RCR welcomes recommendations to overhaul English screening programmes

Wednesday 16 October 2019

Screening programmes in England must have a dedicated equipment fund and urgent improvements in IT, as well as offering patients more evening and weekend appointments to boost uptake, according to the NHS’ top screening advisor.

Last year, Professor Sir Mike Richards was tasked by NHS England (NHSE) with conducting an independent review of the national screening programmes in England – which include abdominal aortic aneurysm, bowel cancer, breast cancer, cervical cancer and diabetic eye screening.

Prof Richards has engaged with hundreds of relevant stakeholders – including The Royal College of Radiologists (RCR) – to understand how the programmes operate and the challenges faced by providers.  

Released today, his recommendations for overhauling the system include streamlining the governance of the programmes under the auspices of NHSE, introducing a protected fund for programme equipment and facilities and increasing patient access to appointments.

The Report of the Independent Review of Adult Screening Programmes in England also touches on the potential for future at-risk screening programmes – including lung and breast density screening – and innovations to improve capacity, such as artificial intelligence (AI).

Strain on the screening workforce is referenced and the issue will be addressed by Prof Richard’s in a standalone diagnostics review due out later this year.   

Dr Caroline Rubin is RCR Vice President for Clinical Radiology and has spent her career working in the breast screening programme. Along with RCR colleagues, she engaged with Prof Richards during his fact-finding.

Welcoming the report, Dr Rubin said:

“Sir Mike’s final report is a real achievement. It builds on his interim conclusions from earlier in the year, comprehensively covers the challenges and opportunities of the national screening programmes – as well as addressing future targeted schemes – and sets clear recommendations for improvement that we fully support. 

“His recommendations for separate ownership and advisory input should enable much-needed innovation across the programmes and we hope NHSE and Public Health England will realise them without delay.

“We also welcome his recommendations to improve sharing of “big data” amassed from the programmes, which should speed up innovation, especially around the development and testing of AI. References are made to the promise of AI to support mammography screen reading and the turnaround of breast scans – AI will help to ease escalating workforce pressures but, as Sir Mike says, it is not a panacea for the lack of imaging staff to run breast screening.

“The call for a dedicated fund for screening equipment and facilities is absolutely crucial. While we welcome funding injections such as the recent £200m pledged to replace aging scanners, breast screening and other programmes must be supported with protected funding to enable rolling hardware replacement.

“On software, Sir Mike firmly places impetus on NHSX to provide urgent, measured improvements to breast screening IT and infrastructure, which could not be more welcome – IT updates are deplorably overdue and will be vital to improving uptake and cancer detection.

“Weighted funding for targeted screening for those at increased risk, incorporated into current and developing screening programmes, should enable seamless adoption of newly identified risk factors and reduce geographical variation in accessing and delivering targeted screening schemes.

“Sir Mike‘s review was originally due to set recommendations on workforce capacity, but, tellingly, the issue is now set to be addressed in isolation. It is reassuring to see he so clearly understands the constraints on workforce, admitting that many of the review’s proposals to increase breast screening uptake – including extended access to screening appointments and clinics and 34-month reminders – have the potential to exacerbate workforce pressures.

“Ultimately, these are serious, sensible recommendations, with the caveat that diagnostic workforce is to be considered separately. We congratulate Sir Mike on such a comprehensive review, and keenly await his forthcoming diagnostic workforce report.”