Guidance

NHS Population Screening Standards

Published 15 October 2025

Applies to England

1. Introduction

The UK National Screening Committee (UK NSC) makes recommendations to ministers on screening policy.

NHS England Screening has a responsibility to:

• implement UK NSC recommendations following decisions from government
• promote equal access to screening
• provide high quality information so individuals can make a personalised informed choice
• support individuals through the screening pathway
• quality assure screening across England
• deliver a consistent approach to screening
• develop, review, publish and report on screening standards

See UK National Screening Committee: information development guidance for definition of personal informed choice.

2. Glossary of Terms and Definitions

Within healthcare there are three main types of standards which can be utilised to assess quality: process, structural and outcome standards.  These are explained in more detail in Table 1.  Although for the purpose of quality assurance and to support the continual improvement of population-based screening programmes information from all three categories can be relevant, indeed Donabedian (Donabedian, 2005 ) describes the interplay between structure and process which in turn affects outcomes, the scope of this guidance is limited to the setting of process standards.

Term	Definition	Example	In scope of this guidance
Process standards	Process standards focus on the way in which the screening pathway works to deliver the programme	Coverage rates	Yes
Structural standards	Structural standards describe the context of the screening programme and the factors that affect how it is delivered.	Facilities	No
Outcome standards	Outcome standards describe the effect of screening programmes at a population level.	Survival rates	No

Table 1 Definition of the different types of standards

3. Out of scope

3.1 Structural standards

These describe the structure of the programme and must be fully met.

Examples of structural standards are:

• provision of comprehensive, accurate and accessible information to all participants
• provision of appropriately trained staff to provide the screening service in line with best practice guidelines and national policy

Structural standards are included in section 7a service specifications and monitored through commissioning and other QA routes. Providers and commissioners should review the service specifications to make sure structural standards are met by all screening services.

3.2 Outcome standards

Outcome standards describe the effect of screening programmes at a population level to achieve its aims such as reduce cause specific mortality.  These are critical in the evaluation of the individual programmes but are challenging as they are impacted by factors external to screening such as changes in treatment regimes, variation in compliance rates or, internal to screening, such as the impact of lead time bias.

4. Screening standards

Screening standards are process indicators that measure performance at critical parts of the screening pathway such as uptake to screening invitation.  They can be used by policy makers, commissioners and service providers to assess the screening process, identify excellence and inform the identification of opportunities for service improvement. They also underpin a consistent, objective quality assurance framework.

Screening standards provide:

• reliable and timely information about the quality of the screening programme
• data at local, regional and national level too allow performance to be contextualised
• uniform quality measures across the screening pathway without gaps or duplications

NHS England supports health professionals and commissioners in providing a high quality screening programme. As part of this support, NHS England develops and reviews screening standards against which data are collected, reported and published annually. The standards provide a defined set of measures that providers must meet to ensure local screening services are safe and effective. As screening standards are clearly defined and centrally analysed, they also make sure there is a consistent approach across screening providers.

4.1 Quality assurance and quality standards

Quality assurance (QA) incorporates the process of checking that screening standards are met and encourage continuous quality improvement. QA of screening in England covers the entire screening pathway from identification of the eligible population to be invited for screening through to referral and treatment where this is required.

Setting high-performance standards is not a one-time effort; it’s an ongoing commitment. The benefits of continuous cycle of setting and reviewing screening standards include the following:

• continuous improvement of quality outcomes
• efficient resetting of contractual requirements and enabling relevant compliance monitoring
• reduced process variation
• improved relevance
• identification of emerging critical performance areas
• supports a quality culture across the system
• set expectations for service users

Quality standards incorporate the guidelines, evidence-based practice, methods, systems, and requirements defined by the screening programmes to help providers to achieve and demonstrate consistent high quality care to the eligible cohort and throughout the screening pathway.  These are described within programme-specific QA guidance documents and used to inform the setting of the relevant QA programme specific operating manuals.  These areas are often the bases of identifying quality improvement opportunities either at provider or programme level.

4.2 Assurance

The three line of defence model can be adapted to demonstrate the roles and responsibilities of different stakeholders in the monitoring of screening standards:

Line of defence	Who is giving assurance	Who is being assured	Involves
First	Provider – operational level	Provider – executive board level	Assures the internal systems in place to identify, mitigate and escalate identified risks within the provider organisation
Second	Provider	Commissioner	Assures that the service is being delivered in line with the service specification, identifies when performance is below specified levels and provides a mechanism to detail what corrective active is being taken
Third	Screening Quality assurance (QA)	Provider and commissioner	Provides external, independent of providers and commissioners an objective assurance of the processes and practices in place to deliver a consistent high quality service through a subject matter led analysis of achievement of defined quality standards

5. Evidence Review

Screening standards are underpinned by evidence.  Ideally this should be evidence derived from high quality research undertaken in a comparable population.  However, as per the hierarchy of evidence, it can also be evidence from audit and routinely collated data or, particularly in the context of new or emerging practice, evidence from the experience of health professionals (Greenhalgh, 2010). 

The type of review undertaken is influenced by the purpose of the review.  The process undertaken when establishing standards for a new pathway will differ to that followed when reviewing existing standards.

When a full literature review is required, the following elements should be included;

• clear inclusion and exclusion search criteria ensuring that where possible the source evidence reflects the core elements of the programme’s such as the target age group, scope and, where possible, adjusts for known underserved communities who are at risk
• specification of data bases, years searched, language and inclusion of grey literature
• development of search terms, this could be derived using the PICO (P: patient, problem or population; I: intervention; C: comparison; O: outcome) framework

6. Gap analysis

The initial planning of the standards review should incorporate a gap analysis to ascertain whether the current programme standards are sufficiently comprehensive and if not whether there are new pathways that need to be assured or new data sets available that provide an opportunity to introduce or improve performance and quality management.

7. Equity impact

Standards should be designed and be able to be monitored to reduce inequalities. Consideration should be given to all standards to establish whether differences in the distribution of health determinants including gender, age, ethnicity, socioeconomic status and other protected characteristics and screening outcomes could be considered avoidable and unfair.

Review at a local level of performance by population group may indicate inequity in participants entering and completing the screening pathway or accessing services within optimal timescales. Local services can use the NHS population screening health equity audit guide and the Health Equity Assessment Tool to help identify and reduce inequalities.

Programmes may identify that it is appropriate that for some standards to set different thresholds based on certain characteristics.  Should this be identified as being required and supportive of reducing known inequalities this should be clearly described in the document with details regarding how these populations will be identified and robustly analysed so that meaningful insight is gained.

8. Scope and terminology

Screening standards look at parts of the screening pathway that assess the screening process and allow for continuous improvement. This enables providers and commissioners to identify where improvements are needed.

Each process standard has 8 parts:

1. Description: what is being measured.
2. Rationale: why is it being measured.
3. Definition: how the numerator and denominator are defined.
4. Performance thresholds: 2 thresholds (acceptable and achievable).
5. Caveats: reasons why providers might not reach the defined thresholds.
6. Data collection and reporting: geography, source of data, responsibility for data quality, completeness and submission.
7. Reporting period: the time period over which activities should be included in a data submission.
8. Review dates: when the standard was introduced and when it was last updated.

9. Pathway themes

There are 8 themes that describe the screening pathway:

1. Population
2. Coverage
3. Uptake
4. Test
5. Diagnosis/intervention
6. Referral
7. Intervention/treatment (including surveillance)
8. Outcome

It is possible to have more than one standard for a particular theme and no standards for a particular theme depending on the screening programme.

10. Performance thresholds

Performance thresholds are selected to align with existing screening standards. One or two thresholds are specified.

The acceptable threshold is the lowest level of performance which screening services are expected to attain. All screening services should exceed the acceptable threshold and agree service improvement plans to meet the achievable threshold. Screening services not meeting the acceptable threshold are expected to put in place recovery plans to deliver rapid and sustained improvement.

The achievable threshold represents the level at which the screening service is likely to be running optimally. All screening services should aspire to attain and maintain performance at or above this level.

Standards where thresholds are not set are reviewed and updated when relevant data and other information, such as research publications, become available.

11. Relationship between standards and key performance indicators

Some standards are also key performance indicators (KPIs) which focus on an area of particular concern and/or critical parts of the screening pathway.

KPIs define performance measures for a selection of public health priorities.  They are selected to provide a high-level overview of the quality of screening programmes at important points on the screening pathway.  They are used to measure how the NHS screening programmes are performing, support a high-level overview of programme quality and reflect areas where consistency and an understanding of variation across England are important.

Each KPI is reviewed once it consistently reaches the achievable threshold. It may then be withdrawn as a KPI and remain as a screening standard, allowing entry of another KPI to focus on additional areas of concern. Alternatively, the KPI thresholds may be changed to promote continuous improvement.

12. Shadow standards

Screening programmes are constantly evolving.  This may be through changes in the screening test, changes in eligibility criteria or the introduction of new cohorts.  In light of this changing landscape, it is sometimes necessary to introduce shadow standards. 

Shadow standards are indicators of future standards in a described part of the screening pathway but where there is not sufficient evidence available to set informed performance thresholds. Details of the description, rationale and definition of the standards to be monitored in shadow form should be provided.

The screening programme should state how long data should be collected on these shadow standards in order to ascertain their utility and inform the required performance thresholds. At this point, the shadow standards will either become established standards with an effective from date given or, if utility cannot be established, should be withdrawn.

The screening QA service should advise whether performance of a shadow standard will be included in their annual assessment of quality.

13. Reporting standards

Standards are formally reported annually unless they are also KPIs, in which case they are usually reported on quarterly.  In such instances annual figures may be aggregated or collected annually as indicated by the data quality achievable.

The organisations collating the data are responsible for making sure the data is accurate, timely and complete.  NHS England will not make modifications to the data but may be able to accept revised submissions where there have been significant changes.

14. Revising standards

NHS England Screening will review screening standards based on stakeholder feedback and data on an annual basis. This is usually a minor review where wording or definitions are clarified.

There will be a comprehensive review of programme standards when indicated. This will be identified by the screening programme and may be triggered by:

• significant changes in the evidence base
• significant changes in the screening pathway
• stakeholder feedback
• priority areas identified by NHS England

The reviews will be integrated into the cycle of agreeing the section 7a service specifications with the Department of Health and Social Care and NHS England.

15. Retiring standards

As part of the review of standards, programmes will assess each standard to ascertain if it is still relevant. If a standard is identified as no longer relevant, then it should be retired.

Retired standards should be clearly described in the programmes consolidated standards document with the rationale for this decision provided.  An effective from date should be given.

16. Consultation

The draft consolidated standards should go through a two stage consultation process.

16.1 Stage 1 consultation - internal

The draft standards should be reviewed within NHS England to gain the input from the following stakeholders:

• Portfolio team working in the relevant screening programme
• Screening Professional & Clinical Advisors
• Screening & Immunisation Teams
• Commissioners
• Inequalities

16.2 Stage 2 consultation – external

The programme should develop a list of stakeholders who should be invited to participate in the consultation. This may include:

• Clinical leads of providers
• Office for Health Improvement and Disparities
• Charities representing the user voice
• Professional bodies
• Royal Colleges

17. References

 Donabedian, A. (2005 ). Evaluating the Quality of Medical Care. The Milbank Quarterly, 515-536.

Greenhalgh, T. (2010). How to Read a Paper: The Basics of Evidence-Based Medicine. 4th Edition. Oxford: BMJ Publishing Group Ltd.