Official Statistics

AAA standards report 2019 to 2020

Published 25 February 2021

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This publication is available at https://www.gov.uk/government/statistics/abdominal-aortic-aneurysm-screening-standards-report-2019-to-2020/aaa-standards-report-2019-to-2020

This data report presents data against each of the 12 screening standards for screening activity related to abdominal aortic aneurysm (AAA) screening.

The data source used for this report is AAA SMaRT (screening management and referral tracking).

The NHS AAA screening programme aims to reduce aneurysm-related mortality through early detection, appropriate monitoring and treatment.

The NHS AAA screening programme invites men for ultrasound screening during the year (1 April to 31 March) in which they turn 65. Men over 65, who have not previously been screened, can self-refer. The programme offers annual or quarterly surveillance for all men who, on initial scan, are found to have a small or medium aneurysm respectively. Men found to have a large aneurysm are referred into the care of specialised vascular services for diagnosis and treatment.

National AAA standards provide a defined set of measures that providers must meet to make sure services are safe and effective. The NHS AAA screening programme published a set of revised standards in April 2016.

This report is an official statistic. Official statistics are an essential public asset. They provide a window on society, the economy, and on the work and performance of government. They are fundamental to the judgements and decisions made by the public, by government, and by an enormous range of other organisations.

The report is a testament to the hard work of everyone involved in the programmes. We would like to thank all those involved in collecting and collating the data, producing the report, and most of all those from the NHS who deliver the screening services.

1. AAA standards

Ten of the 12 national AAA standards are included in this report, which are:

  • AAA-S01a

  • AAA-S01bi

  • AAA-S01bii

  • AAA-S02a

  • AAA-S02bi

  • AAA-S02bii

  • AAA-S03

  • AAA-S04a

  • AAA-S04bi

  • AAA-S04bii

  • AAA-S07

  • AAA-S08

  • AAA-S09

  • AAA-S10

  • AAA-S11

  • AAA-S12

Standards data are published annually. Standard AAA-S02a, AAA-S02bi and AAA-S02bii are also key performance indicators (KPI), which are published quarterly.

Two thresholds, the acceptable threshold and achievable threshold are specified for each standard.

1.1 Organisation table

Charts in this report display the internal code used by the AAA programme. This table shows the name of the provider associated with each code.

Code Provider Region
BBW Bristol, Bath and Weston AAA Screening Cohort South
BCO Black Country AAA Screening Cohort Midlands and East
BLM Bedfordshire, Luton and Milton Keynes AAA Screening Cohort Midlands and East
CAM Cambridgeshire AAA Screening Cohort Midlands and East
CHM Cheshire and Merseyside AAA Screening Cohort North
CML Lancashire and South Cumbria AAA Screening Cohort North
COV Coventry and Warwick AAA Screening Cohort Midlands and East
CYH Central Yorkshire AAA Screening Cohort North
DBY Derbyshire AAA Screening Cohort Midlands and East
DOW Dorset and Wiltshire AAA Screening Cohort South
ESX Essex AAA Screening Cohort Midlands and East
FRV Five Rivers AAA Screening Cohort Midlands and East
GLO Gloucester and Swindon AAA Screening Cohort South
HAM Hampshire AAA Screening Cohort South
HFD Hertfordshire AAA Screening Cohort Midlands and East
HOE Central England AAA Screening Cohort Midlands and East
HRW Hereford and Worcester AAA Screening Cohort Midlands and East
KEN Kent and Medway AAA Screening Cohort South
LEI Leicester AAA Screening Cohort Midlands and East
LNC Lincolnshire AAA Screening Cohort Midlands and East
MAN Manchester AAA Screening Cohort North
NOE North East and North Cumbria AAA Screening Cohort North
NOL North London AAA Screening Cohort London
NOR Norfolk and Waveney AAA Screening Cohort Midlands and East
NOT Nottinghamshire AAA Screening Cohort Midlands and East
NRH Northamptonshire AAA Screening Cohort Midlands and East
NSS North and South Staffordshire AAA Screening Cohort Midlands and East
PEN Peninsula AAA Screening Cohort South
SDE South Devon AAA Screening Cohort South
SOM Somerset and North Devon AAA Screening Cohort South
STW Shropshire, Telford and Wrekin AAA Screening Cohort Midlands and East
SWL South London AAA Screening Cohort London
SYB South Yorkshire and Bassetlaw AAA Screening Cohort North
THV Thames Valley AAA Screening Cohort South
WSR West Surrey AAA Screening Cohort South
WSU Sussex AAA Screening Cohort South
WYO West Yorkshire AAA Screening Cohort North
YOH North Yorkshire and Humber AAA Screening Cohort North

Data is presented by financial year (1 April 2019 to 31 March 2020) unless stated otherwise.

2. Coverage

This section covers standard AAA-S02. See the 5 recommendations relating to coverage.

2.1 AAA-S02a

Figure 1. Coverage: percentage of eligible cohort men conclusively tested within the screening year plus 3 months, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 81.5
BCO 78.8
BLM 81.2
CAM 70.4
CHM 71.3
CML 77.0
COV 81.3
CYH 81.3
DBY 81.7
DOW 84.2
ESX 75.3
FRV 75.4
GLO 77.8
HAM 83.4
HFD 78.2
HOE 61.2
HRW 82.6
KEN 78.6
LEI 78.4
LNC 81.5
MAN 72.4
NOE 78.4
NOL 66.6
NOR 80.9
NOT 80.1
NRH 80.7
NSS 74.2
PEN 81.5
SDE 83.3
SOM 84.6
STW 82.0
SWL 56.3
SYB 79.5
THV 78.9
WSR 81.1
WSU 82.9
WYO 74.0
YOH 81.0

The provider level data for the report showed:

  • Somerset and North Devon AAA Screening Cohort had the highest outcome
  • South London AAA Screening Cohort had the lowest outcome
  • 30 out of 38 screening providers met the acceptable threshold of ≥ 75.0%
  • 0 out of 38 screening providers also reached the achievable threshold of ≥ 85.0%

Several providers did not meet the acceptable threshold, including:

  • Cambridgeshire AAA Screening Cohort
  • Cheshire and Merseyside AAA Screening Cohort
  • Central England AAA Screening Cohort
  • Manchester AAA Screening Cohort
  • North London AAA Screening Cohort
  • North and South Staffordshire AAA Screening Cohort
  • South London AAA Screening Cohort
  • West Yorkshire AAA Screening Cohort

Nationally 76.1% of eligible men were conclusively tested within the screening year plus 3 months. This standard has been affected by the pause in screening activity in response to the coronavirus pandemic. Initial screening appointments for mid-March to June were cancelled which has had an impact on coverage. Providers also experienced an increase in the number of men not attending appointments in March. Two providers who did not meet the acceptable threshold had also experience issues with staffing which affected capacity for screening during the year.

Figure 2. Coverage: percentage of eligible cohort men conclusively tested within the screening year plus 3 months by index of multiple deprivation (IMD) 2019 decile, England, 1 April 2019 to 31 March 2020

The attendance and aorta measurements for each man were linked to the IMD2019 score by the lower super output area of where they live. Men living in the most deprived tenth of areas of the country were less likely to attend for screening compared to those living in the least deprived areas (66.1% to 83.4%). This contrasts with the detection of aneurysms, which was highest for men living in the most deprived tenth of areas and lowest for men living in the least deprived tenth of areas (1.43% to 0.64%). There was a reduction in coverage between 5.3% and 7.9% across each of the IMD2019 deciles between 2018 to 2019 and 2019 to 2020.

Figure 3. Percentage of aneurysms detected in eligible cohort men, England, 1 April 2013 to 31 March 2020

Between 1 April 2019 and 31 March 2020, 2,033 eligible cohort men tested were found to have an aneurysm of 3.0cm or greater (0.92%). This varied from 0.68% in North London to 1.57% in Lincolnshire. The percentage of men with aneurysms continues to decline each year, although there are some providers where the percentage has been increasing for the past 3 years. It is thought to be due to the population of men in the area as the delivery of the screening programme in the areas has not changed and coverage has not increased significantly.

Figure 4. Coverage: percentage of eligible cohort men conclusively tested within the screening year plus 3 months, by region, England, 1 April 2013 to 31 March 2020

Coverage had been gradually increasing nationally from 1 April 2013 onwards. However, there has been a 6.4% decrease between 2018 to 2019 and 2019 to 2020. Thirty-five of the 38 providers had a decrease in coverage in this period. Coverage across the London region has been particularly affected over the past 3 years as a result of commissioning of services. Some providers have experienced capacity issues through the year affecting coverage. There has also been an impact due to the coronavirus pandemic which has varied between providers.

The coverage of the initial screen in men self referring to AAA screening was 88.9%, which was lower than for 1 April 2018 to 31 March 2019 (97.6%). Coverage ranged from 51.9% in Norfolk and Waveney to 100% in West Yorkshire. As with the cohort men coverage will have been impacted by the pandemic response.

The percentage of aneurysms detected in self referral men was higher than in the cohort men, 3.8%, varying from 0.78% in Hampshire to 16.0% in Leicester. The risk of developing an aneurysm increases with age resulting in a higher detection rate in men self referring into the programme. Men who self referred in 2019 to 2020 were on average aged 76 years but this varied from 66 to 98 years.

2.2 AAA-S02bi

Figure 5. Coverage: percentage of annual surveillance appointments due where there is a conclusive test within 6 weeks of the due date, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 83.8
BCO 95.5
BLM 85.2
CAM 90.5
CHM 92.2
CML 93.4
COV 96.4
CYH 95.9
DBY 93.7
DOW 88.0
ESX 93.4
FRV 93.6
GLO 89.9
HAM 90.9
HFD 91.8
HOE 87.3
HRW 94.5
KEN 92.1
LEI 79.5
LNC 92.4
MAN 89.6
NOE 87.9
NOL 84.9
NOR 93.2
NOT 87.4
NRH 95.4
NSS 95.2
PEN 92.9
SDE 92.9
SOM 92.8
STW 84.6
SWL 90.7
SYB 98.4
THV 85.2
WSR 90.4
WSU 90.7
WYO 88.5
YOH 93.6

The provider level data for the report showed:

  • South Yorkshire and Bassetlaw AAA Screening Cohort had the highest outcome
  • Leicester AAA Screening Cohort had the lowest outcome
  • 34 out of 38 screening providers met the acceptable threshold of ≥ 85.0%
  • 6 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%

Several providers did not meet the acceptable threshold, including:

  • Bristol, Bath and Weston AAA Screening Cohort
  • Leicester AAA Screening Cohort
  • North London AAA Screening Cohort
  • Shropshire, Telford and Wrekin AAA Screening Cohort

Of the 12,873 annual surveillance appointments due between 1 April 2019 to 31 March 2020, 90.8% had a conclusive test within 6 weeks of the due date. This varied from 79.5% in Leicester to 98.4% in South Yorkshire and Bassetlaw.

Although the national percentage of annual surveillance coverage has been approximately 91.0% for the past 4 years, there has been a lot of change at a provider level. There were 21 providers who had a decrease of more than 1% in the percentage of appointments with a conclusive test result within 6 weeks of the due date from the previous screening year. A further 6 had no change and 11 had an increase of more than 1%. The largest increase was in South London where there was a rise from 84.6% in 2018 to 2019 to 90.7% in 2019 to 2020.

2.3 AAA-S02bii

Figure 6. Coverage: percentage of quarterly surveillance appointments due where there is a conclusive test within 4 weeks of the due date, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 90.4
BCO 95.2
BLM 88.9
CAM 85.4
CHM 96.1
CML 90.6
COV 95.7
CYH 95.1
DBY 89.7
DOW 92.0
ESX 92.9
FRV 90.2
GLO 93.6
HAM 88.1
HFD 96.2
HOE 87.8
HRW 94.7
KEN 91.0
LEI 87.2
LNC 92.6
MAN 92.4
NOE 91.2
NOL 83.2
NOR 93.8
NOT 88.1
NRH 93.3
NSS 96.3
PEN 95.8
SDE 94.2
SOM 90.6
STW 94.0
SWL 87.3
SYB 94.6
THV 90.9
WSR 93.5
WSU 93.4
WYO 93.9
YOH 92.0

The provider level data for the report showed:

  • North and South Staffordshire AAA Screening Cohort had the highest outcome
  • North London AAA Screening Cohort had the lowest outcome
  • 37 out of 38 screening providers met the acceptable threshold of ≥ 85.0%
  • 7 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%
  • North London AAA Screening Cohort did not meet the acceptable threshold

Of the 10,520 quarterly surveillance appointments due between 1 April 2019 to 31 March 2020, 91.7% had a conclusive test result within 4 weeks of the due date. Performance ranged from 83.2% in North London to 96.3% in North and South Staffordshire. Of those 4 also met the achievable threshold for annual surveillance coverage: Black Country, Coventry and Warwick, Central Yorkshire and North and South Staffordshire.

Coverage of the quarterly surveillance scan has also been stable at about 92.0% over the past 4 years. As with the annual surveillance coverage, this masks change at a provider level. 16 providers had a decrease of more than 1% from last year with the largest being 6.6% in Nottinghamshire. 13 providers had no change and 9 had an increase of more than 1%. Cheshire and Merseyside had the largest increase, a 5.7% increase to 96.1% in 2019 to 2020.

3. Uptake

This section covers standards AAA-S01, AAA-S03 and AAA-S04. See the 10 recommendations relating to uptake.

3.1 AAA-S01a

Figure 7. Percentage of eligible cohort men offered screening within the screening year plus 3 months, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 99.9
BCO 99.7
BLM 99.9
CAM 99.6
CHM 99.6
CML 100.0
COV 100.0
CYH 99.9
DBY 100.0
DOW 99.9
ESX 100.0
FRV 99.9
GLO 99.9
HAM 99.9
HFD 99.6
HOE 96.5
HRW 100.0
KEN 99.9
LEI 99.8
LNC 100.0
MAN 99.9
NOE 100.0
NOL 99.8
NOR 99.9
NOT 99.9
NRH 99.8
NSS 98.7
PEN 99.4
SDE 99.8
SOM 100.0
STW 100.0
SWL 82.4
SYB 100.0
THV 99.8
WSR 99.9
WSU 99.6
WYO 100.0
YOH 99.9

The 2019 to 2020 provider level data showed that:

  • Coventry and Warwick AAA Screening Cohort had the highest outcome
  • South London AAA Screening Cohort had the lowest outcome
  • 37 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
  • 35 out of 38 screening providers also reached the achievable threshold of ≥ 99.0%
  • the South London AAA Screening Cohort did not meet the acceptable threshold

There were 291,904 men aged 65 eligible for AAA screening between 1 April 2019 and 31 March 2020. 98.8% of those eligible men were offered an initial screen. The reasons for not being invited include:

  • incorrect contact details
  • deferring screening
  • opting out of the screening programme receiving personal details for screening
  • offered after 30 June 2020
  • not offered

Figure 8. Percentage of eligible cohort men offered screening within the screening year plus 3 months, by region, England, 1 April 2013 to 31 March 2019

Offer of the initial screen to men in each cohort year has been relatively stable over the past 6 years. However, this is the first time since 1 April 2014 to 31 March 2015 that completeness of offer has fallen below the achievable threshold of 99.0% nationally. Normally providers have an additional 3 months after the end of the screening year in March to invite men who transfer into the screening programme at the end of the year. This year some services experienced a pause in screening activity from mid-March due to the coronavirus pandemic. This will have resulted in some providers not being able to offer all men an appointment before 30 June 2020. South London experienced an additional delay in starting to screen the 2019 to 2020 cohort men as the provider only came into operation in September 2019.

There were 8,340 men who self-referred into the AAA screening programme between 1 April 2019 and 31 March 2020 and 98.5% were offered an initial screen. 127 men were not offered an initial screen. The reasons for not being invited include:

  • deferring screening
  • declining screening
  • offered after 30 June 2020
  • not offered

3.2 AAA-S01bi

Figure 9. Percentage of annual surveillance appointments due where there is an offered appointment within 6 weeks of the due date, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 96.6
BCO 100.0
BLM 97.0
CAM 98.3
CHM 99.5
CML 99.7
COV 100.0
CYH 100.0
DBY 100.0
DOW 95.5
ESX 99.3
FRV 99.7
GLO 97.8
HAM 98.2
HFD 99.1
HOE 98.1
HRW 100.0
KEN 99.2
LEI 86.6
LNC 99.2
MAN 98.4
NOE 99.0
NOL 96.3
NOR 97.8
NOT 100.0
NRH 99.4
NSS 99.4
PEN 99.3
SDE 99.0
SOM 100.0
STW 96.7
SWL 98.6
SYB 100.0
THV 96.8
WSR 99.0
WSU 98.4
WYO 97.4
YOH 99.5

The provider level data for the report showed several providers had the highest outcome, including:

  • Black Country AAA Screening Cohort
  • Coventry and Warwick AAA Screening Cohort
  • Central Yorkshire AAA Screening Cohort
  • Derbyshire AAA Screening Cohort
  • Hereford and Worcester AAA Screening Cohort
  • Nottinghamshire AAA Screening Cohort
  • Somerset and North Devon AAA Screening Cohort
  • South Yorkshire and Bassetlaw AAA Screening Cohort

The data also showed:

  • Leicester AAA Screening Cohort had the lowest outcome
  • 37 out of 38 screening providers met the acceptable threshold of ≥ 95.0%
  • 8 out of 38 screening providers also reached the achievable threshold of 100.0%
  • Leicester AAA Screening Cohort did not meet the acceptable threshold

Between 1 April 2019 and 31 March 2020 there were 12,873 annual surveillance appointments due and 12,675 had an offer within 6 weeks of their due date (98.5%). There was little variation across the country; the interquartile range was 1.76%. The national AAA screening programme introduced the surveillance standards in April 2015 following a year developing and piloting the standards with the local screening providers. Nationally, the performance has remained similar across all 4 years at approximately 98.0%, although 2019 to 2020 is the highest. 11 providers had an increase of more than 1% in the percentage of annual surveillance appointments with an offer within 6 weeks of the due date between 2018 to 2019 and 2019 to 2020. 24 providers had no change and 3 had a decrease of more than 1%.

3.3 AAA-S01bii

Figure 10. Percentage of quarterly surveillance appointments due where there is an offered appointment within 4 weeks of the due date, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 99.4
BCO 100.0
BLM 98.0
CAM 97.5
CHM 98.4
CML 97.9
COV 99.7
CYH 98.5
DBY 99.4
DOW 98.5
ESX 100.0
FRV 97.3
GLO 99.2
HAM 98.8
HFD 99.5
HOE 98.1
HRW 99.5
KEN 96.8
LEI 97.3
LNC 99.2
MAN 98.9
NOE 99.1
NOL 97.1
NOR 99.6
NOT 98.7
NRH 100.0
NSS 100.0
PEN 100.0
SDE 99.5
SOM 98.6
STW 97.4
SWL 97.4
SYB 99.5
THV 99.2
WSR 98.1
WSU 99.3
WYO 99.4
YOH 99.3

The provider level data for the report showed several providers had the highest outcome, including:

  • Black Country AAA Screening Cohort
  • Essex AAA Screening Cohort
  • Northamptonshire AAA Screening Cohort
  • North and South Staffordshire AAA Screening Cohort
  • Peninsula AAA Screening Cohort

The data also showed:

  • Kent and Medway AAA Screening Cohort had the lowest outcome
  • 38 out of 38 screening providers met the acceptable threshold of ≥ 95.0%
  • 5 out of 38 screening providers also reached the achievable threshold of 100.0%
  • there were no providers that did not meet the acceptable threshold

There were 10,520 quarterly surveillance appointments due between 1 April 2019 and 31 March 2020 and 10,391 appointments were offered within 4 weeks of the due date (98.8%). As with the annual surveillance men, there is little variation across the country (interquartile range 1.37%). Offer of quarterly surveillance appointments has been approximately 98.0% over the past 4 years, with 2019 to 2020 being the highest.

Between 2018 to 2019 and 2019 to 2020, 12 providers had an increase of more than 1% in the percentage of appointments with an offer within 4 weeks of the due date. The largest increase was a 5.8% increase to 97.4% in South London. 23 providers had no change in the percentage of appointments offered within the timeframe and 3 had a decrease of more than 1%. The largest decrease was 2.6% to 97.4% in Shropshire, Telford and Wrekin.

3.4 AAA-S03

Figure 11. Percentage of men not responding to first offer to whom a second offer is made, where the appointment is scheduled to take place within the screening year plus 3 months, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 96.9
BCO 98.0
BLM 99.1
CAM 99.4
CHM 99.2
CML 98.8
COV 98.4
CYH 98.8
DBY 99.9
DOW 98.1
ESX 98.6
FRV 92.9
GLO 97.9
HAM 99.7
HFD 100.0
HOE 82.6
HRW 98.5
KEN 99.6
LEI 98.7
LNC 97.9
MAN 99.9
NOE 96.8
NOL 95.8
NOR 98.3
NOT 98.7
NRH 99.8
NSS 98.3
PEN 96.6
SDE 99.6
SOM 99.7
STW 89.8
SWL 98.4
SYB 99.6
THV 99.0
WSR 99.3
WSU 98.9
WYO 99.4
YOH 96.2

The provider level data for the report showed:

  • Hertfordshire AAA Screening Cohort had the highest outcome
  • Central England AAA Screening Cohort had the lowest outcome
  • 36 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
  • 1 out of 38 screening providers also reached the achievable threshold of = 100.0%

Some providers did not meet the acceptable threshold, including:

  • Central England AAA Screening Cohort
  • Shropshire, Telford and Wrekin AAA Screening Cohort

Between 1 April 2019 and 31 March 2020, 68,682 (23.8%) eligible men offered AAA screening did not attend their first non-cancelled appointment and of those 97.7% were offered a second appointment by 30 June. Achievement of this standard is high and was relatively stable with a decrease in 2017 to 2018 primarily due to the recommissioning of the London providers. It has varied from 95.8% for 1 April 2013 to 31 March 2014 to a high of 97.8% for 1 April 2016 to 31 March 2017.

Nationally between 1 April 2015 and 31 March 2016, 36% of men who did not attend their first appointment attended a subsequent appointment. This was 37% for 2017 to 2018 and 2018 to 2019. It has dropped in 2019 to 2020 to 31.4%, which may be a result of fewer providers inviting men who did not attend their first appointment to mop-up clinics at the end of the year because of the pandemic. The highest rate of attendance following a non-attended first appointment between 1 April 2019 and 31 March 2020 was 43.7% in Bedfordshire, Luton and Milton Keynes.

Only 2.2% of men self referring to AAA screening did not attend their first non-cancelled appointment with 88.9% offered a second appointment. Of those that weren’t offered a second appointment by 30 June, 69.6% men were offered a second appointment after 30 June 2020, 5.4% men declined a further appointment, 15.5% were discharged due to non-attendance, 2.7% deferred their appointment and 6.8% have yet to be sent a second invite.

3.5 AAA-S04a

Figure 12. Uptake: percentage of eligible men offered screening who are conclusively tested within the screening year plus 3 months, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 81.6
BCO 79.1
BLM 81.3
CAM 70.7
CHM 71.6
CML 77.0
COV 81.3
CYH 81.4
DBY 81.7
DOW 84.3
ESX 75.3
FRV 75.4
GLO 77.8
HAM 83.4
HFD 78.5
HOE 63.5
HRW 82.6
KEN 78.7
LEI 78.6
LNC 81.6
MAN 72.5
NOE 78.4
NOL 66.7
NOR 81.0
NOT 80.1
NRH 80.8
NSS 75.2
PEN 82.0
SDE 83.5
SOM 84.6
STW 82.1
SWL 68.3
SYB 79.5
THV 79.0
WSR 81.2
WSU 83.2
WYO 74.1
YOH 81.1

The provider level data for the report showed:

  • Somerset and North Devon AAA Screening Cohort had the highest outcome
  • Central England AAA Screening Cohort had the lowest outcome
  • 31 out of 38 screening providers met the acceptable threshold of ≥ 75.0%
  • 0 out of 38 screening providers also reached the achievable threshold of ≥ 85.0%

Some providers did not meet the acceptable threshold, including:

  • Cambridgeshire AAA Screening Cohort
  • Cheshire and Merseyside AAA Screening Cohort
  • Central England AAA Screening Cohort
  • Manchester AAA Screening Cohort
  • North London AAA Screening Cohort
  • South London AAA Screening Cohort
  • West Yorkshire AAA Screening Cohort

Figure 13. Uptake: percentage of men offered screening who are conclusively tested within the initial screening year plus 3 months, by region, England, 1 April 2013 to 31 March 2020

Nationally, uptake was 77.0% for the screening year plus 3 months. As with coverage, uptake has decreased from 2018 to 2019. The 5.4% decrease will be due to the same reasons as described above. Uptake across the London region has been particularly affected over the past 3 years as a result of commissioning of services. However, Sussex and Leicester had increases in uptake from the previous year (2.1% and 3.8% respectively).

3.6 AAA-S04bi

Figure 14. Uptake: percentage of annual surveillance appointments offered where there is a conclusive test within 6 weeks of the due date, by screening provider, England, 1 April 2013 to 31 March 2020

Code Performance
BBW 86.8
BCO 95.5
BLM 87.8
CAM 92.0
CHM 92.7
CML 93.7
COV 96.4
CYH 95.9
DBY 93.7
DOW 92.1
ESX 94.1
FRV 93.9
GLO 91.9
HAM 92.6
HFD 92.6
HOE 89.0
HRW 94.5
KEN 92.9
LEI 91.8
LNC 93.2
MAN 91.0
NOE 88.9
NOL 88.2
NOR 95.2
NOT 87.4
NRH 96.0
NSS 95.7
PEN 93.6
SDE 93.8
SOM 92.8
STW 87.5
SWL 92.0
SYB 98.4
THV 88.0
WSR 91.3
WSU 92.2
WYO 90.9
YOH 94.1

The provider level data for the report showed:

  • South Yorkshire and Bassetlaw AAA Screening Cohort had the highest outcome
  • Bristol, Bath and Weston AAA Screening Cohort had the lowest outcome
  • 30 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
  • 7 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%

Several providers did not meet the acceptable threshold, including:

  • Bristol, Bath and Weston AAA Screening Cohort
  • Bedfordshire, Luton and Milton Keynes AAA Screening Cohort
  • Central England AAA Screening Cohort
  • North East and North Cumbria AAA Screening Cohort
  • North London AAA Screening Cohort
  • Nottinghamshire AAA Screening Cohort
  • Shropshire, Telford and Wrekin AAA Screening Cohort
  • Thames Valley AAA Screening Cohort

Of the 12,675 annual surveillance appointments that were offered within 6 weeks of the due date, 92.2% had a conclusive test within the 6 weeks. Uptake of the annual surveillance appointment was introduced as a standard from April 2015. As with standards 1b and 2b, they were developed and piloted during the year with 1 April 2016 to 31 March 2017 being the first year the data was reported on. Uptake of the annual surveillance screen has decreased slightly this year but there has been significant change at a provider level. The largest increase was in South London where there was an 3.8% increase from 2018 to 2019 to 92.0% in 2019 to 2020. Over the past year, Central Yorkshire and Northamptonshire have increased performance up to the achievable level. The largest decrease was by 9.4% from 2018 to 2019 to 86.8% in 2019 to 2020 for the uptake of the annual surveillance appointments in Bristol, Bath and Weston.

3.7 AAA-S04bii

Figure 15. Uptake: percentage of quarterly surveillance appointments offered where there is a conclusive test within 4 weeks of the due date, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 91.0
BCO 95.2
BLM 90.7
CAM 87.6
CHM 97.6
CML 92.6
COV 96.0
CYH 96.6
DBY 90.3
DOW 93.4
ESX 92.9
FRV 92.7
GLO 94.3
HAM 89.1
HFD 96.8
HOE 89.5
HRW 95.2
KEN 94.0
LEI 89.6
LNC 93.3
MAN 93.5
NOE 92.1
NOL 85.7
NOR 94.1
NOT 89.3
NRH 93.3
NSS 96.3
PEN 95.8
SDE 94.6
SOM 91.9
STW 96.5
SWL 89.7
SYB 95.0
THV 91.7
WSR 95.3
WSU 94.0
WYO 94.5
YOH 92.7

The provider level data for the report showed:

  • Cheshire and Merseyside AAA Screening Cohort had the highest outcome
  • North London AAA Screening Cohort had the lowest outcome
  • 31 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
  • 11 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%

Several providers did not meet the acceptable threshold, including:

  • Cambridgeshire AAA Screening Cohort
  • Hampshire AAA Screening Cohort
  • Central England AAA Screening Cohort
  • Leicester AAA Screening Cohort
  • North London AAA Screening Cohort
  • Nottinghamshire AAA Screening Cohort
  • South London AAA Screening Cohort

Nationally, 92.9% of quarterly surveillance appointments offered within 4 weeks of the due date had a conclusive test result within 4 weeks. Cheshire and Merseyside had the highest uptake of quarterly surveillance appointments at 97.6%. Only Central Yorkshire reached the achievable threshold for the uptake of both annual and quarterly surveillance appointments.

Uptake of the quarterly surveillance appointments has also decreased this year by 1.3% from 94.1% in 2018 to 2019. 21 providers had a decrease of more than 1% and 5 had an increase of more than 1%. The greatest decrease was Hampshire, by 6.2% from 95.0% in 2018 to 2019 to 89.1% in 2019 to 2020. The greatest increase was in Cheshire and Merseyside, from 93.0% in 2018 to 2019 to 97.6% in 2019 to 2020. Shropshire, Telford and Wrekin, Hertfordshire and, Cheshire and Merseyside have increased performance up to the achievable level over the past year.

4. Test

This section covers standards AAA-S05, AAA-S06, AAA-S07, AAA-S08. See the 3 recommendations relating to test.

4.1 AAA-S05

This standard was unable to be measured. The national AAA screening programme has been working to identify an appropriate method for assessing screener performance.

4.2 AAA-S06

This standard was unable to be measured. The national AAA screening programme has been working to identify an appropriate method for assessing screener performance.

4.3 AAA-S07

Figure 16. Percentage of screening encounters where aorta could not be visualised, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 0.68
BCO 0.29
BLM 0.49
CAM 2.33
CHM 2.41
CML 0.52
COV 1.94
CYH 0.32
DBY 0.53
DOW 2.08
ESX 3.34
FRV 1.39
GLO 0.97
HAM 0.17
HFD 0.63
HOE 1.36
HRW 0.73
KEN 0.23
LEI 0.74
LNC 1.72
MAN 2.99
NOE 0.10
NOL 1.61
NOR 0.72
NOT 2.59
NRH 0.88
NSS 0.19
PEN 0.76
SDE 1.20
SOM 0.46
STW 2.35
SWL 1.75
SYB 0.49
THV 0.32
WSR 0.79
WSU 1.44
WYO 1.36
YOH 0.28

For this standard, providers should be attaining the lowest percentage possible. The provider level data for the report showed:

  • North East and North Cumbria AAA Screening Cohort had the lowest outcome
  • Essex AAA Screening Cohort had the highest outcome
  • 37 out of 38 screening providers met the acceptable threshold of ≤ 3.0%
  • 22 out of 38 screening providers also reached the achievable threshold of ≤ 1.0%
  • Essex AAA Screening Cohort did not meet the acceptable threshold

Screening providers should aim to minimise the percentage of screens that cannot be visualised. Therefore, the lower the value the better for this standard. Nationally 1.14% of cohort screens were non-visualised. This was 1.03% for self-referral screens.

Figure 17. Percentage of screening encounters where aorta could not be visualised, by region, England, 1 April 2013 to 31 March 2020

Over the past 5 years, the percentage of non-visualised screens has been decreasing across England, however, there has been significant variation between the providers. Although still within the acceptable threshold, there has been a small increase in the London region over the past 4 years which may be due to an increase in trainee screeners following the recommissioning of providers and also due to the higher turnover of staff in London.

4.4 AAA-S08

Figure 18. Percentage of incomplete screening episodes, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 0.28
BCO 0.26
BLM 0.13
CAM 0.86
CHM 0.95
CML 0.21
COV 0.66
CYH 0.19
DBY 0.37
DOW 0.53
ESX 1.03
FRV 0.78
GLO 0.55
HAM 0.26
HFD 0.13
HOE 0.82
HRW 0.33
KEN 0.14
LEI 0.16
LNC 0.51
MAN 0.97
NOE 0.20
NOL 0.73
NOR 0.42
NOT 0.87
NRH 0.32
NSS 0.10
PEN 0.34
SDE 0.40
SOM 0.18
STW 1.37
SWL 1.06
SYB 0.33
THV 0.16
WSR 0.25
WSU 0.30
WYO 0.68
YOH 0.26

For this standard, providers should be attaining the lowest percentage possible. The provider level data for the report showed:

  • North and South Staffordshire AAA Screening Cohort had the lowest outcome
  • Shropshire, Telford and Wrekin AAA Screening Cohort had the highest outcome
  • 29 out of 38 screening providers met the acceptable threshold of ≤ 0.75%
  • 8 out of 38 screening providers also reached the achievable threshold of ≤ 0.20%

Several providers did not meet the acceptable threshold, including:

  • Cambridgeshire AAA Screening Cohort
  • Cheshire and Merseyside AAA Screening Cohort
  • Essex AAA Screening Cohort
  • Five Rivers AAA Screening Cohort
  • Central England AAA Screening Cohort
  • Manchester AAA Screening Cohort
  • Nottinghamshire AAA Screening Cohort
  • Shropshire, Telford and Wrekin AAA Screening Cohort
  • South London AAA Screening Cohort

Nationally 0.48% of screening episodes were incomplete. As with the non-visualised screens, providers should be aiming to reduce the percentage of incomplete screening episodes. Achievement of the standard this year may have been affected by the pause in screening activity as men who required subsequent screens following an initial non-visualised screen, quality assurance review of their images or equipment fault may not have been offered a follow-up appointment by 30 June 2020.

Figure 19. Percentage of incomplete screening episodes, by screening provider, England, 1 April 2013 to 31 March 2020

Nationally, the percentage of incomplete screening episodes had remained very similar between 2014 to 2015 and 2018 to 2019. However, there have been increases in London and Midlands and East since 2016 to 2017. The increase in the London region was marked this year with a 55.9% increase to 0.73% in North London and a 151.2% increase to 1.06% in South London. There were also increases above the acceptable threshold in:

  • Shropshire, Telford and Wrekin AAA Screening Cohort
  • Five Rivers AAA Screening Cohort
  • Manchester AAA Screening Cohort
  • Nottinghamshire AAA Screening Cohort

Following the restoration of screening, the percentage of incomplete screening episodes for Five Rivers and South London has reduced below the acceptable threshold.

5. Referral

This section covers standard AAA-S09. See the recommendation relating to referral.

5.1 AAA-S09

Figure 20. Percentage of men with AAA ≥5.5cm referred within 1 working day, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 100.0
BCO 100.0
BLM 100.0
CAM 100.0
CHM 100.0
CML 100.0
COV 100.0
CYH 100.0
DBY 100.0
DOW 100.0
ESX 100.0
FRV 100.0
GLO 100.0
HAM 100.0
HFD 100.0
HOE 97.1
HRW 100.0
KEN 100.0
LEI 100.0
LNC 100.0
MAN 97.9
NOE 100.0
NOL 100.0
NOR 100.0
NOT 100.0
NRH 100.0
NSS 100.0
PEN 100.0
SDE 100.0
SOM 100.0
STW 100.0
SWL 100.0
SYB 100.0
THV 100.0
WSR 100.0
WSU 100.0
WYO 100.0
YOH 100.0

The provider level data for the report showed:

  • 36 out of 38 screening providers met the acceptable threshold of ≥ 95.0%
  • 36 out of 38 screening providers also reached the achievable threshold of = 100.0%
  • no providers did not meet the acceptable threshold

Nationally, this standard was well achieved across the country. 99.8% of men were referred to a vascular service within 1 day of the screen where a 5.5cm or greater aneurysm was detected. The standard has remained stable varying from 98.0% for 1 April 2014 to 31 March 2015 to 99.6% for 1 April 2017 to 31 March 2018. However, for 2019 to 2020 performance has been the highest across all regions since the standard was introduced.

6. Diagnosis and intervention

This section covers standards AAA-S10, AAA-S11 and AAA-S12. See the 2 recommendations relating to diagnosis and intervention.

6.1 AAA-S10

The provider level data for the report showed:

  • 27 out of 38 screening providers met the acceptable threshold of ≤ 3.0%
  • 24 out of 38 screening providers also reached the achievable threshold of ≤ 1.0%

Several providers did not meet the acceptable threshold, including:

  • Black Country AAA Screening Cohort
  • Bedfordshire, Luton and Milton Keynes AAA Screening Cohort
  • Cheshire and Merseyside AAA Screening Cohort
  • Coventry and Warwick AAA Screening Cohort
  • Central Yorkshire AAA Screening Cohort
  • Dorset and Wiltshire AAA Screening Cohort
  • Essex AAA Screening Cohort
  • Kent and Medway AAA Screening Cohort
  • Lincolnshire AAA Screening Cohort
  • South London AAA Screening Cohort
  • West Surrey AAA Screening Cohort

Providers should be aiming to reduce the percentage of men found not to have a large aneurysm (aorta ≥5.5cm) on confirmatory scan. There were 875 men referred for surgery between 1 April 2019 and 31 March 2020. Of those, 1.9% were found to have an aorta <5.5cm on confirmatory CT or MRI scan. The majority were men who were found to have an aneurysm <5.5cm with less than 5 men not having an aneurysm at all. In the cases where the aneurysm was less than 5.5cm, the men were retained in hospital surveillance outside of the screening programme and will be monitored until their aneurysm reaches 5.5cm.

24 providers had no false positives for men referred during the screening year. 12 providers had 1 false positive, 1 provider had 2 false positives and 1 had 3 false positives (18.8% of referred men). The PHE screening quality assurance service (SQAS) followed up each of the false positives with the providers to identify if any further action was required.

6.2 AAA-S11

Figure 21. Percentage of men with aorta ≥5.5cm seen by vascular specialist within 2 weeks, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW 100.0
BCO 91.7
BLM 75.0
CAM 100.0
CHM 100.0
CML 100.0
COV 100.0
CYH 100.0
DBY 87.5
DOW 95.8
ESX 92.3
FRV 94.4
GLO 94.1
HAM 82.8
HFD 94.1
HOE 85.3
HRW 96.2
KEN 100.0
LEI 100.0
LNC 100.0
MAN 77.1
NOE 97.9
NOL 82.8
NOR 100.0
NOT 50.0
NRH 94.1
NSS 93.3
PEN 81.8
SDE 100.0
SOM 100.0
STW 100.0
SWL 65.4
SYB 100.0
THV 91.7
WSR 100.0
WSU 95.5
WYO 76.2
YOH 89.2

The provider level data for the report showed:

  • 27 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
  • 19 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%

Several providers did not meet the acceptable threshold, including:

  • Bedfordshire, Luton and Milton Keynes AAA Screening Cohort
  • Derbyshire AAA Screening Cohort
  • Hampshire AAA Screening Cohort
  • Central England AAA Screening Cohort
  • Manchester AAA Screening Cohort
  • North London AAA Screening Cohort
  • Nottinghamshire AAA Screening Cohort
  • Peninsula AAA Screening Cohort
  • South London AAA Screening Cohort
  • West Yorkshire AAA Screening Cohort
  • North Yorkshire and Humber AAA Screening Cohort

Of the 858 men appropriately referred for surgery, 784 (91.4%) were seen for their first specialist assessment within 2 weeks of their last conclusive scan. For the men who were not seen in 2 weeks, just under half (43.5%) were due to patient choice while 40.6% were due to hospital factors. Hospital factors includes delays due to COVID-19, delays in testing, clinic capacity and consultant availability amongst other reasons. The remainder were due to comorbidities that prevented attendance.

Figure 22. Percentage of men with aorta ≥5.5cm seen by vascular specialist within 2 weeks, by region, England, 1 April 2013 to 31 March 2020

Nationally the percentage of men seen for a specialist assessment within 2 weeks (14 days) of their last conclusive scan has decreased by 4.1% since the previous screening year. The greatest decrease was in the London region, which decreased by 23.8%, however, they have the smallest number of referrals across the regions. 6 out of the 13 breaches were patient choice and 3 were due to COVID-19. At a provider level Five Rivers and Northamptonshire increased their performance to reach the acceptable threshold this year. Hereford and Worcester, Kent and Medway and Leicester increased their performance to reach the achievable threshold.

6.3 AAA-S12

Figure 23. Percentage of men with aorta ≥5.5cm deemed fit for intervention and not declining, operated on by a vascular specialist within 8 weeks, by screening provider, England, 1 April 2019 to 31 March 2020

Code Performance
BBW*  
BCO*  
BLM 63.6
CAM*  
CHM*  
CML 48.0
COV*  
CYH 50.0
DBY*  
DOW 26.3
ESX 50.0
FRV 58.8
GLO 48.1
HAM 68.2
HFD 40.0
HOE 15.2
HRW 47.8
KEN 61.1
LEI 88.9
LNC 71.4
MAN 39.1
NOE 48.8
NOL 33.3
NOR 66.7
NOT*  
NRH 66.7
NSS 41.7
PEN*  
SDE 37.0
SOM 42.1
STW*  
SWL 21.7
SYB*  
THV 38.1
WSR 52.9
WSU 36.0
WYO 45.0
YOH 65.0

*Percentage masked due to less than 5 men operated on in 8 weeks

The provider level data for the report showed:

  • Leicester AAA Screening Cohort had the highest outcome
  • Central England AAA Screening Cohort had the lowest outcome
  • 9 out of 38 screening providers met the acceptable threshold of ≥ 60.0%
  • 1 out of 38 screening providers also reached the achievable threshold of ≥ 80.0%
  • 28 out of 38 screening providers did not meet the acceptable threshold of ≥ 60.0%

Nationally, as at 30 June 2020, from the 858 men who were appropriately referred, 124 men were unsuitable for surgery and 41 men declined surgery. Men who were unsuitable for surgery may have had a comorbidity that required treatment prior to the AAA repair, such as cancer treatment or the risk of surgery was greater than the risk of rupture. These men may go on to have treatment in the future if they become suitable for surgery. 43.3% of the men who were appropriately referred, did not decline and were suitable for surgery, were operated on within 8 weeks.

The average wait time for surgery was 96.7 days (range 0 to 473 days). 77 men referred between January and March 2020 had delays in their work up for surgery due to the reduction in vascular services during the pandemic. The pandemic accounted for 63.5% of hospital delays. For the men who did not have surgery within 8 weeks, 30.9% of men had comorbidities that delayed surgical intervention. 7.7% of men had a delay while waiting for a stent and 16.3% opted to delay the surgery due to personal reasons.

94.5% (n=587) of appropriately referred men who did not decline and were suitable for surgery underwent an elective repair. Nationally, just under half of the surgical interventions were open repairs but there was significant variation across the country (range 0% to 100%). The post-operative 30 day mortality for elective repairs was 1.87% overall.

Figure 24. Percentage of men with aorta ≥5.5cm deemed fit for intervention and not declining, operated on by a vascular specialist within 8 weeks, by region, England, 1 April 2013 to 31 March 2020

Nationally, the percentage of men operated on within 8 weeks reached a peak in 2015 to 2016. Performance has since dipped before increasing again in 2018 to 2019. The timeliness of surgical repair for AAA has been affected by several factors including the general increased demand for hospital services and winter pressures which have led to delays in elective surgeries. In 2019 to 2020 there was also a significant impact from COVID-19. For men referred between April and December 2019, 53.1% were operated on within 8 weeks, which was similar to the performance for 2016 to 2017 and 2017 to 2018. Men are also being referred at an older age as more men are being referred from surveillance. In 2013, 60.3% of men were referred from their initial screen compared to 20.2% in 2019 to 2020. The average age for a referred man was 70 years (range 64 to 92 years). Consequently, the men referred tend to have more comorbidities and require more assessments for fitness prior to surgery.

7. Outcomes

There were 30 AAA ruptures during the screening year, 25 of which were fatal. 13 of the deaths were in men on surveillance (3.3% of the deaths in surveillance) and 12 had been referred for surgery. For the men referred to surgery, 8 had been turned down for surgery due to comorbidities or had declined the operation. The remaining 4 died while waiting for surgery although all ruptured within 56 days of referral.

8. Recommendations

8.1 Recommendations on coverage

Recommendation 1:

Providers are encouraged to review the inequalities guidance for best practice on increasing coverage.

Recommendation 2:

Providers should use the deprivation and ethnic group report to better understand coverage within their area.

Recommendation 3:

Providers are encouraged to submit any subsequent interventions to reduce inequalities.

Recommendation 4:

Providers should review the accessibility and number of screening sites to maximise the opportunity for men to attend screening.

Recommendation 5:

Providers should develop local standard operating procedures to show how vulnerable men are supported and when appointments should be sent out.

8.2 Recommendations on uptake

Recommendation 1:

Providers who have not met the acceptable threshold on AAA-S01a must work with commissioners to agree a recovery plan which sets out how men will be offered an opportunity to be screened.

Recommendation 2:

Providers must offer men who do not turn up to their first appointment a second appointment within the initial screening year, so they do not miss out on the opportunity to be screened.

Recommendation 3:

Providers should develop local standard operating procedures to show how vulnerable men are supported and when appointments should be sent out.

Recommendation 4:

Providers must make sure that the process for booking annual surveillance appointments enables appointments to be within 6 weeks either way of the due date.

Recommendation 5:

Providers must make sure that the process for booking quarterly surveillance appointments enables appointments to be within 4 weeks either way of the due date.

Recommendation 6:

Providers must routinely review the SMaRT alert screen for those due to be screened.

Recommendation 7:

Providers should review service accessibility for surveillance men to improve uptake (including clinic venues, geographical locations and numbers, hours and days clinics are planned).

Recommendation 8:

Providers are encouraged to review the inequalities guidance for best practice on increasing uptake.

Recommendation 9:

Providers are encouraged to submit any subsequent interventions to reduce inequalities.

Recommendation 10:

Providers should use the deprivation and ethnic group report to better understand uptake within their area.

8.3 Recommendations on test

Recommendation 1:

Providers should use the monthly screener report to review individual technician’s non-visualised figures.

Recommendation 2:

Providers must make sure equipment is checked and maintained in line with national guidance. The clinical skills trainer must undertake 4 monthly observations of screeners.

Recommendation 3:

The provider should make sure that there is good communication between the service and trust medical imaging and/or vascular laboratory including timely feedback of results.

8.4 Recommendations on referral

Recommendation 1:

Providers should review all men who are not referred within 1 day to identify reasons for delay and remove potential barriers to improvement.

8.5 Recommendations on diagnosis and intervention

Recommendation 1:

The provider should review all men found to be inappropriately referred to identify any training needs.

Recommendation 2:

The provider should ensure there is good communication with the vascular service to enable men to be tracked throughout the screening pathway to identify and resolve potential avoidable delays to treatment.

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