The UK National Screening Committee has not been asked to look at frailty as a screening programme and no specific assessment has been made of the potential impact of York Frailty Hub on the Department's screening and prevention agenda.

The provision of frailty health care services is the responsibility of local integrated care boards (ICBs), and may include services like the York Frailty Hub, which contain an element of frailty prevention. We expect ICBs to commission services based on local population needs, taking account of National Institute for Health and Care Excellence guidelines.

The 10-Year Health Plan sets out how we will work towards a Neighbourhood Health Service, which will give us a significant opportunity to radically change how resources are deployed across health, social care, and wider services in local communities. There needs to be a stronger focus on prevention and early intervention, both to improve outcomes for people and to reduce pressure on both National Health Service and local government services.

We will also deliver the first ever Frailty and Dementia Modern Service Framework to deliver rapid and significant improvements in quality of care and productivity. This will be informed by phase one of the independent commission into adult social care, which is expected this year. The Frailty and Dementia Modern Service Framework will seek to reduce unwarranted variation and narrow inequality for those living with dementia and will set national standards for dementia care and redirect NHS priorities to provide the best possible care and support.

Health checks throughout all stages of life are important, from ensuring the best start in life, through five health and development reviews before a child reaches two and a half years old, to 12 screening programmes from birth through to adulthood that help identify and protect people from a range of diseases, including cancer. In addition, through the NHS Health Check, all eligible people aged 40 to 74 years old are invited to have a cardiovascular disease check every five years. The Government has extended heart health checks to over 130,000 people in their workplaces, to make checks more accessible.

Women at very high risk (VHR) of breast cancer are eligible to be screened from the age of 25 years old upwards, and should be invited every year. The screening includes mammography or magnetic resonance imaging (MRI), depending on age and risk criteria.

In March, NHS England wrote to a small number of VHR women who had not been referred for annual MRI surveillance, and the National Health Service has been working hard to ensure these women are checked as a matter of urgency, as described in their individual letters. To support screening of VHR women, a new central database is planned to ensure all referrals reach NHS breast screening services.

The Government is committed to improving uptake in all screening programmes, including for breast, bowel, and cervical screening. There is no national screening programme for prostate cancer. The improvement in cancer screening programmes is not predicated on a specific timeline, but is focusing on targeting specific groups where uptake is low.

NHS England has developed a national improvement plan in collaboration with key stakeholders to improve uptake within the breast screening programme. This plan will encompass a series of evaluative projects, which are expected to report in April 2024

A range of improvements and innovations have been brought in to help improve uptake in the NHS Cervical Screening Programme. For example, appointments are being made available during evenings and weekends, and in some areas cervical screening appointments can be made in any primary care setting, rather than just at one’s own general practice.

In addition, we are also working to test the effectiveness of human papillomavirus infection self-sampling as a primary cervical screening option, with individuals taking their own cervical screening sample. The findings from this evaluation will be used to inform a UK National Screening Committee recommendation, and it is expected that self-sampling could lead to an increase in uptake as it will reduce some of the barriers that prevent people from attending a screening.

Uptake in the NHS Bowel Cancer Screening Programme is currently above the achievable threshold of 60%, between 1 July and 30 September 2023 it was 67.4%, and therefore the focus for this screening programme is on gradually reducing the age of the eligible cohort from 60 years old down to 50 years old, to increase to numbers eligible for this programme.

The Government is committed to improving uptake in all screening programmes, including for breast, bowel, and cervical screening. There is no national screening programme for prostate cancer. The improvement in cancer screening programmes is not predicated on a specific timeline, but is focusing on targeting specific groups where uptake is low.

NHS England has developed a national improvement plan in collaboration with key stakeholders to improve uptake within the breast screening programme. This plan will encompass a series of evaluative projects, which are expected to report in April 2024

A range of improvements and innovations have been brought in to help improve uptake in the NHS Cervical Screening Programme. For example, appointments are being made available during evenings and weekends, and in some areas cervical screening appointments can be made in any primary care setting, rather than just at one’s own general practice.

In addition, we are also working to test the effectiveness of human papillomavirus infection self-sampling as a primary cervical screening option, with individuals taking their own cervical screening sample. The findings from this evaluation will be used to inform a UK National Screening Committee recommendation, and it is expected that self-sampling could lead to an increase in uptake as it will reduce some of the barriers that prevent people from attending a screening.

Uptake in the NHS Bowel Cancer Screening Programme is currently above the achievable threshold of 60%, between 1 July and 30 September 2023 it was 67.4%, and therefore the focus for this screening programme is on gradually reducing the age of the eligible cohort from 60 years old down to 50 years old, to increase to numbers eligible for this programme.

The NHS Vaccine Strategy, Shaping the future delivery of NHS vaccination services, published in December 2023, sets out that vaccination is a public health opportunity to integrate the delivery of vaccinations with wider person-centred healthcare services, planned and delivered by neighbourhood teams. It advises integrated care systems (ICSs) to structure the delivery of vaccinations via the neighbourhood teams to maximise uptake of other preventative services, as well as vaccination uptake. There are no plans to make a specific assessment of the potential merits of offering a health check alongside annual vaccinations.

NHS England commissions screening programmes, including for Abdominal Aortic Aneurysm (AAA). NHS England collects uptake data for the AAA screening programme, for coverage of the initial scan, coverage of the quarterly surveillance scan, for men with a medium aneurysm, and coverage of the annual surveillance scan, for men with a small aneurysm. NHS England publishes quarterly Key Performance Indicator reports, and an Annual Standards Report, both of which are available at the respective links below:

https://www.gov.uk/government/collections/nhs-population-screening-programmes-kpi-reports

https://www.gov.uk/government/statistics/abdominal-aortic-aneurysm-screening-standards-report-2022-to-2023/aaa-standards-report-2022-to-2023

NHS England is working to improve uptake, including for men at greatest risk, as data shows that men living in more deprived areas are at greater risk from having an AAA. In addition, the Department has published guidance on reducing inequalities in the AAA programme, which is available at the following link:

https://www.gov.uk/government/publications/abdominal-aortic-aneurysm-screening-reducing-inequalities/reducing-inequalities

Health education is mandated from key stages one to four. One of its overarching objectives is teaching pupils about physical health and mental wellbeing, to give them the information that they need to make good decisions about their own health and wellbeing. This should enable them to recognise what is normal and what is an issue in themselves, and when issues arise, how to seek support as early as possible from appropriate sources.

The Government is working with the National Health Service to support earlier diagnosis of liver disease and the identification of patients at risk. This includes plans agreed as part of the £2.3 billion of diagnostics transformation programme funding, to upgrade laboratory digital capabilities to ensure that labs across the country have the capability required to offer Intelligent Liver Function Tests.

Over the coming year, NHS England is due to pilot a new diagnostic pathway for liver disease, which will include fibrosis scanning in community diagnostic centres. The Government looks forward to seeing the results of that pilot.

Decisions on the use of diagnostic tests for individual patients both under and over 16 years old, are the responsibility of a referring clinician or a healthcare professional, where delegated, taking into account local priorities and clinical guidance.

Alcohol-related liver disease is relatively uncommon in patients under 16 years old as it usually results from several years of heavy drinking. There are no National Institute for Health and Care Excellence (NICE) guidelines and guidance, recommending the use of liver and blood tests for young people.

NICE has made the following recommendations about the use of liver and blood tests for patients over 16 years old: for adults referred to specialist alcohol services, it recommends considering blood tests to help identify physical health needs, but to not use blood tests routinely for the identification and diagnosis of alcohol use disorders; and it recommends liver testing for all men who regularly drink more than 50 units of alcohol per week or women who drink more than 35 units per week. However, routine liver blood tests should not be used to rule out liver fibrosis and cirrhosis.

NHS England is currently reviewing existing liver diagnosis pathways as part of its wider diagnostic transformation work, to determine what the best approach should be to identify patients at an earlier stage of liver disease, through a liver pathway starting in primary care and involving pathology labs and community diagnostic centres. This will likely include a combination of blood tests and transient elastography.

No specific assessment has been made. At present, there are no plans to expand the seven conditions covered by Pharmacy First.

Asylum seekers and their dependants are exempt from charges for primary care services. The NHS England Standard Contract Service Condition 13 for screening providers outlines the contractual requirements for equity of access to services, equality, and the avoidance of discrimination.

To this end, the NHS England screening service specifications set out that local screening providers should have procedures in place to identify and support people who are considered vulnerable or underserved, including asylum seekers.

1,241,038 people have been invited for a lung cancer check, as part of the biggest programme to improve early lung cancer diagnosis in the history of the National Health Service. The Targeted Lung Health Check uses vans parked in supermarkets or sports stadium car parks. Risk assessments are often carried out over the phone.

The national targeted lung cancer screening programme will implement a standard IT system that will ensure consistent call and recall so that people are invited regularly.

Sepsis can be a devastating condition and patients rightly expect the NHS to be able to recognise, diagnose and treat it early. Clinicians are supported to recognise sepsis by using the National Early Warning Score (NEWS2), now used in 98% of acute trusts and 100% of ambulance trusts in England.

Building on the latest evidence from the Academy of Medical Royal Colleges, the National Institute of Health and Care Excellence (NICE) will publish updated national sepsis guidance in January 2024 reflecting a targeted and measured approach to the antimicrobial treatment and management of sepsis.

No assessment has been made. The lung cancer screening programme is a targeted screening programme for people aged between 55 and 74 years old identified as being at high risk of lung cancer. Any proposals to modify a screening programme, such as adding an additional condition to it should be submitted via the UK National Screening Committee’s (UK NSC) annual call for topics and must be underpinned by published peer reviewed evidence that supports this targeted approach.

The UK NSC has separately examined the evidence for dementia and made a recommendation in 2019 not to introduce this as a population screening programme. More information is available at the following link:

https://view-health-screening-recommendations.service.gov.uk/dementia/

By the end of the Parliament, core Departmental spending will have increased from £140.5 billion in 2019/20 to £193.1 billion in 2024-25, representing a cash increase of £52.6 billion. That is a 37% cash increase in the Department’s total budget between 2019/20 and 2024/25. This means total health and social care spending will continue to grow in real terms between 2019/20 and 2024/25 by 3.4%, which represents the compound annual growth rate in 2022/23 prices.

The Public Health Grant will increase over the current spending review period, rising to £3.6 billion in 2024/25. Taking the Public Health Grant together with additional grants for drug treatment and start for life services, the funding that the Department provides to local authorities for public health will grow by more than 5% in real terms over the two years 2023/24 and 2024/25. Moreover, from 2024/25 we are investing an additional £70 million per year to support local authority-led stop smoking services, more than doubling current spend on these services, in support of our commitment to deliver a smoke-free generation.

Funding for prevention services and for screening programmes is also included in the overall 2023/24 National Health Service budget of £172 billion. Furthermore, in July 2023, the Government invested in the launch of a new targeted lung cancer screening programme, which when fully rolled out will detect approximately 9000 cancers earlier each year.

For registered patients aged 75 years old and over, their named accountable general practitioner (GP) is responsible for ensuring that any GP services which they are contracted to provide, and are necessary to meet the patient’s needs, are coordinated, and delivered to that patient.

This includes ensuring these patients receive an annual health check on request and taking all reasonable steps to recognise and appropriately respond to the physical and psychological needs of the patient in a timely manner.

Since Autumn 2020, NHS England has run the ‘Help Us, Help You’ (HUHY) campaigns, and it will continue to run them. The campaigns use a series of TV adverts, social media posts and billboards to promote and encourage people to get in touch with their general practitioner (GP) if they notice or are worried about symptoms that could be cancer.

NHS England also funds community engagement events which share the same aim and works with partners to encourage body awareness and share information about cancer at moments during people’s everyday lives; for example, a recent partnership with Morrisons supermarket to include cancer messaging on their home-brand underwear labels.

The NHS website outlines the importance of being aware of new or worrying symptoms in a person’s health and the importance of speaking to a GP to initiate investigations early. The relevant page is available at the following link:

https://www.nhs.uk/conditions/cancer/symptoms/

Decisions on the age eligibility for national screening programmes is set in recommendations from the UK National Screening Committee (UK NSC). The UK NSC makes informed decisions on age eligibility based on scientific evidence on the effectiveness and harms to different age cohorts if they are invited to be screened.

Th UK NSC works to review and adapt programmes according to the latest scientific evidence. Following a UK NSC recommendation, the bowel cancer screening programme is currently lowing the eligible age to 50 years old from 60 years old. This is due to be finished by 2024/25. UK NSC awaits the outcome of a large research project called AgeX which is looking at the upper and lower age limit for breast screening.

The Department has no plans to take additional steps. The National Health Service website assists in raising awareness of checking breasts for potential symptoms of breast cancer, and more information is available at the following link:

https://www.nhs.uk/common-health-questions/womens-health/how-should-i-check-my-breasts/

Additionally, the NHS Breast Screening Programme produced a five-point plan for being breast aware: that individuals should know what's normal for them; that they look at their breasts and feel them; know what changes to look for; to report any changes to a general practitioner without delay; and attend routine screening if they are aged between 50 and 70 years old.