Scottish Screening Committee minutes: April 2023

Attendees and apologies

Members

• Jann Gardner, Chief Executive, NHS Lanarkshire (Chair)
• Gareth Brown, Scottish Director of Screening, NHS National Services Scotland
• Nick Phin, Clinical Director and Director of Health Protection, PHS
• Christine McLaughlin, Director of Population Health, Scottish Government
• Fraser Tweedie, Public Partner
• Susan Siegel, Public Partner  
• Scott Urquhart, Director of Finance, NHS Forth Valley
• Janette Fraser, Head of Planning, NHS Forth Valley
• Fiona McQuiston, Cancer Research UK 

In attendance

• Tasmin Sommerfield, National Clinical Advisor for Screening, NHS NSO
• Fiona Wardell, Healthcare Improvement Scotland
• Liz Sadler, Deputy Director, Population Health Directorate, Scottish Government
• Laura McGlynn, Committee Secretariat, Health Protection Division, Scottish Government 
• Alexander Cruickshank, Committee Secretariat, Health Protection Division, Scottish Government
• Chloe Kelly, Committee Secretariat, Health Protection Division, Scottish Government

Apologies

• Graham Foster,  Director of Public Health, NHS Forth Valley
• Bob Steele, UK National Screening Committee Representative
• Safia Qureshi, Director of Public Health, Healthcare Improvement Scotland

Items and actions

Welcome and apologies

• Jann Gardner (JG) welcomed the committee and noted apologies from Bob Steele, Graham Foster and Safia Qureshi

• Minutes from the previous meeting were approved and will be published on the Scottish Government website

Screening Programme funding prioritisation

Alex Cruickshank (AC) led a presentation on prioritisation of the screening programmes, seeking advice and discussion from the committee. 

The presentation reflected on the current fiscal position, looking at the current challenges in the delivery of core activities of the national screening programmes, particularly recruitment challenges and technological development which are key areas of demand. 

The current resource environment means that it is not possible to respond to all demands simultaneously and hence prioritisation is required to ensure best use of available resource, whilst continuing to ensure patient safety and quality of the programmes is not negatively impacted.  For this financial year (2023/24), a significant amount of resource is being invested into the work of the National No Cervix Audit. Beyond this, other priorities need to be addressed for the longer term over the next three to five years, where development or investment is required to maintain and strengthen the screening programmes.

AC welcomed discussion, Scottish Government (SG) requires considered and expert advice on how to sequence and prioritise the major pressures across the screening programmes over the coming years in relation to funding. 

JG noted that across the entire NHS there are challenges seen within the Health and Social Care landscape due to the financial situation but noted the importance of screening. 

Christine McLaughlin (CM) welcomed Elizabeth Sadler (ES) to the committee, who has taken over as deputy director of Public Health Capabilities (PHC) Division at SG. She provided assurance that this is consistent with other areas in SG. She reiterated that this is not just a financial exercise, the overall objective is to increase healthy life expectancy whilst reducing inequalities, acknowledging how screening supports this. There is also a need to understand how screening fits with other parts of the healthcare system, such as vaccinations and cancer policy, to reach this objective. 

CM added that there is also a need to understand the extent to which the UK National Screening Committee (UK NSC) and other governing bodies are looking at this, and use information from that to inform what we do for Scotland. 

Fiona McQuiston (FM) noted that Cancer Research UK could help with this work in terms of providing evidence required, and the UK experience in relation to innovation and prioritisation. 

Scott Urquhart (SU) asked how can we assure ourselves that the value of the current funding across the screening programmes is being optimised, and to understand if there is anything more that can be done in terms of innovation and use of technology to maximise the available funding. He added that we know that screening provides good value for money in terms of investment. 

GB agreed, but also noted that innovation itself often requires considerable investment before the benefits can be gained.  For example the technological innovations around HPV self-sampling may bring benefits in terms of uptake, but considerable investment is needed to IT systems and training etc to support self-sampling.  He also advised that lung cancer screening as a new targeted screening programme would require significant investment, likely millions of pounds per year. 

TS added that whilst the performance and efficiency of the nationally commissioned elements of screening can be monitored, it is not possible to monitor at a national level how screening is delivered within the 14 territorial boards.

TS also added that the UK NSC considers all the best available evidence and undertakes an extremely robust analysis. A screening programme is only recommended if it has been  shown to meet several criteria, including cost-effectiveness. This is the extent of their advice, it is then down to each of the four nations to make their own policy decisions.

JG noted that each of the territorial boards looking at their own financial challenges would help to baseline the understanding of what is being spent locally. This provides a better overall picture of both national and local investment that is required. GB noted that NSO had previously sought to baseline current investment locally in screening but this was very difficult to do given the historic nature of much of the funding, and that screening activity is usually supported across different parts of a Board and many screening responsibilities are parts of roles rather than dedicated. It would be difficult and time consuming to accurately describe all local investment. 

CM added that we know of the benefit that investment into screening brings. Innovation and technological advancements would be welcome investments to improve the service. There are already projects on our radar that will require investment, such as investment in digital solutions which could improve efficiency.

SU commented on the sequencing the next steps of priorities. As well as looking at the input costs, information is required around the expected outputs in terms of outcomes for patients from these investments, to help inform the prioritisation. 

TS proposed that a short life working group (SLWG) is established with members from NSO, NSD and other key screening stakeholders to begin work imminently on a prioritisation framework. 

ES introduced herself and added that across the PHC division as a whole within SG, she is looking at this more generally. Vaccinations policy is having the same discussions with a number of upcoming changes and innovations, as well as digital and equality challenges, and understanding what will give best value for money. There is a broader context to investing in these preventative measures, with potential savings further downstream, whilst helping to increase life expectancy. In terms of inequalities, it is the same groups of people being targeted to encourage them to participate in both vaccination and screening, hence collaborative working and some of the digital work could be joined up to address this. 

JG summarised that a task and finish group should be established with a very clear commission from the SSC. The findings should be reported to the SSC with key recommendations.

GB added that NSO can discuss with SG colleagues to establish a remit of the group and circulate to ensure committee members are happy and then by the next meeting of the SSC, to have at least an initial assessment against key criteria of the known pressures over the next three to five years we are aware of to discuss and then can dig into more detail following that. 

TS noted that the importance of each component of the screening pathway being delivered optimally in order to maximise the benefits to the population. This is slightly separate to the prioritisation work but is something that the SSC could do more to champion. 

JG added that the committee was supportive of the timelines GB proposed for prioritisation and asked if he can circulate via email an outline proposition of the commission from the SSC to ensure all in agreement. 

Any other business

JG asked GB/TS to provide any final key points on the current screening landscape.

GB advised that each of the screening programmes are continuing to operate in line with previous updates, as constrained as the rest of the system but continuing to deliver. Colonoscopy and colposcopy capacity in particular continue to be challenges. It has been agreed with SG colleagues that an Expert Advisory Group for Lung Screening in Scotland will be established, this is not an implementation group, it is to help our understanding of what the potential challenges around implementation are and provide advice, and that will feed into the UK NSC Lung Task Group. 

TS added that the Cervical Screening Audit has now commenced and is an extremely complex piece of work, with a bespoke database developed and all 14 boards involved with planning their pathways. NSO have been working with SG colleagues to address some of the factual inaccuracies being reported in the media. The Equity in Screening Strategy is also due to be published in the next few months. SSC members will be sent a copy of the final version. 

JG thanked the committee for attending.