Health Education England has pledged to fund the training of 200 non-medical endoscopists, which will significantly increase endoscopy capacity in England. The first cohort will begin training in January 2016. NHS England’s Sustainable Improvement Team (formerly NHS Improving Quality) is working intensively with trusts that have significant endoscopy waiting lists, in order to improve performance. NHS England is also exploring ways to improve endoscopy performance through pricing changes.

The UK National Screening Committee (UK NSC) advises Ministers and the NHS in all four countries about all aspects of screening policy.

In 2009-10 the UK NSC recommended that routine screening for adult hearing loss should not be offered because of the lack of evidence to warrant a screening programme. In particular:

- it is not clear what the test should be;

- there is no agreed time or schedule for carrying out the testing;

- the acceptability of the test and in particular the treatment (hearing aids) is unclear; and

- there had been no randomised trials of screening.

As part of its routine evidence review process the UK NSC has just reviewed its recommendation on screening adults for hearing loss again. Ministers expect to receive a recommendation from the UK NSC shortly.

NHS England published a new Clinical Commissioning Policy on Genetic Testing for BRCA1/2 mutations in July 2015, based on updated guidelines issued by the National Institute for Health and Care Excellence. This policy applies to patients diagnosed with ovarian cancer and people likely to have the BRCA gene mutation due to their family history.

Improving the proactive detection, surveillance and management of infectious diseases in prisons is a shared priority for the National Offender Management Service, NHS England and Public Health England, as described in the Second National Partnership Agreement published earlier this year. A copy is attached.

Included within this work programme is implementation of the blood-borne virus (BBV) opt-out testing programme for people in prisons, which includes testing for Hepatitis C virus infection as well as Hepatitis B virus and HIV.

The ambition is to have BBV opt-out testing in all adult prisons in England by end of the financial year 2016-17.

While there are currently no financial incentives or direct performance targets, performance in this activity is measured by NHS England through the collection of data via the Health & Justice Indicators of Performance. The data are used by NHS England commissioners to performance manage healthcare providers in prisons.

NHS England has not, to date, undertaken a direct comparison of the English and French health systems in respect of genetic testing practice for cancer.

NHS England does not hold data on the percentage of stage 2b, or higher, cancer patients in secondary and tertiary centres who were genetically tested. Detailed information on the clinical circumstances, or reasons, for referral for genetic testing for individual patients is not currently collated on a national basis.

NHS England does not consider business cases from individual National Health Service trusts in relation to the adoption of new genetic tests. Instead, NHS England considers national clinical commissioning policy proposals on the eligibility of a particular test, or treatments to be made available in the presence of particular genetic markers. These are considered and where agreed, funded consistently across England for services falling within NHS England's direct commissioning responsibilities.

Examples include the separate policies (published in July 2015) confirming eligibility for Ivacaftor for the treatment of cystic fibrosis in the presence of certain gene mutations, and confirming eligibility for testing for BRCA1 and BRCA2 gene mutations, respectively. Copies of the policies are attached.

In addition, the UK Genetic Testing Network currently presents new genetic testing proposals to NHS England for funding consideration based on the conclusions of their assurance programme. These are considered, alongside other new policy proposals, as part of the annual funding prioritisation process, where there is a net annual investment to be made to support their adoption.

Information on the average turnaround time for cancer genetic tests is not currently collated, or analysed, nationally. However, NHS England will be undertaking a procurement exercise in the coming months to support the strengthened provision of genetic testing across England. This includes more consistent reporting of activity and other performance indicators, including the timeliness of reporting on receipt on referrals. The supporting national service specification, setting out the standards required of commissioned providers, has been the subject of a recent public consultation.

NHS England has not, to date, undertaken a direct comparison of the English and French health systems in respect of genetic testing practice for cancer.

NHS England does not hold data on the percentage of stage 2b, or higher, cancer patients in secondary and tertiary centres who were genetically tested. Detailed information on the clinical circumstances, or reasons, for referral for genetic testing for individual patients is not currently collated on a national basis.

NHS England does not consider business cases from individual National Health Service trusts in relation to the adoption of new genetic tests. Instead, NHS England considers national clinical commissioning policy proposals on the eligibility of a particular test, or treatments to be made available in the presence of particular genetic markers. These are considered and where agreed, funded consistently across England for services falling within NHS England's direct commissioning responsibilities.

Examples include the separate policies (published in July 2015) confirming eligibility for Ivacaftor for the treatment of cystic fibrosis in the presence of certain gene mutations, and confirming eligibility for testing for BRCA1 and BRCA2 gene mutations, respectively. Copies of the policies are attached.

In addition, the UK Genetic Testing Network currently presents new genetic testing proposals to NHS England for funding consideration based on the conclusions of their assurance programme. These are considered, alongside other new policy proposals, as part of the annual funding prioritisation process, where there is a net annual investment to be made to support their adoption.

Information on the average turnaround time for cancer genetic tests is not currently collated, or analysed, nationally. However, NHS England will be undertaking a procurement exercise in the coming months to support the strengthened provision of genetic testing across England. This includes more consistent reporting of activity and other performance indicators, including the timeliness of reporting on receipt on referrals. The supporting national service specification, setting out the standards required of commissioned providers, has been the subject of a recent public consultation.

NHS England has not, to date, undertaken a direct comparison of the English and French health systems in respect of genetic testing practice for cancer.

NHS England does not hold data on the percentage of stage 2b, or higher, cancer patients in secondary and tertiary centres who were genetically tested. Detailed information on the clinical circumstances, or reasons, for referral for genetic testing for individual patients is not currently collated on a national basis.

NHS England does not consider business cases from individual National Health Service trusts in relation to the adoption of new genetic tests. Instead, NHS England considers national clinical commissioning policy proposals on the eligibility of a particular test, or treatments to be made available in the presence of particular genetic markers. These are considered and where agreed, funded consistently across England for services falling within NHS England's direct commissioning responsibilities.

Examples include the separate policies (published in July 2015) confirming eligibility for Ivacaftor for the treatment of cystic fibrosis in the presence of certain gene mutations, and confirming eligibility for testing for BRCA1 and BRCA2 gene mutations, respectively. Copies of the policies are attached.

In addition, the UK Genetic Testing Network currently presents new genetic testing proposals to NHS England for funding consideration based on the conclusions of their assurance programme. These are considered, alongside other new policy proposals, as part of the annual funding prioritisation process, where there is a net annual investment to be made to support their adoption.

Information on the average turnaround time for cancer genetic tests is not currently collated, or analysed, nationally. However, NHS England will be undertaking a procurement exercise in the coming months to support the strengthened provision of genetic testing across England. This includes more consistent reporting of activity and other performance indicators, including the timeliness of reporting on receipt on referrals. The supporting national service specification, setting out the standards required of commissioned providers, has been the subject of a recent public consultation.

NHS England has not, to date, undertaken a direct comparison of the English and French health systems in respect of genetic testing practice for cancer.

NHS England does not hold data on the percentage of stage 2b, or higher, cancer patients in secondary and tertiary centres who were genetically tested. Detailed information on the clinical circumstances, or reasons, for referral for genetic testing for individual patients is not currently collated on a national basis.

NHS England does not consider business cases from individual National Health Service trusts in relation to the adoption of new genetic tests. Instead, NHS England considers national clinical commissioning policy proposals on the eligibility of a particular test, or treatments to be made available in the presence of particular genetic markers. These are considered and where agreed, funded consistently across England for services falling within NHS England's direct commissioning responsibilities.

Examples include the separate policies (published in July 2015) confirming eligibility for Ivacaftor for the treatment of cystic fibrosis in the presence of certain gene mutations, and confirming eligibility for testing for BRCA1 and BRCA2 gene mutations, respectively. Copies of the policies are attached.

In addition, the UK Genetic Testing Network currently presents new genetic testing proposals to NHS England for funding consideration based on the conclusions of their assurance programme. These are considered, alongside other new policy proposals, as part of the annual funding prioritisation process, where there is a net annual investment to be made to support their adoption.

Information on the average turnaround time for cancer genetic tests is not currently collated, or analysed, nationally. However, NHS England will be undertaking a procurement exercise in the coming months to support the strengthened provision of genetic testing across England. This includes more consistent reporting of activity and other performance indicators, including the timeliness of reporting on receipt on referrals. The supporting national service specification, setting out the standards required of commissioned providers, has been the subject of a recent public consultation.

The UK National Screening Committee recently consulted on the use of Faecal Immunochemical testing (FIT) as an alternative screen test for bowel cancer. Initial results of the FIT pilot, indicates that this test is more acceptable to the screened population with a significant increase in participation (10%). This is particularly marked amongst men and disadvantaged groups.

At the end of January 2015, 25 million faecal occult blood test kits had been sent out to men and women aged 60-74 to self-sample at home. Over 15 million kits have been returned by post to one of five regional laboratories (programme hubs). Over 21,000 cancers have been detected and over 122,000 patients have been managed for polyps, including polyp removal.

Public Health England (PHE) Screening held a national workshop engaging various organisations to discuss inequalities in accessing screening programmes.

The national workshop was attended by colleagues from local authorities, the Department of Health, PHE, National Health Service and cancer research UK. The day looked at current knowledge about the extent of inequitable access, what works to improve access for those in deprived and protected groups, how existing levers might best be used and by whom.

NHS Screening Programmes are committed to giving people information to support them to make an informed choice about whether or not to take up the offer of screening. There is a group dedicated to researching, developing and evaluating information for those invited for screening, and service users and providers are involved at all stages.

The NHS Screening Programmes aim to provide clarity in the leaflets and information given to people.

The NHS Screening Programmes will continue to work closely with voluntary sector groups like Jo’s Cervical Cancer Trust and with NHS Choices to help raise awareness of the intentions of the programmes.

NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.

The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.

In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.

There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.

A consensus statement by the NICE Implementation Collaborative was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.

The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in Innovation Health and Wealth, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.

Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.

No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.

Copies of the guidance referred to have been placed in the Library.

All NHS England commissioned secondary and tertiary hospitals will be able to collect blood and/or tissue samples for the purpose of genetic testing, depending on the sampling technique required. The testing itself is however usually undertaken by commissioned genetic laboratories, which will typically serve a catchment area much greater than the hospital in which they are based. There will usually be recommended criteria in place to guide National Health Service referrals for genetic testing.

In a small number of cases, usually for very rare conditions, a test may need to be sent away to a non commissioned laboratory, including some abroad and some falling within the private sector, to access expertise. Funding will, however, continue to be provided from NHS budgets.

The United Kingdom is also leading the world by using cutting edge technology in the form of whole genome sequencing to transform healthcare and health research. The Prime Minister launched the 100,000 Genomes Project to bring the benefits of genome sequencing to NHS patients. The Project will sequence 100,000 whole human genomes of NHS patients with cancer or a rare disease by the end of 2017. Eleven Genomic Medicine Centres have been established across the country and are recruiting patients to this landmark project. Otherwise, NHS England does not hold data on private or self-funded care or testing commissioned from either NHS or third party laboratories.

Information on the percentage of eligible patients who received access to genetic testing is not held by NHS England. Due to data protection requirements, detailed data on the reasons for referral for specific tests are not currently aggregated at national level.

All NHS England commissioned secondary and tertiary hospitals will be able to collect blood and/or tissue samples for the purpose of genetic testing, depending on the sampling technique required. The testing itself is however usually undertaken by commissioned genetic laboratories, which will typically serve a catchment area much greater than the hospital in which they are based. There will usually be recommended criteria in place to guide National Health Service referrals for genetic testing.

In a small number of cases, usually for very rare conditions, a test may need to be sent away to a non commissioned laboratory, including some abroad and some falling within the private sector, to access expertise. Funding will, however, continue to be provided from NHS budgets.

The United Kingdom is also leading the world by using cutting edge technology in the form of whole genome sequencing to transform healthcare and health research. The Prime Minister launched the 100,000 Genomes Project to bring the benefits of genome sequencing to NHS patients. The Project will sequence 100,000 whole human genomes of NHS patients with cancer or a rare disease by the end of 2017. Eleven Genomic Medicine Centres have been established across the country and are recruiting patients to this landmark project. Otherwise, NHS England does not hold data on private or self-funded care or testing commissioned from either NHS or third party laboratories.

Information on the percentage of eligible patients who received access to genetic testing is not held by NHS England. Due to data protection requirements, detailed data on the reasons for referral for specific tests are not currently aggregated at national level.

All NHS England commissioned secondary and tertiary hospitals will be able to collect blood and/or tissue samples for the purpose of genetic testing, depending on the sampling technique required. The testing itself is however usually undertaken by commissioned genetic laboratories, which will typically serve a catchment area much greater than the hospital in which they are based. There will usually be recommended criteria in place to guide National Health Service referrals for genetic testing.

In a small number of cases, usually for very rare conditions, a test may need to be sent away to a non commissioned laboratory, including some abroad and some falling within the private sector, to access expertise. Funding will, however, continue to be provided from NHS budgets.

The United Kingdom is also leading the world by using cutting edge technology in the form of whole genome sequencing to transform healthcare and health research. The Prime Minister launched the 100,000 Genomes Project to bring the benefits of genome sequencing to NHS patients. The Project will sequence 100,000 whole human genomes of NHS patients with cancer or a rare disease by the end of 2017. Eleven Genomic Medicine Centres have been established across the country and are recruiting patients to this landmark project. Otherwise, NHS England does not hold data on private or self-funded care or testing commissioned from either NHS or third party laboratories.

Information on the percentage of eligible patients who received access to genetic testing is not held by NHS England. Due to data protection requirements, detailed data on the reasons for referral for specific tests are not currently aggregated at national level.

All NHS England commissioned secondary and tertiary hospitals will be able to collect blood and/or tissue samples for the purpose of genetic testing, depending on the sampling technique required. The testing itself is however usually undertaken by commissioned genetic laboratories, which will typically serve a catchment area much greater than the hospital in which they are based. There will usually be recommended criteria in place to guide National Health Service referrals for genetic testing.

In a small number of cases, usually for very rare conditions, a test may need to be sent away to a non commissioned laboratory, including some abroad and some falling within the private sector, to access expertise. Funding will, however, continue to be provided from NHS budgets.

The United Kingdom is also leading the world by using cutting edge technology in the form of whole genome sequencing to transform healthcare and health research. The Prime Minister launched the 100,000 Genomes Project to bring the benefits of genome sequencing to NHS patients. The Project will sequence 100,000 whole human genomes of NHS patients with cancer or a rare disease by the end of 2017. Eleven Genomic Medicine Centres have been established across the country and are recruiting patients to this landmark project. Otherwise, NHS England does not hold data on private or self-funded care or testing commissioned from either NHS or third party laboratories.

Information on the percentage of eligible patients who received access to genetic testing is not held by NHS England. Due to data protection requirements, detailed data on the reasons for referral for specific tests are not currently aggregated at national level.

All NHS England commissioned secondary and tertiary hospitals will be able to collect blood and/or tissue samples for the purpose of genetic testing, depending on the sampling technique required. The testing itself is however usually undertaken by commissioned genetic laboratories, which will typically serve a catchment area much greater than the hospital in which they are based. There will usually be recommended criteria in place to guide National Health Service referrals for genetic testing.

In a small number of cases, usually for very rare conditions, a test may need to be sent away to a non commissioned laboratory, including some abroad and some falling within the private sector, to access expertise. Funding will, however, continue to be provided from NHS budgets.

The United Kingdom is also leading the world by using cutting edge technology in the form of whole genome sequencing to transform healthcare and health research. The Prime Minister launched the 100,000 Genomes Project to bring the benefits of genome sequencing to NHS patients. The Project will sequence 100,000 whole human genomes of NHS patients with cancer or a rare disease by the end of 2017. Eleven Genomic Medicine Centres have been established across the country and are recruiting patients to this landmark project. Otherwise, NHS England does not hold data on private or self-funded care or testing commissioned from either NHS or third party laboratories.

Information on the percentage of eligible patients who received access to genetic testing is not held by NHS England. Due to data protection requirements, detailed data on the reasons for referral for specific tests are not currently aggregated at national level.

Self-testing and self-sampling kits have an important part to play in the detection of a number of conditions provided they are used in conjunction with advice from a healthcare professional.

To be placed on the market in the United Kingdom, they must satisfy the necessary requirements of European Union legislation.

UK microbiology laboratories that do not use Standards for Microbiological Investigations (SMIs) should be able to demonstrate at least equivalence in their testing methodologies to the relevant accreditation body. Public Health England is not an accrediting body in these circumstances therefore we do not hold information as to what tests are deemed to be equivalent to UK SMI B58.

UK SMIs are not mandatory and Public Health England does not have data as to how many laboratories, National Health Service or otherwise use UK SMI B58 or equivalent testing for detecting Group B Strep.

SMIs are intended as a general resource for practising professionals operating in the field of laboratory medicine and infection specialties in the United Kingdom.

SMIs help laboratories to meet accreditation requirements by promoting high quality practices which are auditable.