Non cancer screening
Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.
The UK National Screening Committee (UK NSC) assesses the evidence for screening programmes against a set of internationally recognised criteria to ensure screening does more good than harm.
There are currently two UK National Screening Committee approved cardiovascular screening programmes.
Diabetic retinopathy screening
Diabetic retinopathy is the most common cause of blindness in patients of working age in the UK. The risk of developing retinopathy can be reduced by good management and control of diabetes (glycaemia control) and blood pressure.
The NHS Diabetic Eye Screening Programme (NDESP) aims to reduce the risk of sight loss among people with diabetes by the early detection and treatment, if needed, of sight-threatening retinopathy.
NHS Health Check Programme - a health improvement programme focusing on risk reduction
The NHS Health Check programme is a mandated public health programme in England for people aged 40-74 which aims to keep people well for longer. It is a risk assessment and management programme to prevent or delay the onset of diabetes, heart and kidney disease and stroke.
Together diabetes, heart and kidney disease and stroke make up a third of the difference in life expectancy between the most deprived areas and the rest of the country. Addressing these differences is a key aim of the programme. With the rise in levels of obesity and type 2 diabetes, and the associated costs to the NHS and social care, prevention of this disease is also a key driver.
The programme also aims to reduce levels of alcohol related harm, and to raise awareness of the signs of dementia and where people can go for help. Everyone attending a NHS Health Check will have their alcohol consumption risk assessed. In addition, people aged 65-74 will be informed of the signs and symptoms of dementia and sign posted to memory clinics if needed.
From 1 April 2013, local authorities became responsible for the risk assessment and life style interventions for the programme, which will be funded through the public health ring fenced budget. The risk assessment element of the check is a mandatory function which local authorities are required to commission or provide.
An overview of the NHS Health Check Programme is available on page 6 in NHS Best Practice Guidance, 2013.
What do we know?
National AAA screening programme
Abdominal Aortic Aneurysm (AAA) screening
The NAAASP annual report indicates that during 2011-12, 107,000 men were screened for the first time, around 75% of invited men attended their screening appointments and more than 1,600 aneurysms were detected.
During the year, 190 men underwent elective surgery to repair aneurysms detected by screening. There were three postoperative deaths. That equates to an elective AAA repair mortality rate of 1.6%, which is far lower than the 2.4% reported by a Vascular Society of Great Britain and Ireland (VSGBI) audit in February 2012.
This improvement in outcomes has been driven by the remodelling of vascular services with AAA repair procedures moving to fewer, higher volume hospitals. See here for more information about AAA screening programme.
Facts, figures and trends
99.8% of men who were eligible for abdominal aortic aneurysm screening were made an initial offer of screening in Bracknell Forest in 2013/14. This is significantly higher than both the England average and the South East average (Public Health Outcomes Framework).
Diabetic retinopathy screening
Increasing uptake for diabetic eye screening is a priority in Bracknell Forest. Data from the Thames Valley Local Area Team indicates that uptake for 2011/12 was 74.6%. This is lower than the national average of 80%, which is also the target for screening. In 2012/13 this uptake decreased to 70.1%, which is just 0.1% above the acceptable target.
Figure 1 Diabetic retinopathy screening uptake in Bracknell Forest (2011/12 and 2012/13)
Source: Thames Valley Local Area Team
NHS Health Check Programme
Take up of NHS health checks is measured as part of the Public Health Outcomes Framework under two different measures. The first, health checks offered, shows the cumulative number of health checks that were offered as a percentage of those people eligible for a health check. The second, health check take-up shows the cumulative number of people who received a health check as a proportion of those that were offered a health check. Figure 2 shows that the cumulative percentage of the eligible population aged 40-74 offered an NHS Health Check in Bracknell Forest in 2013/14 and 2014/15 was 33.3%. This is significantly worse than both the regional average of 35.6% and the national average of 37.9%. Of those who were offered an NHS Health Check in Bracknell Forest, however, 67.9% received one. This is significantly better than both the regional average of 43.2% and the national average of 48.9%.
Figure 2 Take up of NHS health checks 2013/14 to 2014/15
Source: Public Health England – Public Health Outcomes Framework, 2015
Legal duties exist for local authorities to make arrangements for health checks:
- for each eligible person aged 40-74 to be offered a NHS Health Check once in every five years and for each person to be recalled every five years if they remain eligible
- to ensure that the risk assessment includes specific tests and measurements
- to ensure the person having their health check is told their cardiovascular risk score, and other results are communicated to them
- for specific information and data to be recorded and, where the risk assessment is conducted outside the person’s GP practice, for that information to be forwarded to the person’s GP
For more information see NHS Health Checks best practice guidance
National & local strategies (current best practices)
Cardiovascular Disease Outcome Strategy. – Improving outcomes for those with or at risk of developing Cardiovascular Disease (Department of Health, March 2013).
National Institute for Health and Care Excellence Guidelines (2010) “Prevention of Cardiovascular Disease” at a population level, Public Health guidance 25.
Diabetic Retinopathy Screening is provided by the Berkshire Diabetic Retinopathy Screening service based in Wokingham Hospital and provided by Berkshire Healthcare Foundation Trust. See Diabetic Retinopathy Screening for more information about the programme.
What is this telling us?
One of the main aims of the NHS Health Check programme is to help narrow health inequalities from the conditions covered by it. The programme has been designed so that the majority of the check – including the tests and measurements required for the risk assessment section can be delivered in different settings, thus improving access for those from deprived communities.
In addition the NHS Health Check programme needs to be in keeping with the Equality Act 2010. Cardiovascular disease (CVD) is responsible for around 33% of the observed gap in life expectancy among people living in areas with the worst deprivation scores compared with the living in more affluent areas.
In addition people from Black and Minority groups for example South Asians and African and African Caribbeans have increased risk of developing CVD.
Recommendations for consideration by other key organisations
NHS Health Checks are generally only available via General Practice settings. It is recommended that work should be undertaken to pilot a range of community approaches to delivering the NHS Health Check programme to increase accessibility in community settings.
It would be advantageous to explore the possibility of offering the NHS Health Check to those with Learning Disabilities by including it within the protocol for the Learning Disability Annual Health Check.
It would also be beneficial to work should also be conducted with Broadmoor Hospital (a specialist hospital for offenders) to ensure that patients have access to the NHS Health Check programme.
Work could be carried out to access data from the Area Team on the uptake, surveillance and referral rates for AAA screening for 2012-13 by practice and analyse data for inequalities.
In addition, data on Diabetic Retinopathy Screening (DRS) by practice could be explored and work undertaken to develop a targeted approach to increase awareness and uptake of the programme, particularly for vulnerable groups for example people from South Asian and black African and Caribbean communities, older people and those living in deprived areas.
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