Scottish Screening Committee minutes: 17 November 2020

Attendees and apologies

Attendees:

• Jann Gardner, Chief Executive, Golden Jubilee Hospital (Chair)
• Lorna Ramsay, Medical Director, NHS National Services Scotland 
• Michael Kellet, Director of Population Health, Scottish Government
• Jane Burns, Medical Director, NHS Lanarkshire
• Belinda Henshaw, Senior Inspector/Reviewer, NHS Healthcare Improvement Scotland
• Marion O’Neill, 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
• Graham Foster, Director of Public Health, NHS Forth Valley

In attendance:

• Tracey Syme, Deputy National Screening Coordinator, NHS NSS
• Tasmin Sommerfield, Consultant in Public Health Medicine for National Screening Programmes, NHS NSS
• Julie Anderson, Senior Programme Manager, NHS NSS 
• Jo Swanson, Interim Deputy Director, Health Protection Division, Scottish Government 
• Laura McGlynn, Committee Secretariat, Health Protection Division, Scottish Government 
• Sheila Devlin, Committee Secretariat, Health Protection Division, Scottish Government
• Agnes Munyoro, Committee Secretariat, Health Protection Division, Scottish Government
• Stacey Berwick, Committee Secretariat, Health Protection Division, Scottish Government

Apologies:

• Scott Urquhart, Director of Finance, NHS Forth Valley
• Colin Briggs, Director of Planning, NHS Lothian

Items and actions

Welcome and apologies

 JG welcomed attendees and apologies were noted as above. 

Following the last SSC meeting, Scott Urqhuart had been identified to represent the Directors of Finance but had sent his apologies. The chair welcomed him and Scottish Director of Screening, Gareth Brown to the SSC as new members. 

Launching the National Screening Oversight Function (NSOF) 

GB provided an update on NSOF implementation and shared the role and strategic vision of the NSOF. There was confirmation that all components and personnel were now in post. GB presented the work plan which outlined strategic themes that were to be achieved at the end of this financial year: governance, data, quality, digital, patient centred care. 

SSC members discussed data challenges associated with upstream diagnostic and treatment data, NSOFs governance role in relation to the SSC and dynamic governance structures in relation to decision making. 

The SSC confirmed that the NSOF can be considered established

Screening recovery update 

GB provided an update on the screening programmes progress on the recovery route map. 

From 12 October, all screening programmes were at stage 3 of the recovery plan and, despite programmes operating at reduced capacity, routine screening had continued. 

GB recommended splitting recovery plan stage 3 into stage 3a and 3b which reflected capacity challenges while Covid rates were high, and that programmes may not be operating at pre-Covid capacity.  The SSC agreed that allowing flexibility for individual programmes to move up and down between stage 2/3a/3b would allow programmes to adapt and manage capacity challenges with the fluctuating situation. 

NSOF were working to monitor the restart and impact of the pause, identifying any new inequalities that programmes may be experiencing as a result of Covid impact. Downstream capacity issues were identified and were being monitored. 

Framework for flexibility 

GB presented the framework for flexibility that would allow the screening programmes to respond to Covid pressures and adapt to national or local lockdowns. Programmes predicted that the fluctuating situation could have an impact on screening uptake and capacity.

The SSC was asked to reflect on the restart principles that had been presented at previous meetings and were also asked to consider complex issues from recovery in relation to the ongoing developments in the spread of Covid.

The SSC discussed how each screening programme can respond to variable pressures in the coming months. Mitigation systems were considered and it was agreed that Programme Boards would monitor the capacity challenges of screening programmes and apply a risk stratification system where possible to maintain core services for each programme. 

The SSC acknowledged that unlike other programmes, bowel screening would not be able to apply risk stratification as there isn’t a high risk bowel screening cohort. The only option for the programme if capacity challenges became unsustainable would be a national pause.

SSC agreed that screening programmes should be maintained, with reduced capacity if necessary, until such time as a full national pause is the only option, and that, at that stage, an escalation process would be followed through the NSOB.
SSC agreed the following core service for each programme, to be maintained as a minimum:  

• for AAA, Cervical, and DRS this is Stage 2/High risk cohorts
• for Breast this would be calibrating local capacity to respond to pressure
• Bowel - existing programme is minimum possible, short of national pause
• Pregnancy and Newborn Screening should not be paused/reduced

Cervical Screening incident

TS informed the SSC about the technical error in the cervical screening programme which prevented 15,000 letters being issued to participants over an eight day period at the end of August. 

National action was taken to issue mailers to all affected women, and additional resources were provided to facilitate Health Boards locally managing screening. 

There was ongoing work to establish the root cause and an external audit has been commission to provide assurance on IT pathways across screening programmes. 

The SSC noted the update 

AOB 

Date of the next meeting agreed for mid-January 2021.