Population screening: applying All Our Health
Updated 10 March 2022
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This publication is available at https://www.gov.uk/government/publications/population-screening-applying-all-our-health/population-screening-applying-all-our-health
The Public Health England team leading this policy transitioned into the Office for Health Improvement and Disparities (OHID) on 1 October 2021.
Introduction
This guide is part of ‘All Our Health’, a resource which helps health and care professionals prevent ill health and promote wellbeing as part of their everyday practice. The information below will help front-line health and care staff use their trusted relationships with patients, families and communities to raise awareness of NHS population screening.
We also recommend important actions that managers and staff holding strategic roles can take.
View the full range of ‘All Our Health’ topics.
Raising awareness of NHS population screening in your professional practice
Screening is the process of identifying healthy people who may have an increased chance of having a disease or condition, enabling earlier treatment. Screening programmes can improve health, prevent disability and save thousands of lives each year.
Screening is a choice and individuals are offered information to help them decide if they wish to accept the offer of screening.
These videos explain more about population screening:
The basics of screening
Screening offered to pregnant women and newborn babies
Screening offered to pregnant women and newborn babies
The NHS offers 11 national screening programmes, covering 36 health conditions. Screening is offered to the different sections of the population most likely to benefit from it.
The UK National Screening Committee (UK NSC) also recommends screening for reduced vision in children aged 4 to 5 years. Local authorities offer child vision screening using the national guidance. Find out more about child vision screening on the Screening blog.
Every year the NHS offers bowel, breast cancer and cervical screening, antenatal and newborn (ANNB) screening, abdominal aortic aneurysm (AAA) screening and diabetic eye screening (DES) to millions of people.
While screening is offered to everyone who is eligible, certain groups are less likely to accept it.
Reducing screening inequalities and sharing best practice is a priority for the NHS. Health practitioners can help address some of the inequalities by making people aware of the NHS screening programmes and supporting them to make informed choices about screening.
Young person and adult (YPA) screening
There are 5 NHS YPA screening programmes:
NHS bowel cancer screening programme (BCSP)
Bowel cancer causes about 16,700 deaths in the UK each year. Bowel cancer screening can detect bowel cancer at an early stage, when treatment is most likely to be effective.
Who is screened
People aged 60 to 74 are automatically invited to take part in bowel cancer screening every 2 years. This age range is gradually being extended, so that by 2025 people will receive invitations every 2 years from the age of 50 to 74. People aged 75 and over can request screening every 2 years via a self-referral process.
The screening test
Bowel screening looks for blood in a stool sample. Those eligible receive a home test kit by post and return the collected sample for laboratory analysis.
Purpose of screening
Every year more than 4.5 million people in England are screened for bowel cancer leading to early detection and better outcomes.
Find out more about the NHS bowel cancer screening programme (BCSP).
NHS breast screening programme (BSP)
Breast cancer is the most common type of cancer. There are about 12,000 breast cancer deaths in the UK every year.
Who is screened
Breast screening is offered every 3 years to women aged 50 up until their 71st birthday.
The screening test
Breast screening uses an x-ray test called a mammogram to check for signs of cancer.
Purpose of screening
About one in 8 women are diagnosed with breast cancer in their lifetime. If detected at an early stage there is a good chance of recovery.
Find out more about the NHS breast screening programme (BSP).
NHS cervical screening programme (CSP)
Cervical screening is not a test for cancer. It looks for abnormal cells in the cervix which, if left untreated, can turn into cancer. Every year almost 3.5 million women in England are screened. There are about 850 cervical cancer deaths in the UK every year.
Who is screened
All women and people with a cervix aged between 24 and a half and 64. People aged 24 and a half to 49 are invited every 3 years, and people aged 50 to 64 every 5 years.
The screening test
A small sample of cells is taken from the cervix and sent for laboratory analysis. The sample is tested for certain types of human papillomavirus (HPV) that can, if the virus persists, cause abnormal cell changes which can develop into cervical cancer.
Purpose of screening
If abnormal cervical cells are found they can be removed before they turn into cancer. Every year the cervical screening programme saves thousands of lives. In England cervical screening currently prevents 70% of cervical cancer deaths.
Find out more about the NHS cervical screening programme (CSP).
NHS diabetic eye screening (DES)
Diabetic eye screening (DES) checks for signs of diabetic retinopathy, a condition caused by diabetes, which damages the small blood vessels in the retina at the back of the eye.
Who is screened
DES is currently offered every 12 months to anyone with diabetes aged 12 or over. Extra screening tests are offered to people who have diabetic retinopathy but do not yet require treatment and to pregnant women who have diabetes. This is because the risk of sight loss is greater in these people.
The screening test
Drops are put in the eyes to temporarily make the pupils larger and images of the retina are taken.
Purpose of screening
If left undiagnosed and untreated, diabetic retinopathy can cause blindness.
Find out more about the NHS diabetic eye screening (DES) programme.
NHS abdominal aortic aneurysm (AAA) screening
Abdominal aortic aneurysm (AAA) screening checks for weakness and swelling of the aorta, the main blood vessel that runs from the heart down through the chest and abdomen. Men aged 65 and older are most at risk of having an AAA.
Who is screened
Men receive a screening invitation by post when they are aged 64 or 65.
The screening test
AAA screening involves an ultrasound scan of the abdomen to measure the width of the aorta.
Purpose of screening
An AAA will often cause few or no obvious symptoms. If it is not detected early, it could get bigger and eventually burst. A burst AAA is usually fatal.
Find out more about the NHS abdominal aortic aneurysm (AAA) screening programme.
YPA screening for trans and non-binary people
Trans and non-binary people will be invited for screening according to how they’re registered with their GP. More information is available in NHS population screening: information for trans and non-binary people.
Antenatal and newborn (ANNB) screening
There are 6 NHS ANNB screening programmes. Different screening tests are offered at different times during pregnancy and after the baby is born. Every year about 650,000 pregnant women and newborn babies are offered ANNB screening.
The ANNB screening timeline outlines when pregnant women and newborn babies should be offered the 6 NHS ANNB screening tests.
NHS sickle cell and thalassemia (SCT) screening programme
Sickle cell disease (SCD) is the most common genetic condition in England and causes the red blood cells to become sickle shaped. This can lead to life‐threatening acute and chronic restricted blood flow to organs. People with thalassemia, the other blood condition screened for, need a blood transfusion every 2 to 5 weeks, as well as injections and medicines throughout their lives.
The screening test
A blood test in early pregnancy. The baby is tested for SCD at 5 days old as part of the newborn blood spot screen.
When the test is offered
SCT screening should be offered as early as possible before 10 weeks of pregnancy.
Purpose of screening
Early identification of SCD and thalassemia leads to early support and more effective treatment.
Find out more about the NHS sickle cell and thalassemia (SCT) screening programme.
NHS infectious diseases in pregnancy screening (IDPS) programme
Pregnant women are offered screening for 3 infectious diseases: human immunodeficiency virus (HIV), hepatitis B and syphilis. The IDPS screening blood test is recommended.
The screening test
A blood test.
When the test is offered
IDPS is offered as early as possible in pregnancy. Retesting is available at any time in pregnancy if the woman changes her sexual partner or feels she may be at risk.
Purpose of screening
Specialist care and treatment can be offered to protect the mother’s health and significantly reduce the chance of the baby being infected.
Find out more about the NHS infectious diseases in pregnancy screening (IDPS) programme.
NHS fetal anomaly screening programme (FASP)
The FASP offers screening to all eligible pregnant women in England to assess the chance of their baby being born with Down’s syndrome, Edwards’ syndrome or Patau’s syndrome and 11 physical conditions.
The screening test
A blood test. The physical development screen involves an ultrasound scan.
When the test is offered
Down’s syndrome, Edwards’ syndrome and Patau’s syndrome screening is offered at around 11 to 14 weeks of pregnancy. The baby’s development screen is offered at around 18 to 21 weeks of pregnancy.
Purpose of screening
Pregnant women are supported to make timely personal, informed reproductive choices based on accessible, accurate and evidence-based information.
Find out more about the NHS fetal anomaly screening programme (FASP)
NHS newborn and infant physical examination (NIPE) screening programme
The NIPE includes 4 specific screening tests to find out whether the baby has a suspected problem with their eyes, heart, hips or testes, plus an overall physical check.
The screening test
Physical examinations.
When the test is offered
The newborn examination is carried out within 72 hours of birth. A second infant examination screen is needed between 6 and 8 weeks of age because some conditions appear later.
Purpose of screening
About 2 or 3 in 10,000 babies have problems with their eyes and around 8 in 1,000 babies are born with a heart problem.
About one or 2 in 1,000 babies have hip problems that if untreated can lead to a limp and joint problems.
About one in 100 baby boys have problems with undescended testes that need treatment to reduce the risk of problems later in life, such as reduced fertility.
Find out more about the NHS newborn and infant physical examination (NIPE) screening programme.
NHS newborn blood spot (NBS) screening programme
The NBS screening programme enables early identification, referral and treatment of babies with 9 rare but serious conditions such as cystic fibrosis. Six of the conditions are inherited metabolic diseases.
The screening test
A blood test.
When the test is offered
Parents are offered the NBS screen for their baby, also known as the heel prick test, when the baby is 5 days old.
Purpose of screening
The NBS screening programme helps to improve babies’ health and prevent severe disability or even death. About one in 2,500 babies born in the UK has cystic fibrosis. Early treatment can help them live longer, healthier lives.
Find out more about the NHS newborn blood spot (NBS) screening programme.
NHS newborn hearing screening programme (NHSP)
The NHSP identifies babies born with a permanent childhood hearing impairment (PCHI). In England, on average, 1,400 babies each year are diagnosed with a permanent hearing impairment. Most of these babies are born to families with no history of hearing loss.
The screening test
Gentle clicking sounds are played into the baby’s ear via a small soft-tipped earpiece. Sometimes a second screen is required that involves placing 3 small sensors on the baby’s head, neck and shoulder and playing the clicking sounds via headphones.
When the test is offered
Ideally the hearing screen should be offered before the baby is 4 weeks old, but it can be done up to 3 months of age.
Purpose of screening
Finding and managing hearing loss early gives babies a better chance of developing language, speech and communication skills as well as making sure their families receive the support they need.
Find out more about the NHS newborn hearing screening programme (NHSP).
Core principles for health and care professionals
This ‘All Our Health’ NHS population screening information has been created to help all health and care professionals:
- understand specific activities and interventions that can support population screening
- think about the resources and services available in your area that can help people access local screening services
- find information about the NHS screening programmes
- support people to make the right screening choices for them
Taking action
Front-line staff
If you’re a front-line health and care professional:
- find local screening services and work with them to support access
- raise awareness of appropriate screening opportunities
- familiarise yourself with the population screening timeline and 3-minute screening tests for you and your baby video
- familiarise yourself with the antenatal and newborn screening timeline and support timely access to screening choices in pregnancy
- ensure all eligible people have access to screening (the NHS population screening: access for all guidance and resources can help)
- reduce inequalities by sharing information with local screening programmes, such as language, concerns, disabilities and easy read screening resources
- support individuals to access population screening programmes and obtain screening results (the NHS screening programmes: information for GPs and practice staff can help)
- signpost people to Screening online public information
If an individual has taken up an offer of screening:
- check the screening process has been completed
- help explain screening results
- encourage attendance at any follow-up appointments
Team leaders and managers
If you’re a team leader or manager:
- find local screening services and establish links with them
- reduce inequalities by sharing information with local screening programmes, such as language, concerns, disabilities and easy read screening resources
- raise awareness and promote screening among the public and other health professionals by editing national screening resources to include local screening provider contact details
- signpost people to Screening online public information
- raise awareness of appropriate screening opportunities for workforce
Senior and strategic leaders
If you’re a senior or strategic leader:
- establish networks with local screening and immunisation service providers
- work with local screening and immunisation teams and local authority public health directorates to focus on promoting awareness and reducing screening inequalities
- reduce inequalities by sharing screening access challenges and details of local areas of depravation
- promote shared training and learning opportunities represent on local screening governance boards
Understanding local needs
The Public Health Outcomes Framework examines indicators that help understanding of trends in public health.
The NHS population screening inequalities strategy contains guidance to support the health system to reduce inequalities in screening.
Information about local cancer services is provided.
NHS population screening: access for all has links to guidance and resources to help reduce inequalities in population screening that ensure all eligible people have access.
Measuring impact
As a health and care professional there are a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution. This could be about sharing what has worked well in order to benefit your colleagues and local people, or help you with your professional development.
Population screening: data and intelligence has links to data and guidance templates, KPI reports, and data requests and research.
NHS Digital publishes cervical screening reports and breast screening reports.
The National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) is a service to support clinicians and patients, service delivery, commissioning and public health.
Data analysed through the Integrated Screening Outcomes Surveillance Service (ISOSS) allows the impact of the IDPS programme to be assessed.
Further reading, resources and good practice
Advice for patients and the public
The population screening timeline outlines all NHS national screening programmes offered in England.
The antenatal and newborn screening timeline outlines when ANNB screening tests should be offered.
What is screening? is a 2-minute video explaining the basics of screening.
Screening tests for you and your baby is a 3-minute video covering the screening tests offered to pregnant women and newborn babies (available in several languages, including British sign language).
Using your bowel cancer screening kit is a short animation explaining how to use the bowel screening kit (subtitles available in English and other languages).
Population screening programmes: leaflets and how to order them has links leaflets to support screening programmes, and guidance on how to order them.
NHS screening programmes: information for GPs and practice staff has information on how to support patients to access screening programmes and obtain screening results.
Patient confidentiality in NHS population screening programmes has information about what personally identifiable information is used by the screening programmes and why.
Professional resources and tools
Find your local NHS screening services.
Information about all 11 NHS population screening programmes.
The UK National Screening Committee (UK NSC) advises ministers and the NHS in the 4 UK countries about all aspects of population screening and supports implementation of screening programmes.
NHS population screening: education and training has resources to support screening professionals in their initial training and continuing professional development (CPD).
There are relevant modules on e-Learning for healthcare (e-LfH) including:
- Introduction to population screening: a short, interactive module giving an overview of health screening as it’s applied to large populations of people, core concepts and principles of screening and how national screening programmes are implemented in the NHS
- NHS antenatal and newborn screening programmes: an interactive module providing up-to-date information about the 6 ANNB screening programmes offered in England (login required)
Good practice examples
The Screening blog has examples of good practice including:
- GPs’ role in helping people decide whether they want screening
- GPs’ duty to share information can be just as important as duty to protect confidentiality
- GP-endorsed text reminders help increase cervical screening attendance in London
- Helping health visitors to make every contact count for screening and immunisation
- Raising awareness of the AAA screening programme in rural areas
- Tackling inequalities in bowel cancer screening
- Short film aims to reduce barriers to AAA screening attendance for men with learning disabilities
- New breast screening film focuses on women with learning disabilities
- Bowel cancer screening – new information for people with learning disabilities
- How we worked across teams to make sure a young man with complex needs could receive important eye check