Scottish Screening Committee minutes: 2 November 2021

Attendees and apologies

Members:

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

In attendance:

• Tasmin Sommerfield, National Clinical Advisor for Screening, NHS NSS
• David Proud, Associate Director, Digital & Security (DaS), NHS National Services Scotland
• Kirsty Kiln, Public Health Trainee, National Screening Oversight
• Laura McGlynn, Committee Secretariat, Health Protection Division, Scottish Government
• Susan Thompson, Committee Secretariat, Health Protection Division, Scottish Government

Apologies:

• Bob Steele, UK National Screening Committee Representative

Items and actions

Welcome and apologies

• Jann Gardner (JG) welcomed attendees and introduced two attendees to the meeting, Kirsty Kiln and David Proud.
• Minutes from the previous meeting were approved and will be published on the Scottish Government website.

Digital modernisation

Gareth Brown (GB) introduced David Proud (DP). GB advised the Committee that DP works in National Screening Oversight (NSO) as the Digital and Change Lead, while also working within Digital and Security (DaS) in National Services Scotland (NSS). He reminded the committee that one of the strategic themes NSO is taking forward is Digital Modernisation, and the aim is to build the capability to develop the screening programmes. DP is leading the work for this.

• DP highlighted the vision of modernising the technology to support screening – including being cost effective, increasing participation, and improving service quality.
• the modernisation has four key objectives – empowering participants; improving accessibility of the service by using technology to break down barriers, especially for non-participants; greater use of data effectively to help with planning, resources and operations; and improving performance
• nationally, the technology supporting the health service is moving to a modernised architecture, such as cloud technologies, and there are components and capabilities that are being built that can be used across different services
• work has been done on how to integrate screening into the national technological infrastructure; this is recognised to be a complex undertaking with numerous constraints and dependencies, including the demands of each screening programme, and the end of the national IT contract with ATOS due in 2026
• current applications will be developed where appropriate, and new technologies brought in where possible
• highly collaborative working will be required – e.g. working with NHS 24 who will take lead on public facing technologies. However, there may need to be interim solutions for screening
• the strategic assessment for digital modernisation has been done, and an initial agreement is currently being worked on
• it was determined the proposals for screening could not realistically be contained in one business case or project, but that it would require multiple business cases
• an initial vision framework agreement and a series of business cases have been developed
• consideration is also needed on how to manage the end of the ATOS contract in 2026. While the NHS owns the applications developed by ATOS,  expert knowledge of these applications currently sits within ATOS
• there is also a need to prepare for the new medical device regulations due to be enforced from 2023. Software will be considered a medical device, and so the screening systems, including automated decision making, will need to comply with these regulations. There is therefore a need to ensure it is compliant

Members were invited to ask questions.

GB added that the data platform developments will significantly reduce the need for  manual tasks, increasing capacity across the system. Artificial intelligence will also reduce need for manual input. Innovation that can increase capacity will be prioritised.

JG agreed with the breaking down of business cases into multiple cases rather than one, as it allows flexibility. She also felt one of the biggest opportunities is advertising what benefits digital capabilities can offer. JG suggested the thought leadership regarding multiple business cases and technologies, and how to increase visibility of this, is shared with chief execs and other colleagues. GB advised DP has had success in the past with raising awareness and NSO will consider, on an ongoing basis, how to share and promote its work.

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 itself is performing well in the current circumstances. Uptake for screening is slightly higher overall than pre-COVID
• however colonoscopy capacity is a challenge. All available capacity for colonoscopies is being utilised, including at Golden Jubilee Hospital and through private providers
• the bowel screening programme is looking at alternatives to FIT scores to prioritise colonoscopy demand
• in the winter period, there may be increased colonoscopy waiting times
• tis an ethical question regarding continuing the bowel screening programme when colonoscopy waiting lists are long. NSO is trying to obtain waiting times data and will come back to SSC if there is a need for further discussion on this point

Diabetic Eye Screening (DES)

• capacity of the programme is improving. Some boards’ capacity is higher than 100% compared to pre-COVID levels, but others are below this level
• challenges include COVID infection control measures and staffing, but challenges vary between boards
• the programme board is working to triage those who are waiting for appointments, to prioritise those with highest need first. However, further work is still required to increase capacity

Breast

• overall, the breast screening programme is doing well in the present circumstances
• some boards are operating at above 100% capacity compared to pre-COVID levels. However other boards are facing issues such as short staffing. NSD is working with one board with particular challenges regarding increasing capacity
• breast surgery is currently constrained, therefore there are downstream service issues, similar to the bowel screening programme
• intervals between appointments are still longer than the target of 36 months
• the boards and screening centres are working hard to reduce wait times

Cervical

• there has been a reduction in samples taken from primary care seen in most recent data,  although it is too early to say if this is a temporary issue or a sustained trend
• there are also colposcopy challenges in multiple boards. The Scottish Government has recently provided additional funding to help address capacity and reduce colposcopy waiting times
• the cervical incident has increased demand for cervical screening

Abdominal Aortic Aneurysm

• most boards are performing well
• appointment times are longer in some boards due to infection control measures
• overall in Scotland, attendance is at pre-COVID levels. However there is variation between boards
• to catch up on the backlog, capacity will need to exceed pre-COVID levels for some time
• downstream services are facing challenges, similar to other screening programmes

Other key points

• there is no current anticipation of any further pause to the screening programmes
• all adult screening programmes are operating at reduced capacity nationally compared to before the COVID-19 screening programme pause
• TS added that one of the main challenges with boards is a delay in implementing 1 metre distancing regulations. There is variability for how quickly this is being implemented across and within boards

GB welcomed questions and comments from the Committee.

It was acknowledged the COVID-19 vaccines have reduced the risk of severe illness and death from COVID-19 infection, however the disruption caused by infection, for example absence from work and spreading to family, reduces the support for a reduction in distancing.

GB noted some data is not routinely collated within screening, such as colonoscopy data, and NSO is trying to obtain this information.

NSO has been meeting with board coordinators and programme managers to discuss DES capacity and is willing to meet with others if helpful - there had been some caution about asking for meetings with medical directors due to the current challenges but NSO is very happy to respond to requests.

GB reiterated there is no plan to pause screening, but there may be requests for this. It is felt that it would be preferable to reduce the screening programme capacity rather than pause altogether, due to the challenges faced after the pause in 2020. The data around this will be analysed to assess the situation.

TS highlighted that when the adult screening programmes were paused in March 2020, everyone was under the impression COVID-19 challenges would not last as long as they have, and it would not be as challenging as it has been to catch up. However now it is clearer COVID-19 will be a longer term issue, and there isn’t the opportunity to run at full capacity quickly after a pause, it makes a pause a less feasible option. However TS accepted there are ethical considerations, and advised that the UK NSC commissioned a workshop regarding COVID – related ethics in screening. Bowel cancer UK carried out a survey across UK regarding attitudes to screening. This found that those surveyed were happy to continue with screening despite delays, as long as they were made aware of the delays at the outset. Therefore in the bowel screening and breast screening leaflets, it is noted there may be delays.

It was noted that there may be different views on this from those who experience significant delays for follow-up appointments after screening results, even if they are eventually not diagnosed with the condition. This can be very difficult and life-changing for the individuals affected. 

Breast screening review

TS provided a brief overview on the breast screening review. This review was announced in parliament in 2019, was commissioned by NSD and covered the whole breast screening programme. A multi-disciplinary review group was formed to take this forward. Because it was commissioned by NSD, it was required to initially go through the internal NSS governance structure. It was noted that it was still awaiting final sign off, which was expected to be imminent. It then was taken forward into the wider screening programme governance structure, and was discussed by the breast screening programme board. The board carried out a prioritisation exercise on the recommendations. After this, it was presented at the National Screening Oversight Board meeting, where it was endorsed, with some recommendations made for  further scoping work to be taken forward by a programme established as a sub-group of the NSOB. Once sign off has been received from the SSC and it is formally approved by NSS, it will be shared with board chief executives and Scottish Government Ministers.

JG asked if the SSC endorsed the report and were in agreement for it to be progressed. The SSC agreed to this, including the proposal for a new subgroup of the NSOB tasked with taking forward work to scope and implement the recommendations of the review.

AOB and next meeting

No other business was raised. The SSC was advised that the next meeting is due to take place on 17 February.