Improving access to cancer screening programmes is one of NHS England’s key priorities. To help deliver this, plans for improving uptake in cancer screening during 2019-20 have been developed and shared with regional Public Health Commissioning leads for consideration and action. Plans cover opportunities for improving access that can be implemented locally and regionally in collaboration with charities, third sector organisations, and other parts of the National Health Service. These opportunities include:

Increasing flexibility within existing services (e.g. extending out of hours appointments and making greater use of mobile screening units); and

Improving accessibility to cancer screening via alternative settings (e.g. integrated in sexual health clinics).

In addition to this, Professor Richards’ review of national adult screening programmes, published on 16 October, made a number of recommendations on increasing uptake and accessibility, including how we use financial incentives to promote out of hours and weekend appointments. Professor Richards called for more convenience with regard to screenings, saying patients should be able to choose appointments close to their work, and local screening services should put on extra evening and weekend appointments for breast, cervical and other cancer checks. The report also called for more to be done to drive uptake through social media campaigns and text reminders. The Department, NHS England and Public Health England will consider the recommendations of Professor Richards’ report and publish an implementation plan early next year.

The Department, NHS England and Public Health England (PHE) are committed to increasing the proportion of invites for National Health Service cancer screening appointments that are accepted, through increasing uptake and making appointments more accessible. NHS cancer screening programmes cover breast, bowel and cervical cancer.

PHE’s ‘Be Clear on Cancer’ and ‘Cervical Screening Saves Lives’ campaigns use social media and online platforms to increase awareness of cancer symptoms and the importance of screening and thereby improve attendance at cancer screening appointments. The ‘Cervical Screening Saves Lives’ campaign encouraged women to respond to their cervical screening invitation letter, and if they missed their last screening, to book an appointment at their general practitioner practice. The campaign also provided practical information about how to make the test more comfortable, which could also improve attendance.

In addition to this, Professor Richards’ review of national adult screening programmes, published on 16 October, made a number of recommendations on using technology to improve attendance. These recommendations included rolling-out text reminders nationally that have been successfully piloted at a local level and improving functionality of the screening IT systems to support improvements in uptake and coverage. The Department, NHS England and PHE will carefully consider the recommendations in Professor Richards’ report and publish an implementation plan in due course.

Information on how many and what proportion of women with a disability have attended cervical cancer screening through the National Health Service is not held centrally by NHS England.

The latest uptake figures for cervical cancer screening show that 71.7% of the eligible population, or 3.2 million women, were screened for cervical cancer in 2017–18.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

Prevention is key in the fight against breast cancer and increasing the proportion of women that accept their invitation and attend their breast screening appointments saves lives. NHS England is continuing to invest in initiatives to help ensure equality of access to screening, including through locally targeted interventions to understand and address a range of issues.

In supporting NHS England, Public Health England (PHE) has undertaken a review of effective interventions to encourage uptake and included those in the Breast Screening Service Specifications. These specifications set out the service and quality indicators and expectations to ensure that a high standard of service is provided. Examples include ensuring breast screening services offer second timed appointments; and the importance of commissioners and providers working with local authority colleagues to understand local cultural/ethnic and travelling issues.

PHE has worked on the information provided to women when breast screening is offered. The new ‘Breast Screening: Easy Guide’, along with local initiatives such as text and general practitioner reminders, are some of the ways the programme is getting the information to women so they can decide whether screening is right for them.

NHS England is investing in initiatives to help ensure equality of access to screening. These include locally-targeted interventions such as text and general practitioners (GP) reminders.

As part of the delivery of the GP Five Year Forward View, the NHS has invested more than £258 million this year to improve access to general practice, including improved access to all routine appointments (including screening) at weekends and/or evenings.

The UK National Screening Committee recently reviewed the evidence for self-sampling as part of the programme modifications to the NHS Cervical Screening programme, to support non-attendance and access. The Committee will submit its recommendations shortly.

In addition, Professor Sir Mike Richards, as part of his review which was commissioned by NHS England to review screening programmes in England, will further consider ways to increase uptake of and access to cervical screening.

NHS England is taking steps to make sure the delivery, performance and oversight of screening services meet the high standard National Health Service patients rightly expect. This includes moving samples around the country to reduce the burden on those laboratories most under pressure.

Unpublished management data has also shown a significant improvement in turnaround times in the last quarter of 2018/19, therefore it is expected that as the proportion of women benefitting from HPV primary screening continues to increase, waiting times for smear test results will reduce.

Nevertheless, the 14-day turnaround time for test results to be provided remains a vital target for the NHS Cervical Screening Programme.

There has been a steady rise in coverage in the National Health Service Infectious Diseases in Pregnancy Screening programme, from 96% in 2010 to 99% in 2016 in England.

Coverage for University Hospitals Coventry and Warwickshire NHS Trust was 99.4% (5,960/5,994), both attaining the achievable level for a screening programme (acceptable threshold greater than or equal to 95% / achievable threshold greater than or equal to 99%).

NHS England is responsible for commissioning antenatal screening services to meet programme standards including coverage. NHS England is working with providers to help identify and address any issues and is committed to improving coverage and reducing morbidity from this condition. It is important to note that the aim of antenatal screening is not to promote uptake but to ensure that eligible women are able to make an informed choice as to whether to participate in screening or not.

Screening for sickle cell and thalassaemia are carried out jointly as a blood test. The programme identifies people who are genetic carriers for sickle cell, thalassaemia and other haemoglobin disorders.

Between 1 April 2016 and 31 March 2017 Coventry and Warwickshire NHS Trusts had 5,925 women tested out of 5,989 eligible women (98.9% uptake).

Between 1 April 2016 and 31 March 2017 the West Midlands had 57,578 women tested out of 58,093 eligible women (99.1% uptake).

During 2016/17 the national average for screening uptake in England was 99.3%.

Further information is available at:

https://www.gov.uk/government/publications/nhs-screening-programmes-kpi-reports-and-briefings-2016-to-2017

NHS England is responsible for commissioning antenatal screening services to meet programme standards including coverage. NHS England is working with providers to help identify and address any issues and is committed to improving coverage and reducing morbidity from this condition.

Screening is offered and recommended to all pregnant women in England as part of the United Kingdom National Screening Committee’s National Health Service Infectious Disease in Pregnancy Screening (IDPS) Programme. The aim of antenatal screening is not to promote uptake but to ensure that eligible women are able to make an informed choice as to whether to participate in screening or not.

Coverage is measured in the IDPS programme and reports a steady increase in the number of eligible women taking up the offer to be screened. This has risen from 96% in 2010 to 99% in 2016 in England. Further information is available at:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/583576/hpr0217_naism.pdf

Midwives and healthcare professionals offer screening to all pregnant women as part of their antenatal care package. The first offer to screen is at the start of the pregnancy and then a second reoffer at around 20 weeks. This is following a recommendation from a HIV expert review panel in response to findings from the Perinatal HIV Audit conducted by the National Study of HIV in Pregnancy and Childhood.

Published data for coverage on screening for IDPS can be viewed at:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/682471/Screening_KPI_SummaryFactsheets_Feb2018_Issue2_V1.1.pdf

The most recent data available is for 2016/17.

During 2016/17 the national average for screening uptake was 58.8%.

The uptake for Coventry was 56.4% (Coventry’s uptake rate is included in the West Midlands figure) and the West Midlands was 57.7% (this is a consolidated percentage based on all regions within the West Midlands).

NHS England is responsible for commissioning bowel screening services to meet programme standards including coverage. NHS England is working with providers to help identify and address any issues and is committed to improving coverage and reducing mortality from bowel cancer.

The most recent data available is for 2016/17 published by NHS Digital. Information for each area is available at:

https://digital.nhs.uk/catalogue/PUB30195

During 2016/17 the national average for breast screening uptake was 71.1%.

The uptake for Coventry was 68.1% (Coventry’s uptake rate is included in the West Midlands figure) and for West Midlands was 71.2% (this is a consolidated percentage based on eight regions within the West Midlands).

NHS England is responsible for commissioning breast screening services to meet programme standards including coverage. NHS England is committed to improving coverage and reducing variation between all age groups and catchment areas.

The most recent data available is for 2016/17.

During 2016/17 the national average for screening uptake was 58.8%.

The uptake for Coventry was 56.4% (Coventry’s uptake rate is included in the West Midlands figure) and West Midlands was 57.7% (this is a consolidated percentage based on all regions within the West Midlands).

NHS England is responsible for commissioning bowel screening services to meet programme standards including coverage. NHS England is working with providers to help identify and address any issues and is committed to improving coverage and reducing mortality from bowel cancer.

Prostate screening is not offered as a population screening programme in the United Kingdom.

The UK National Screening Committee (UK NSC) last reviewed the evidence about screening for prostate cancer in 2016 and recommended against a population screening programme. The reasons for this included that the test which is available for use in screening, Prostate-Specific Antigen, is neither very specific nor very sensitive, and is unable to distinguish between slow-growing and fast-growing cancers; there is therefore a risk that a national screening programme would lead to a high number of false positives. There are major harms of treating men who incorrectly test positive (i.e. have false positive tests), these include impotence, incontinence and rectal problems.

The UK NSC will be reviewing the evidence to screen for prostate cancer later in 2019/20. More information is available at:

https://legacyscreening.phe.org.uk/prostatecancer

NHS England is responsible for commissioning bowel screening services to meet programme standards including coverage. They are committed to improving coverage and reducing mortality from bowel cancer.

The steps taken to increase the uptake of bowel screening include reminders, ensuring that men and women are invited every two years, tailoring information for men and women with learning difficulties and using general practice endorsement of invitation letters in accordance with evidence of effectiveness.

Further information is available here:

https://www.england.nhs.uk/wp-content/uploads/2017/04/service-spec-26.pdf

NHS England is responsible for commissioning breast screening services to meet programme standards including coverage. They are committed to improving coverage and reducing variation between all age groups and catchment areas.

The National Service specification for breast screening requires providers to have systems in place to ensure women who do not respond to the invitation to screen are provided with an opportunity not to miss screening. The efforts to increase the uptake include: reminders, second timed appointments, ensuring that women are invited every three years, and tailored information for women with learning difficulties.

Further information is available here:

https://www.england.nhs.uk/wp-content/uploads/2017/04/service-spec-24.pdf

The National Health Service Cervical Screening Programme measures coverage rather than uptake rate. NHS England is responsible for monitoring the coverage rates for cervical screening in all age groups and is committed to improving coverage and reducing variation between all age groups.

The percentage of coverage for each area requested at the end of 2016-17 is: West Midlands, 71.4%; Coventry, 70.5%.

Cervical cancer screening data for the West Midlands are available here:

https://digital.nhs.uk/catalogue/PUB30134

Data for Coventry are available through the Public Health England Fingertips tool:

http://fingertips.phe.org.uk/profile/cancerservices

The Secretary of State has not received any representation from National Health Service trusts on difficulties experienced in recruiting breast radiologists.