Scottish Screening Committee minutes: 1 September 2021

Attendees and apologies

Members:

• Jann Gardner, Chief Executive, Golden Jubilee Hospital (Chair)
• Michael Kellet, Director of Population Health, Scottish Government
• Jane Burns, Medical Director, NHS Lanarkshire
• Lisa Cohen, Cancer Research UK
• Susan Siegel, public partner
• Bob Steele, UK National Screening Committee Representative
• Fraser Tweedie, Public Partner
• Gareth Brown, Scottish Director of Screening, NHS National Services Scotland
• Scott Urquhart, Director of Finance, NHS Forth Valley 
• Safia Qureshi, Director of Evidence, Healthcare Improvement Scotland 
• Graham Foster, Director of Public Health, NHS Forth Valley 
• Janette Fraser, Head of Planning, NHS Forth Valley

In attendance:

• Tasmin Sommerfield, National Clinical Advisor for Screening, NHS NSS
• Joanna Swanson, Deputy Director, Health Protection Division, Scottish Government
• Laura McGlynn, Committee Secretariat, Health Protection Division, Scottish Government 
• Susan Thompson, Committee Secretariat, Health Protection Division, Scottish Government

Items and actions

Welcome and apologies

Jann Gardner (JG) welcomed attendees and introduced the new planning representative, Janette Fraser (JF), Head of Planning in NHS Forth Valley, who will be replacing the previous representative, Colin Briggs, Director of Planning for NHS Lothian. 

JG advised the Committee of the proposal to add a Public Health Scotland representative as a member of the Committee. There were no objections to this proposal, therefore JG advised that a suitable candidate will be identified and added to the membership.  

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) gave an update regarding the UK NSC. The last meeting occurred on the 25th of June.

A recruitment campaign has begun for the UK NSC.

UK Chief Medical Officers have reviewed the current UK NSC, and an updated Terms and Reference is expected shortly.

BS updated the Scottish Screening Committee (SSC) regarding the research by the Exeter Group regarding a cost effective lung cancer screening model. 

There has been discussion on ethical engagement and the development of an ethical framework to ensure ethical principles are embedded in the committee’s work. This was presented to the UK NSC and was largely accepted.

There was an ethics task related to the restoration of the adult screening programmes – it was felt the most important issue was transparency with the public, for example around delays due to the pandemic.

There was a stakeholder engagement review, which resulted in useful information. There is an action plan for stakeholder engagement with the UK NSC which will become available on their website.

A public dialogue process on the implications of whole genome sequencing for newborn screening was commissioned by Genomics England and the UK NSC. Participants were supportive of the potential use but expected proper consideration to be given to designing and planning any future use of this technology. They also wanted the public to be involved in this process an appropriate investment, resources and safeguards to be in place.

Use of AI in Diabetic Eye Screening (DES) was not recommended at this time. It was noted that further research was required. It should be noted that the technology evaluated differed to the Autograder which is currently used in the Scottish DES programme.

Screening for anaemia in pregnancy was also considered. The criteria to recommend this was not met, and so this was not recommended to be included as part of the screening programme at this time. 

Screening for gestational diabetes was also considered. The criteria to recommend this was not met, and so this was also not recommended to be included in the screening programme at this time. 

Update on the Adult Screening Programmes Recovery in Scotland

Gareth Brown (GB) gave a presentation to members on the progress of the adult screening programme recovery in Scotland.  

Diabetic Eye Screening – There are continuing capacity challenges for some health boards, however other boards are meeting or exceeding pre-COVID-19 capacity levels. The programme is looking at possible prioritisation methods, however all high risk participants are being screened.  

Abdominal Aortic Aneurysm – Attendance rates are similar to pre-COVID-19, with some variation between boards. COVID-19 pressures are impacting capacity in some boards but overall there has been good progress. 

Cervical – Pressures on primary care are impacting this programme but attendance rates are higher than earlier in the year. Pressures of COVID-19 will also impact uptake.

Bowel – The screening programme itself is not experiencing any major issues and there has been a greater return rate of kits. However, there are challenges in some health boards regarding colonoscopy capacity. Work is continuing with the Scottish Government (SG) on this. 

Breast – While there are ongoing capacity challenges, most screening centres are allocating more appointments than pre-COVID-19, for example through additional mobile units and staff being available for longer hours. Referral rates for assessment and treatment remain consistent with pre-COVID-19 levels. 

The SSC were invited to comment on the update. It was noted it was good to see improvement, albeit with some variation across the country. It was queried what work was being done to improve uptake in parts of the population which typically have lower rates of uptake. GB advised that a lot of work has been done to help tackle inequality, however he also noted some of the COVID-19 challenges don’t necessarily directly contribute to the inequalities of uptake, such as staffing issues. However NSO are working with boards which are having greater challenges in increasing capacity and uptake.

Tasmin Sommerfield (TS) advised that inequality and uptake is being monitored, but highlighted that the programme has only restarted for approximately a year after the pause, therefore meaningful information is only becoming available now. She advised that text messaging service for breast screening was about to go live, and this in addition to changes to the IT system to make invites more personalised will hopefully increase uptake in groups that have shown a lower uptake rate. 

GB advised that he has not escalated challenges within the screening programmes to Board Chief Executives at this time, in recognition of the many other NHS challenges and priorities Boards are dealing with, but it continues to be important to monitor the situation. Discussions at the SSC and the NSOB provide an opportunity to discuss challenges, and Chief Executives will receive updates after the SSC as usual. 

There was discussion regarding the concern that breast screening self-referrals for people over 71 continue to be paused. It was noted that this is generating increasing media and MSP interest. TS advised that the risks versus benefits of screening this age group have not yet been fully established.. Therefore, considering the limited capacity within the programme, the Breast Screening Programme Board still considers it to be the correct decision to continue to focus screening on those aged 50-70 for whom the benefits are clear. It is an evidence based approach, and ensures limited resources are used most effectively. It was acknowledged other parts of the UK are allowing for self-referrals. 

The possibility of a future pause in the screening programmes was raised. However, it was discussed that much has been learned from the pause that took place last year and the resulting challenges, and it was felt that screening should continue for as long as possible. It was highlighted that a further pause would create a number of very significant challenges, and it would always be better to continue screening, even if it at lower rate, than to pause completely.

National Screening Oversight (NSO)

GB discussed the ongoing work in the NSO regarding each of the strategic themes – governance, quality, data, digital, and participants - and the work plan that was signed off in May 2021. 

Governance – GB advised that work is ongoing to understand gaps in governance in screening. This includes work to increase the understanding of the finance that supports screening e.g. in health boards. The Research and Innovation Group is working to define its role and approach, considering how to innovate and best support programme boards in a consistent way. The Data Management Board, which was established in April and meets monthly, manages the IT system and is developing digital capability.

GB informed the SSC that work is also going into a guide for screening. The guide to screening, intended primarily for professionals, will be presented to NSOB first and later to the SSC prior to publication.

Quality – GB advised the SSC that another challenge for the NSO is to understand and strengthen the quality approach across the screening programmes. This will be discussed with Health Improvement Scotland (HIS) in a planning session on 2 September. There is a need for greater understanding of quality across the programmes to reduce any inconsistencies. GB confirmed policies on risk, adverse events and duty of candour are to be developed by the end of this year. Further workshops are also planned to focus on the use of KPIs, Standards and QA audits.  

Data – GB advised that work has been done to develop a screening intelligence platform. This includes automating data into the platform, which should be completed by the end of the year (except for the pregnancy and newborn programme). It has been agreed that development of the Screening Intelligence Platform and Cancer Intelligence Platform will be processed together. 

Digital - GB confirmed the Digital Management Board has been established and is managing developments and maintenance of existing screening systems. This includes text messaging for the breast screening programme that is due to go live on 17 September. The digital board has allowed NSO to identify additional resource to address backlogs. It is also overseeing the Screening Digital Modernisation Programme. 

Participants – GB updated the SSC about funding secured from the Scottish Government to fund a national screening inequalities health improvement post. A national screening participants group is also being developed, to obtain the views of screening programme participants. Work is ongoing with the HSCPs regarding tackling inequalities and increasing uptake.

Bowel screening and FIT 

TS updated the SSC regarding the Bowel Screening Programme and the use of FIT scores. 

The bowel screening programme board does not endorse FIT scores for screening participant prioritisation; however, it had been agreed that if Board Chief Executives requested the FIT scores, these would be issued. Two boards have started using the scores, and one has expressed interest in doing so. The continued use of scores is to be reviewed at the end of September. 

The Bowel Screening Programme Board does not dispute the colonoscopy capacity challenges, and wants to support health boards, so will look into alternatives to FIT score prioritisation to manage colonoscopy demand. 

It was raised that availability of the FIT scores can help inform the clinicians work, and therefore using FIT scores doesn’t necessarily undermine screening principles. It was also agreed there was interest in using additional Golden Jubilee Hospital colonoscopy capacity, but some clinicians have found it difficult to establish clinical pathways that can provide assurance that patients will be followed up in their own board of residence. However it was agreed it would be beneficial to use the additional capacity. 

JG advised that one of the boards has now expressed interest in using the capacity, and she would be able to update on this in due course. 

It was highlighted that the NHS recovery plan doesn’t contain much information regarding the screening programmes. JG reflected that there are many ongoing challenges, and what has been put into the recovery plan may be superseded by other challenges. GB also highlighted the issue of relative priority. Some of the recovery issues that affect the screening programmes are not specifically about screening, but are further along the pathway in the acute sector which the recovery programme does cover. GB felt that screening wasn’t needed in the recovery plan to get the support needed for the programmes, and that there had been strong support in government, such as through providing funding for posts and regular engagement and discussion on the issues the programmes are currently dealing with. 

Cervical screening incident update

TS advised that the initial focus in regards to the incident has been on women with a record of sub-total hysterectomy on the Scottish Morbidity Record 01/02 from before and after 1997 who are excluded from cervical screening. These women have been reviewed and contacted to arrange follow up with them. TS confirmed the next stage is to look at women who are excluded from the cervical screening programme and who have no record of sub-total hysterectomy type on SMR01/02 (around 199,000). It had been agreed there was a need for a wider review of these women to ensure they have been correctly excluded from the screening programme. 

Michael Kellet thanked colleagues involved with working on this incident. He advised the SSC that the next parliamentary statement on the incident would be 15th September. This will include information on a plan for the remaining records that need to be reviewed. He noted it would be important to put in place a wider review of exclusions, including lessons learned. 

AOB and next meeting

No other business was raised. The SSC was advised that the next meeting is due to take place on 2 November.