was anything more that could be done to help improve the performance and capacity of the breast screening programme. GB advised that the challenges within the programme are not simply due to the pandemic, but also a result of longer term issues, such as staffing and the sustainability of the workforce. There is the challenge of ensuring staffing is sustainable in the longer term, however pragmatic approaches can help reduce the current staffing issues. The modernisation work will look at this and the delivery model.

Tasmin Sommerfield (TS) also noted that the Omicron variant of COVID-19 had impacted significantly on the screening programmes, for example through clinics being cancelled due to staff absence. She also highlighted that there is an overall speciality staff shortage and that funding is not the issue, and posts are being advertised internationally in a bid to recruit trained staff to vacant posts. All assets are currently being utilised and maximised, and everything that can help increase capacity and performance is currently being done.

On the breast screening programme, TS advised that one health board piloted a system whereby women who had previously defaulted on their appointments were sent an open invitation letter, asking them to make contact to arrange a suitable time for their appointment. This was followed up with a phone call. 38% of the women contacted in this way took up the offer of an appointment, and the number of appointments that were not attended decreased. This reduced the slippage times within the board, bringing the interval between appointments closer to the target of 36 months.

On breast screening self-referrals for over 71s, TS advised that in England an open appointment system continues to be used and uptake overall has reduced significantly. In Scotland, with the closed invitation system and pause on self-referrals, overall screening uptake is much higher.

Cervical incident update

TS updated the Committee on the progress of the record reviews resulting from the cervical screening incident. Women and individuals who had subtotal hysterectomies have now all been contacted. There was lower than expected attendance of those women who were invited to clinic; a follow up letter was sent to those who did not attend. Those who have continued to not respond have now been reinstated to the cervical screening programme where appropriate and moved to routine follow ups.

The focus is now on the wider group of women and individuals who have had hysterectomies, who don’t have a sub total hysterectomy recorded but whose records are being checked to ensure they have correctly been excluded from the cervical screening programme. The methodology for reviewing the records has been agreed. It had been hoped that more admin staff would have been acquired for this, however the latest COVID variant delayed this. Work is ongoing with the health boards, however boards have expressed concerns that it will be a significant undertaking both in terms of staffing and funding, which may have to be found from other areas.

GB noted the importance that senior management support would be needed given the resources required, and that it is a substantial piece of work. There will be a need for dedicated and significant resources to carry out the review, that will at times be challenging. GB proposed writing to the boards about this.

Any other business and next meeting

No other business was raised. The SSC was advised that the next meeting is due to take place on 24 May 2022.