Health screening: equity in screening strategy 2023 to 2026

Context and background

National population screening programmes

Screening is a way of identifying people who appear healthy but who may have a higher chance of having a disease or condition^[1]. Screening aims to detect early signs of a condition, enabling earlier treatment and improved health outcomes. Screening also provides better outcomes for the health service, by reducing demand on services associated with more serious or later-stage disease.

There are currently six national population screening programmes delivered in Scotland (see Table 1 below). These programmes have been introduced based on recommendations from the UK National Screening Committee. Each screening programme proactively invites people who, on the basis of age and sex, have a higher risk of the disease or condition.

Individuals can decide not to engage in a screening test, or to withdraw from interventions at later stages in the pathway after screening. This decision should be a personal informed choice. This means, a person should have access to accurate, evidence-based information in a format which meets their needs.

Screening includes both a 'screening pathway' and a 'treatment pathway' (Figure 1). Screening programmes invite people from an eligible population for a screening test. Depending on the outcome of that test, some people will then be invited for a diagnostic test as the final step in the screening pathway. Following a positive diagnosis, an individual is then referred into the treatment pathway. Individuals must complete their journey through the screening and treatment pathways to improve health outcomes.

It is important to understand that inequalities can occur at any point along the screening or treatment pathways.

Source: National Services Scotland (2022), A guide to National Population Screening in Scotland.

How the strategy has been developed

A great deal of national and local NHS work has been undertaken to address inequalities in screening in the past. Often though, this has lacked dedicated and sustained system-wide leadership, and that lack of leadership has affected the momentum for tackling inequalities at scale across screening programmes.

In 2022, National Screening Oversight (NSO) – which was established in early 2020 to provide oversight, assurance, and direction to Scotland's national screening programmes – identified an opportunity to provide greater direction and leadership to reducing inequalities in screening.

NSO engaged key stakeholder and partner organisations in a reference group to discuss how best to drive improvement in inequalities, and the production of this strategy and separate action plan (appendix 1). Representation included Scottish Government, NHS Boards, third sector organisations and academic institutions (appendix 2).

The reference group met five times between July 2022 and April 2023 and identified five priority areas for improvement and action:

• Communications, engagement, and learning
• Access to screening
• Data collection and monitoring
• Research and evaluation
• 'Overarching issues'

The theme of 'overarching issues' was discussed by the reference group. The remaining four priority areas were explored in more detail by four corresponding sub-groups. Sub-groups met on several occasions between October and December 2022 to agree a range of actions needed to address the main challenges to uptake and engagement across the screening pathway.

For all five sub-themes, long-term outcomes have been agreed (as set out above), detailing what we will need to deliver if we are to achieve our vision.

Data and evidence have played a central role to the development of this strategy. Public Health Scotland has provided valuable insight into the published data. Systematic reviews have provided the published evidence, together with some Scottish research studies.

NSO carried out an equality and fairer Scotland impact assessment (EFSIA) with partner organisations to help us consider the likely effects of the strategy on different groups eligible for screening. A copy of the EFSIA is available on request.

In collaboration with the reference group and sub-groups, NSO has written this strategy and separate action plan. The National Screening Oversight Board (NSOB) will be responsible for overseeing the implementation and delivery of these.