The National Institute for Health Research will launch the expression of interest for the trial to compare universal screening for Group B strep carriage in late pregnancy with usual risk-based care shortly. Following a full Health Technology Assessment board commissioning process, it is anticipated that the pilot phase of the trial will start at the beginning of 2019.

The trial to compare universal screening for Group B Streptococcus (GBS) carriage in late pregnancy with usual risk-based care is not expected to be complete until the end of 2021 at the earliest. We anticipate that the UK National Screening Committee’s scheduled triennial review on GBS will not commence until the findings of the trial are known.

No representations have been made to Ministers, this parliamentary session, regarding meeting stakeholders to discuss Group B Streptococcus (GBS).

Information on GBS in pregnancy is publically available on the NHS Choices website at:

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-infections.aspx

Public Health England (PHE) established enhanced surveillance of infant GBS disease in April 2014, in partnership with St George’s Hospital, the British Paediatric Surveillance Unit and national public health bodies across the United Kingdom and Ireland, in order to assess disease incidence, associated mortality and frequency of established risk factors. Several candidate GBS vaccines are in development and PHE will continue to monitor these. The National Institute for Health Research has recently approved funding for a study on accuracy of a rapid intrapartum test for maternal group B streptococcal colonisation and its potential to reduce antibiotic usage in mothers with risk factors (GBS2). The study is expected to begin this summer.

UK standards for microbiology investigations B58: Detection of carriage of Group B Streptococci, which was updated in June 2015, is publically available on the gov.uk website at:

https://www.gov.uk/government/publications/smi-b-58-processing-swabs-for-group-b-streptococcal-carriage.

The Royal College of Obstetricians and Gynaecologists (RCOG) has produced a Green-top guideline: Prevention of Early-Onset Neonatal Group B Streptococcal Disease. The Green-top guideline provides guidance for obstetricians, midwives and neonatologists on the prevention of early-onset neonatal GBS disease. The first edition was published in 2003 and the second updated edition was published in 2012. A UK audit in partnership with the London School of Hygiene and Tropical Medicine and supported by the Royal College of Midwives was recently carried out by the RCOG. It examined current practice in preventing early-onset neonatal GBS disease by investigating the implementation of the RCOG Green-top guideline (2012 edition) and identified key areas for improvement. The first report was published on 5 March 2015 and found that the majority of obstetric units in the UK have written protocols to prevent early-onset GBS disease in newborn babies. However, there is still variation in practice across units. The second report is due to be published later this year. Further information is available at:

https://www.rcog.org.uk/en/news/rcog-release-new-audit-into-gbs-finds-variation-in-practice-across-obstetric-units/.

The Northern Ireland Executive and Welsh Government are responsible for healthcare in Northern Ireland and Wales, therefore no further information on GBS prevention strategies in these countries is held centrally.

The UK National Screening Committee’s (UK NSC) review of antenatal screening for GBS carriage is due to begin in August 2015. The UK NSC will consider whether its review of the evidence should be undertaken as a systematic review to PRISMA standards or whether a rapid review should be carried out. The timescale for the review process will be available once the UK NSC has made a decision on whether a systematic or rapid review should take place. The review process will include a three month public consultation period which the charity, Group B Strep Support and other interested stakeholder groups and individuals will be able to input into. The UK NSC may take clinical advice from a range of specialists and experts as part of the review process. This may include advice from individuals and groups that were involved in the development of the current guidelines as well as those who were not. This is supported by a public consultation process, which ensures that the review and recommendations of the committee are open and transparent.

No representations have been made to Ministers, this parliamentary session, regarding meeting stakeholders to discuss Group B Streptococcus (GBS).

Information on GBS in pregnancy is publically available on the NHS Choices website at:

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-infections.aspx

Public Health England (PHE) established enhanced surveillance of infant GBS disease in April 2014, in partnership with St George’s Hospital, the British Paediatric Surveillance Unit and national public health bodies across the United Kingdom and Ireland, in order to assess disease incidence, associated mortality and frequency of established risk factors. Several candidate GBS vaccines are in development and PHE will continue to monitor these. The National Institute for Health Research has recently approved funding for a study on accuracy of a rapid intrapartum test for maternal group B streptococcal colonisation and its potential to reduce antibiotic usage in mothers with risk factors (GBS2). The study is expected to begin this summer.

UK standards for microbiology investigations B58: Detection of carriage of Group B Streptococci, which was updated in June 2015, is publically available on the gov.uk website at:

https://www.gov.uk/government/publications/smi-b-58-processing-swabs-for-group-b-streptococcal-carriage.

The Royal College of Obstetricians and Gynaecologists (RCOG) has produced a Green-top guideline: Prevention of Early-Onset Neonatal Group B Streptococcal Disease. The Green-top guideline provides guidance for obstetricians, midwives and neonatologists on the prevention of early-onset neonatal GBS disease. The first edition was published in 2003 and the second updated edition was published in 2012. A UK audit in partnership with the London School of Hygiene and Tropical Medicine and supported by the Royal College of Midwives was recently carried out by the RCOG. It examined current practice in preventing early-onset neonatal GBS disease by investigating the implementation of the RCOG Green-top guideline (2012 edition) and identified key areas for improvement. The first report was published on 5 March 2015 and found that the majority of obstetric units in the UK have written protocols to prevent early-onset GBS disease in newborn babies. However, there is still variation in practice across units. The second report is due to be published later this year. Further information is available at:

https://www.rcog.org.uk/en/news/rcog-release-new-audit-into-gbs-finds-variation-in-practice-across-obstetric-units/.

The Northern Ireland Executive and Welsh Government are responsible for healthcare in Northern Ireland and Wales, therefore no further information on GBS prevention strategies in these countries is held centrally.

The UK National Screening Committee’s (UK NSC) review of antenatal screening for GBS carriage is due to begin in August 2015. The UK NSC will consider whether its review of the evidence should be undertaken as a systematic review to PRISMA standards or whether a rapid review should be carried out. The timescale for the review process will be available once the UK NSC has made a decision on whether a systematic or rapid review should take place. The review process will include a three month public consultation period which the charity, Group B Strep Support and other interested stakeholder groups and individuals will be able to input into. The UK NSC may take clinical advice from a range of specialists and experts as part of the review process. This may include advice from individuals and groups that were involved in the development of the current guidelines as well as those who were not. This is supported by a public consultation process, which ensures that the review and recommendations of the committee are open and transparent.

No representations have been made to Ministers, this parliamentary session, regarding meeting stakeholders to discuss Group B Streptococcus (GBS).

Information on GBS in pregnancy is publically available on the NHS Choices website at:

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-infections.aspx

Public Health England (PHE) established enhanced surveillance of infant GBS disease in April 2014, in partnership with St George’s Hospital, the British Paediatric Surveillance Unit and national public health bodies across the United Kingdom and Ireland, in order to assess disease incidence, associated mortality and frequency of established risk factors. Several candidate GBS vaccines are in development and PHE will continue to monitor these. The National Institute for Health Research has recently approved funding for a study on accuracy of a rapid intrapartum test for maternal group B streptococcal colonisation and its potential to reduce antibiotic usage in mothers with risk factors (GBS2). The study is expected to begin this summer.

UK standards for microbiology investigations B58: Detection of carriage of Group B Streptococci, which was updated in June 2015, is publically available on the gov.uk website at:

https://www.gov.uk/government/publications/smi-b-58-processing-swabs-for-group-b-streptococcal-carriage.

The Royal College of Obstetricians and Gynaecologists (RCOG) has produced a Green-top guideline: Prevention of Early-Onset Neonatal Group B Streptococcal Disease. The Green-top guideline provides guidance for obstetricians, midwives and neonatologists on the prevention of early-onset neonatal GBS disease. The first edition was published in 2003 and the second updated edition was published in 2012. A UK audit in partnership with the London School of Hygiene and Tropical Medicine and supported by the Royal College of Midwives was recently carried out by the RCOG. It examined current practice in preventing early-onset neonatal GBS disease by investigating the implementation of the RCOG Green-top guideline (2012 edition) and identified key areas for improvement. The first report was published on 5 March 2015 and found that the majority of obstetric units in the UK have written protocols to prevent early-onset GBS disease in newborn babies. However, there is still variation in practice across units. The second report is due to be published later this year. Further information is available at:

https://www.rcog.org.uk/en/news/rcog-release-new-audit-into-gbs-finds-variation-in-practice-across-obstetric-units/.

The Northern Ireland Executive and Welsh Government are responsible for healthcare in Northern Ireland and Wales, therefore no further information on GBS prevention strategies in these countries is held centrally.

The UK National Screening Committee’s (UK NSC) review of antenatal screening for GBS carriage is due to begin in August 2015. The UK NSC will consider whether its review of the evidence should be undertaken as a systematic review to PRISMA standards or whether a rapid review should be carried out. The timescale for the review process will be available once the UK NSC has made a decision on whether a systematic or rapid review should take place. The review process will include a three month public consultation period which the charity, Group B Strep Support and other interested stakeholder groups and individuals will be able to input into. The UK NSC may take clinical advice from a range of specialists and experts as part of the review process. This may include advice from individuals and groups that were involved in the development of the current guidelines as well as those who were not. This is supported by a public consultation process, which ensures that the review and recommendations of the committee are open and transparent.

NHS Cancer Screening Programmes gave approval for human papilloma virus (HPV) testing to begin across Sussex and East Surrey (which covers Mid and West Sussex) in early July 2012, and testing commenced on 25 July 2012. In year one of implementation, HPV testing for triage was done on the first occurrence of low grade abnormalities in eligible women routinely invited for screening (women aged 25 to 64), along with HPV test-of-cure for newly treated women with normal or low grade abnormalities six months after treatment. In year two, from July 2013, HPV testing as triage will be extended to all women with low grade abnormalities, and HPV test-of-cure extended to all women treated for abnormalities who have normal or low grade abnormalities six months after treatment.

The pilot of HPV testing as primary screening began in May 2013 at two of the six pilot sites. None of the six pilot sites covers the Mid and West Sussex areas. The pilot will be formally evaluated and, based on the results of the evaluation, HPV testing as primary screening will be rolled out across England. Timetables for this roll-out will be determined once we have the results of the evaluation.

NHS Cancer Screening Programmes gave approval for human papilloma virus (HPV) testing to begin across Sussex and East Surrey (which covers Mid and West Sussex) in early July 2012, and testing commenced on 25 July 2012. In year one of implementation, HPV testing for triage was done on the first occurrence of low grade abnormalities in eligible women routinely invited for screening (women aged 25 to 64), along with HPV test-of-cure for newly treated women with normal or low grade abnormalities six months after treatment. In year two, from July 2013, HPV testing as triage will be extended to all women with low grade abnormalities, and HPV test-of-cure extended to all women treated for abnormalities who have normal or low grade abnormalities six months after treatment.

The pilot of HPV testing as primary screening began in May 2013 at two of the six pilot sites. None of the six pilot sites covers the Mid and West Sussex areas. The pilot will be formally evaluated and, based on the results of the evaluation, HPV testing as primary screening will be rolled out across England. Timetables for this roll-out will be determined once we have the results of the evaluation.

At its meeting on 24 November 2011, the Advisory Committee on Cervical Screening recommended that there was enough evidence for a proposal of a pilot of human papillomavirus (HPV) testing as primary screening to go to the UK National Screening Committee. At its meeting on 25 April 2012, the UK National Screening Committee gave support for a pilot to assess the value of using HPV testing as the primary screen for cervical disease.

As set out in the second annual report of “Improving Outcomes: A Strategy for Cancer” in December 2012, six cervical screening sites will begin piloting HPV testing as primary screening shortly. The pilot sites are Liverpool; Manchester; Northwick Park, London; Bristol; Sheffield and Norwich.

At its meeting on 24 November 2011, the Advisory Committee on Cervical Screening recommended that there was enough evidence for a proposal of a pilot of human papillomavirus (HPV) testing as primary screening to go to the UK National Screening Committee. At its meeting on 25 April 2012, the UK National Screening Committee gave support for a pilot to assess the value of using HPV testing as the primary screen for cervical disease.

As set out in the second annual report of “Improving Outcomes: A Strategy for Cancer” in December 2012, six cervical screening sites will begin piloting HPV testing as primary screening shortly. The pilot sites are Liverpool; Manchester; Northwick Park, London; Bristol; Sheffield and Norwich.

“Improving Outcomes: A Strategy for Cancer” (January 2011) makes clear the important role that cervical screening plays in preventing cervical cancer. The strategy also notes that some groups and communities are not accessing cancer screening services. To encourage all eligible women aged 25 to 64 to make the important

decision to attend routine cervical screening, we are working with NHS Cancer Screening Programmes, the Advisory Committee on Cervical Screening and stakeholders to refine the information we provide to women when they are invited for screening so all are fully supported to make an informed choice to attend.

To tackle low uptake among women aged 25-29, the National Institute for Health Research Health Technology Assessment programme has commissioned a study costing over £1 million to determine which interventions are effective at increasing screening uptake amongst women receiving their first invitation from the NHS Cervical Screening Programme. The “Strategies to increase cervical screening uptake at first invitation (STRATEGIC)” study is trialling interventions such as a pre-invitation leaflet; internet appointment booking; timed appointments; the provision of personal support through nurse navigators; and human papillomavirus self-sampling. The study began in November 2011 and is due to run until October 2015.

On 26 January 2012, NHS Cancer Screening Programmes and Jo's Cervical Cancer Trust jointly held an event at the King's Fund looking at challenges to screening uptake among black and minority ethnic (BME) communities. The meeting updated attendees on current data about challenges to improve screening uptake among BME groups and offered an opportunity to share best practice. Documents and links from the event have been circulated to all attendees to help promote information on cervical screening in their respective communities. This was the second such meeting. The National Cancer Action Team, in partnership with BME charities and faith communities, is piloting a targeted approach to raise awareness about cancer and increase screening uptake among BME communities. As part of the Cancer Does Not Discriminate campaign, the pilot, which is due to end in March 2013, is using commercial radio, targeted and tailored information, and direct awareness raising events.

NHS Cancer Screening Programmes has funded an award winning campaign targeting lesbian and bisexual women in the north west of England to raise awareness about the need to attend for regular cervical screening tests. The Lesbian and Gay Foundation's Are You Ready for Your Screen Test? campaign was the winner of the Jo's Cervical Cancer Trust 2011 Cervical Screening Award. This is now being rolled out across the country.

From April 2011, in agreement with the General Practitioners (GPs) Committee of the British Medical Association, we amended the existing Directed Enhanced Service arrangements to provide practices with additional flexibilities for them to offer patients appointments at more convenient times to see a general practitioner or nurse within their practice. The Quality and Outcomes Framework for GP practices also includes incentives for practices to achieve high uptake levels in cervical screening. Cervical screening coverage is also an indicator in the Public Health Outcomes Framework.

“Improving Outcomes: A Strategy for Cancer” (January 2011) makes clear the important role that cervical screening plays in preventing cervical cancer. The strategy also notes that some groups and communities are not accessing cancer screening services. To encourage all eligible women aged 25 to 64 to make the important

decision to attend routine cervical screening, we are working with NHS Cancer Screening Programmes, the Advisory Committee on Cervical Screening and stakeholders to refine the information we provide to women when they are invited for screening so all are fully supported to make an informed choice to attend.

To tackle low uptake among women aged 25-29, the National Institute for Health Research Health Technology Assessment programme has commissioned a study costing over £1 million to determine which interventions are effective at increasing screening uptake amongst women receiving their first invitation from the NHS Cervical Screening Programme. The “Strategies to increase cervical screening uptake at first invitation (STRATEGIC)” study is trialling interventions such as a pre-invitation leaflet; internet appointment booking; timed appointments; the provision of personal support through nurse navigators; and human papillomavirus self-sampling. The study began in November 2011 and is due to run until October 2015.

On 26 January 2012, NHS Cancer Screening Programmes and Jo's Cervical Cancer Trust jointly held an event at the King's Fund looking at challenges to screening uptake among black and minority ethnic (BME) communities. The meeting updated attendees on current data about challenges to improve screening uptake among BME groups and offered an opportunity to share best practice. Documents and links from the event have been circulated to all attendees to help promote information on cervical screening in their respective communities. This was the second such meeting. The National Cancer Action Team, in partnership with BME charities and faith communities, is piloting a targeted approach to raise awareness about cancer and increase screening uptake among BME communities. As part of the Cancer Does Not Discriminate campaign, the pilot, which is due to end in March 2013, is using commercial radio, targeted and tailored information, and direct awareness raising events.

NHS Cancer Screening Programmes has funded an award winning campaign targeting lesbian and bisexual women in the north west of England to raise awareness about the need to attend for regular cervical screening tests. The Lesbian and Gay Foundation's Are You Ready for Your Screen Test? campaign was the winner of the Jo's Cervical Cancer Trust 2011 Cervical Screening Award. This is now being rolled out across the country.

From April 2011, in agreement with the General Practitioners (GPs) Committee of the British Medical Association, we amended the existing Directed Enhanced Service arrangements to provide practices with additional flexibilities for them to offer patients appointments at more convenient times to see a general practitioner or nurse within their practice. The Quality and Outcomes Framework for GP practices also includes incentives for practices to achieve high uptake levels in cervical screening. Cervical screening coverage is also an indicator in the Public Health Outcomes Framework.

“Improving Outcomes: A Strategy for Cancer” (January 2011) makes clear the important role that cervical screening plays in preventing cervical cancer. The strategy also notes that some groups and communities are not accessing cancer screening services. To encourage all eligible women aged 25 to 64 to make the important

decision to attend routine cervical screening, we are working with NHS Cancer Screening Programmes, the Advisory Committee on Cervical Screening and stakeholders to refine the information we provide to women when they are invited for screening so all are fully supported to make an informed choice to attend.

To tackle low uptake among women aged 25-29, the National Institute for Health Research Health Technology Assessment programme has commissioned a study costing over £1 million to determine which interventions are effective at increasing screening uptake amongst women receiving their first invitation from the NHS Cervical Screening Programme. The “Strategies to increase cervical screening uptake at first invitation (STRATEGIC)” study is trialling interventions such as a pre-invitation leaflet; internet appointment booking; timed appointments; the provision of personal support through nurse navigators; and human papillomavirus self-sampling. The study began in November 2011 and is due to run until October 2015.

On 26 January 2012, NHS Cancer Screening Programmes and Jo's Cervical Cancer Trust jointly held an event at the King's Fund looking at challenges to screening uptake among black and minority ethnic (BME) communities. The meeting updated attendees on current data about challenges to improve screening uptake among BME groups and offered an opportunity to share best practice. Documents and links from the event have been circulated to all attendees to help promote information on cervical screening in their respective communities. This was the second such meeting. The National Cancer Action Team, in partnership with BME charities and faith communities, is piloting a targeted approach to raise awareness about cancer and increase screening uptake among BME communities. As part of the Cancer Does Not Discriminate campaign, the pilot, which is due to end in March 2013, is using commercial radio, targeted and tailored information, and direct awareness raising events.

NHS Cancer Screening Programmes has funded an award winning campaign targeting lesbian and bisexual women in the north west of England to raise awareness about the need to attend for regular cervical screening tests. The Lesbian and Gay Foundation's Are You Ready for Your Screen Test? campaign was the winner of the Jo's Cervical Cancer Trust 2011 Cervical Screening Award. This is now being rolled out across the country.

From April 2011, in agreement with the General Practitioners (GPs) Committee of the British Medical Association, we amended the existing Directed Enhanced Service arrangements to provide practices with additional flexibilities for them to offer patients appointments at more convenient times to see a general practitioner or nurse within their practice. The Quality and Outcomes Framework for GP practices also includes incentives for practices to achieve high uptake levels in cervical screening. Cervical screening coverage is also an indicator in the Public Health Outcomes Framework.

The UK National Screening Committee (UK NSC) advises Ministers and the national health service in all four United Kingdom countries about all aspects of screening policy, including screening policy for group B streptococcus (GBS) carriage in pregnancy. In 2008-09 the UK NSC recommended that a national screening programme to test for GBS carriage in pregnancy using the enriched culture medium test should not be offered.

The UK NSC is currently reviewing the evidence for screening for GBS carriage in pregnancy, a public consultation on the screening review opened on 16 July 2012 and will close on 23 October 2012. As part of the consultation, Group B Streptococcus Support's report, ‘Screening will save newborn lives: A case for the

introduction of routine screening for group B streptococcus in late pregnancy’ will be discussed by the UK NSC. The Department expects to receive a recommendation from the UK NSC in the autumn.

The Royal College of Obstetricians and Gynaecologists (RCOG) published on 18 July 2012 a revised Green-Top guideline, originally published in November 2003, to take into account any new evidence on the prevention of early-onset neonatal GBS disease. In addition, the National Institute for Health and Clinical Excellence (NICE) published a new guideline on antibiotics for the prevention and treatment of early-onset neonatal infection, including GBS on 22 August 2012.

National guidelines are developed to set the standards for high quality health care. In the prevention of early onset GBS disease, local maternity services should develop local guidelines (based on the RCOG's and NICE'S national guideline) which all medical and midwifery staff would be expected to follow. The implementation of all guidelines should be audited regularly to confirm compliance and formulate an action plan for change in areas such as service.

The RCOG has produced patient information, ‘Preventing group B streptococcus infection in newborn babies (information for you)’, for women and their families who are expecting a baby or are planning to get pregnant. Advice from that guidance also features on the NHS Choices website.

The UK National Screening Committee (UK NSC) advises Ministers and the national health service in all four United Kingdom countries about all aspects of screening policy, including screening policy for group B streptococcus (GBS) carriage in pregnancy. In 2008-09 the UK NSC recommended that a national screening programme to test for GBS carriage in pregnancy using the enriched culture medium test should not be offered.

The UK NSC is currently reviewing the evidence for screening for GBS carriage in pregnancy, a public consultation on the screening review opened on 16 July 2012 and will close on 23 October 2012. As part of the consultation, Group B Streptococcus Support's report, ‘Screening will save newborn lives: A case for the

introduction of routine screening for group B streptococcus in late pregnancy’ will be discussed by the UK NSC. The Department expects to receive a recommendation from the UK NSC in the autumn.

The Royal College of Obstetricians and Gynaecologists (RCOG) published on 18 July 2012 a revised Green-Top guideline, originally published in November 2003, to take into account any new evidence on the prevention of early-onset neonatal GBS disease. In addition, the National Institute for Health and Clinical Excellence (NICE) published a new guideline on antibiotics for the prevention and treatment of early-onset neonatal infection, including GBS on 22 August 2012.

National guidelines are developed to set the standards for high quality health care. In the prevention of early onset GBS disease, local maternity services should develop local guidelines (based on the RCOG's and NICE'S national guideline) which all medical and midwifery staff would be expected to follow. The implementation of all guidelines should be audited regularly to confirm compliance and formulate an action plan for change in areas such as service.

The RCOG has produced patient information, ‘Preventing group B streptococcus infection in newborn babies (information for you)’, for women and their families who are expecting a baby or are planning to get pregnant. Advice from that guidance also features on the NHS Choices website.