Scottish Screening Committee minutes: 2 June 2020

Attendees and apologies

Attendees

• Jann Gardner, Chief Executive, Golden Jubilee Hospital (Chair)
• Lorna Ramsay, Medical Director, NHS National Services Scotland
• Colin Briggs, Director of Planning, NHS Lothian
• Graham Foster, Director of Public Health, NHS Forth Valley
• Jane Burns, Medical Director, NHS Lanarkshire
• Belinda Henshaw, Senior Inspector/Reviewer, NHS Healthcare Improvement Scotland
• Elizabeth Sadler, Deputy Director, Health Improvement Division and Interim Deputy Director, Health Protection Division, Scottish Government
• Susan Siegel, public partner
• Fraser Tweedie, public partner 

In attendance

• Bryan Davies, Programme Associate Director, Cancer Screening Services, NHS National Services Scotland
• Tasmin Sommerfield, Consultant in Public Health Medicine for National Screening Programmes, NHS National Services Scotland
• David Steel, Programme Associate Director, Non-cancer Screening Services, NHS National Services Scotland
• Tracey Syme, Programme Board Co-ordinator, NHS National Services Scotland
• Joanna Swanson, Health Protection Division, Scottish Government (Secretariat)
• Martyn Lindsay, Health Protection Division. Scottish Government (Secretariat)

Apologies

• Hilary Dobson, UK National Screening Committee Representative

Items and actions

Scottish Government/ministerial context

LS provided an update on the Scottish Government (SG) position and on the current plan to remobilise the NHS and the principles by which this will be done. Resumption of screening is included in this plan and there is a high degree of political and media interest in how screening will resume.

Screening Programme decisions for discussion and endorsement 

LR summarised the work that has been undertaken to bring the recovery proposals for each of the paused screening programmes to the Scottish Screening Committee for consideration.

LR described the governance arrangements for each programme board and noted the 5 key considerations that were taken into account during the development of the recovery plans:

• participant and population safety must be the overriding consideration
• clinical prioritisation of people at highest risk is critical
• the whole screening pathway must be operational 
• clinical safety and person centred standards assurance need to be maintained
• system capacity and control measures will need to be managed

She also discussed the principles that the National Screening Oversight Function had brought to bear in assessing the plans. These were safety, quality assurance, equity, person-centredness, inclusion and engagement, quality improvement, efficiency, transparency and effective communication. 

The recovery plans for the paused programmes were then discussed.

Cervical

BD introduced the cervical screening programme recovery proposal, describing plans for the phased restart, the risks and mitigations and key points to consider. The proposal was developed with the input of primary care and the third sector stakeholders.

When the programme restarts it will be with hr-HPV testing which was successfully launched immediately prior to the pause. Non-routine screening will commence in phase 2, with routine screening recommenced in phase 3. The number of new prompts issued would be halved until non-routine screening is up-to-date. It was noted that GP capacity is a major consideration for this programme, and constraints on this are likely to affect capacity to deliver into phase 4. Phase 4 will include an element of programme redesign, with national piloting of self-sampling kits.

The SSC agreed with the recommended recovery plan for cervical screening.

Bowel

BD took the group through the recovery proposal, the plan for each of the 4 phases of recovery and renewal, and how to deal with people affected by the pause.

The plan sets out that NHS Boards will commence screening colonoscopy on phase 2 and will be provided with numerical FIT values to enable local prioritisation. In phase 3 the recall dates for all participants would be moved forward by the length of the pause. 

There was discussion of the risks involved in moving too quickly into and through phase 3. JB indicated that colonoscopies may require full PPE and environmental deep-cleaning between patients, and the ongoing need to protect patients and staff from Covid-19 infection. It was agreed that bowel screening services must be recommenced in a measured and planned way as part of the wider planning for remobilisation of NHS services, taking full account of the balance of risks to the patient and the capacity within boards to clear waiting lists for colonoscopy to pre-Covid-19 levels. 

The SSC agreed with the recommended recovery plan for bowel screening.

Breast

BD introduced the recovery proposal for the breast screening programme, the phases, issues, risks and mitigations.

It was noted that the focus in phase 2 would be on symptomatic and high risk clinics, with population screening recommencing, from where the pause was implemented, at phase 3. The proposal includes a temporary pause on self-referrals for those aged 71 and over. 

The SSC agreed with the recommended recovery plan for breast screening.

Abdominal Aortic Aneurysm (AAA)

DS took the group through the recovery proposal for the AAA screening programme. 

The plan proposes prioritisation of high-risk participants in phase 2, together with screening those 2019-20 participants who had their appointments cancelled prior to the pause. Telephone conversations would be offered for those shielding to support them to arrive at an informed decision about attendance. Screening for all eligible 2020-21 participants would recommence in phase 3, with a temporary two-year review interval introduced for those with a small AAA.

There will also be a temporary pause on all self-referral into the programme for men over the age of 66 who have not previously been invited to the programme.

The SSC agreed with the recommended recovery plan for AAA screening.

Diabetic Retinopathy Screening (DRS)

DS introduced the recommendations for restarting the programme, including the intention to prioritise higher risk groups including pregnant women with diabetes, R3/4 participants, R2 six month recall participants and people with a new or recent diagnosis of diabetes. This approach is supported by stakeholders including the RNIB and Diabetes UK (Scotland).

Revised interval screening will be adopted when the programme recommences. 

The SSC agreed with the recommended recovery plan for DRS screening.

General discussion on recovery plans

Consistency of phasing in the different recovery plans was discussed, with planning and preparation happening in phase 1 and a carefully planned and measured resumption of screening services across phases 2 and 3. 

It was agreed that, for each programme, screening should be restarted on a national basis, with all NHS boards resuming screening services for each programme at the same time. There was acknowledgement, however, that there may be variation across the five programmes in the pace at which each then proceeds through the four phases of recovery and renewal.

The importance of clear and aligned public communications was discussed and agreed. It was stressed that there needs to be clear messaging about what people are being asked to do when screening restarts, which does not conflict with any other messaging about accessing health services or the easing of lockdown. There was confirmation that public messaging is being developed in partnership with Public Health Scotland and NHS Boards, alongside work to address health inequalities.

It was noted and agreed that capacity to deliver all of the programmes will be affected by new ways of working and restrictions necessitated by COVID-19, including the need for enhanced infection control measures and PPE, even when NHS remobilisation is well underway. 
The importance of engaging with key partners and stakeholders was stressed, this is to ensure that all parts of the pathway were capable of dealing with the restart. There was assurance that engagement is ongoing with a variety of partners.

There was also consensus that there needed to be an element of flexibility when progressing through the phases of the restart. A range of factors including a possible second spike of COVID-19 infection may impact on the timing and capacity of NHS Boards and primary care services to extend screening to the wider population in phases 3 and 4.

Overarching screening recovery route map

LR presented an overarching route map for all of the programmes and explained the risks and mitigation that were being considered and would be proactively managed throughout the recovery process. It was recognised that the phases of screening programme recovery may not correspond at each point with the phases outlined in the Scottish Government Route Map, and agreed that this should be made clear in the SSC’s  recommendations. This will be done by changing the terminology for the screening programme to stages instead of phases.

Next steps

Agreement was reached to discuss the recovery plans with NHS Chief Executives and with John Connaghan, NHS Scotland Chief Executive. 

Close/AOB

Attendees offered their thanks to the programme boards, sub groups, NSS and everyone else involved in getting the work to this stage, recognising the difficult circumstances and time constraints they were working under.