Guidance

Our approach to NHS population screening standards

Published 26 July 2019

1. Introduction

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

PHE Screening has a responsibility to:

• implement UK NSC policies
• 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.

Screening standards provide:

• reliable and timely information about the quality of the screening programme
• data at local, regional and national level
• quality measures across the screening pathway without gaps or duplications

They also make sure there is a consistent approach across screening programmes and that data collection is beneficial.

PHE Screening supports health professionals and commissioners in providing a high quality screening programme. This involves developing and reviewing screening standards against which data is collected, reported and published annually. The standards provide a defined set of measures that providers have to meet to make sure local screening services are safe and effective.

Quality assurance (QA) is the process of checking that these standards are met, and encourage continuous quality improvement. QA 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.

2. Equity impact

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 PHE Health Equity Assessment Tool to help identify and reduce inequalities.

3. 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.

4. 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
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.

5. Exclusions – structural standards

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

Examples of structural standards are:

• provision of 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.

6. Performance thresholds

Performance thresholds are selected to align with existing screening standards. One or 2 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.

7. Relationship between standards and key performance indicators

Some standards are also key performance indicators (KPIs) which focus on an area of particular concern.

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.

8. Reporting standards

Standards are reported annually unless they are also KPIs, in which case they are usually reported on quarterly and annual figures are aggregated. We coordinate an annual collection and analysis of standards data. The organisations collating the data are responsible for making sure the data is accurate, timely and complete.

9. Revising standards

PHE Screening will review screening standards based on 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 every 3 years where new standards may be introduced or existing standards are withdrawn.

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.