BOARD MEETING 24 JUNE 2015 AGENDA ITEM 3.2 POPULATION BASED NATIONAL SCREENING PROGRAMMES IN POWYS TEACHING HEALTH BOARD Report of Paper prepared by Purpose of Paper Action/Decision required Director of Public Health and Acting Medical Director Director of Public Health and Acting Medical Director Acting Consultant in Public Health Senior Public Health Practitioner To provide the Board with the annual update on population based national screening programmes that are led by the Division, Public Health Wales NHS Trust. Board is asked to note the content of this report. Link to Health & Care Standards Link to Health Board s Annual Plan Acronyms and abbreviations This paper supports: Governance, Leadership and Accountability Theme 1: Staying Healthy This paper supports: Improving Health and Wellbeing Abdominal Aortic Aneurysm (AAA) Breast Test Wales (BTW) HPV Human Papilloma Virus Medium chain acyl-coa dehydrogenase deficiency (MCADD) Newborn Hearing Wales (NBHSW) Public Health Wales NHS Trust (PHW) Wales Abdominal Aortic Aneurysm Project (WAAASP) Annual Report Page 1 of 6 Board
POPULATION BASED NATIONAL SCREENING PROGRAMMES IN POWYS TEACHING HEALTH BOARD 1. Purpose and Background This is a high-level briefing report based on the 2013/14 annual report of the Public Health Wales Division, which was published in January 2015. identifies apparently healthy people who may be at increased risk of a disease or condition. Those identified can be offered information, further tests and/or appropriate treatment to reduce their risk and/or any complications arising from the disease or condition. The Division of Public Health Wales leads six population based national screening programmes across Wales: Breast Test Wales Cervical Wales Bowel Wales Newborn Hearing Wales Wales Abdominal Aortic Aneurysm Programme. Newborn blood spot screening Wales The Division also leads the Antenatal Clinical Network. 2. Summary of Performance Across Wales, minimum uptake/coverage targets have been set for each of the screening programmes. Table 1 (below) summarises the targets for each programme and the uptake/coverage figures for Wales and Powys during the 2013/14 financial year. The Table also highlights changes from the previous financial year; no confidence intervals are available, so these changes may not be statistically significant. Table 1: Uptake/Coverage figures for Wales and Powys, 2013/14 Breast Bowel Cervical AAA Target 70% (min. standard) Wales 2013/14 Change in Wales from 2012/13 Powys 2013/14 Change in Powys from 2012/13 72.1% + 0.6 % 72.1% - 2 % 60% 52.6% + 4.4 % 54.2% + 3.3 % 80% 78.4% - 0.9% 81.2% - 1 % 80% 74.1% N/A 71.3% N/A Annual Report Page 2 of 6 Board
Newborn Hearing 95% 99.4% -0.1 % 99.4% +0.3 % (Produced by Division Informatics Team, PHW) The uptake of breast screening in Powys in 2013/14 was 72.1%, a slight decrease from the uptake of 74.1% in 2012/13. Performance still exceeded the 70% national uptake target. The uptake of bowel screening has not yet met the 60% target in Wales or Powys, although uptake is increasing. Uptake in Powys was above the Wales average and increased by 3.3% from 2012/13. Waiting times for colonoscopy following bowel screening remain a challenge in many areas of Wales, including for Powys residents. A service improvement plan has been agreed by the Programme Board and will be implemented over the next few months. The figure for cervical screening coverage shows the percentage of eligible women tested during the last five years. In Powys, performance met the 80% target, the only Health Board in Wales where this was achieved. The Wales Abdominal Aortic Aneurysm (AAA) screening programme was only launched in 2013, so analysis of a complete financial year of data was not possible. The data presented in the report are from May 2013 and include men invited up until the end of the financial year in March 2014. The uptake in Powys was 71.3%, below the Wales average of 74.1%, but still a positive start for a new programme. The uptake of Newborn Hearing remains very high in both Wales (99.4%) and Powys (99.4%). These data exceed the 95% target. 3. The PHW National Division: National and Local Delivery in 2013/14 The Division of Public Health Wales leads the six population based national screening programmes in Wales and hosts the Antenatal Clinical Network. The Division is part of the Public Health Services Directorate and is committed to the aim of a healthier, happier and fairer Wales, playing a particular role in two of PHW s key commitments - to improve health and wellbeing and reduce inequalities; and to improve the quality, equity and effectiveness of healthcare services. Key changes in screening during 2013/14 included: The Wales Abdominal Aortic Aneurysm Programme was implemented, in May 2013 Sickle cell newborn bloodspot testing was implemented in June 2013 The age range and frequency of cervical screening was changed in September 2013, raised from 20 to 25 years Newborn Bloodspot Wales was established as a programme during 2014 Annual Report Page 3 of 6 Board
HPV test of cure was implemented during 2014 as part of the cervical screening modernisation programme women who have had treatment following abnormal smears are tested for HPV as part of their clinical followup A new screening test for Down s syndrome is being implemented in a phased approach across Wales. Four Health Boards have already implemented, with the rest (including Powys) to follow during 2015/16 Following work during 2013/14, four additional tests for inherited metabolic conditions will be included as part of newborn bloodspot screening from 2015 Other programme-specific developments are described in the national report. As part of the Division, the Engagement Team works across the national programmes to engage the public around screening and facilitate informed choice by the population. The team works in partnership with local PHW public health teams to ensure that messages are communicated effectively to the public. The screening team works across the population, with a particular focus on groups or communities where uptake is known to be low. Examples of engagement activities undertaken by the screening team across Wales in 2013/14 included: Development of key messages for each of the screening programmes (launched in April 2014) Work with the transgender community including development of resources and staff training Resource developed for care homes and people who care for those eligible to participate in bowel screening Development of an action plan to work with gypsy and traveller groups for Life, a national campaign to raise awareness of screening programmes. Specific activities included training, community events, use of social media and education in relation to the national website Inequities in screening uptake are evident in Health Boards across Wales, with uptake of adult screening programmes decreasing with increasing deprivation. There is however, no marked difference in uptake by deprivation for the newborn hearing screening programme. Tackling inequities is a key priority for the Division. Particular actions delivered in Powys during 2013/14 included delivery of a revised programme of quality assurance for the cervical screening programme and roll out of AAA screening in clinics in Newtown and Welshpool, both of which have been well attended. Following earlier issues in relation to the model of colposcopy provision, Cervical Wales worked with PTHB to establish a new colposcopy service in Newtown, which opened in May 2014. Considering inequalities, the figure below shows uptake by deprivation quintile in Powys for the four adult screening programmes and for newborn hearing screening. Annual Report Page 4 of 6 Board
Figure 1: by Deprivation Quintile in Powys, 2013/14 (Produced by Division, PHW) For adult programmes in Powys, uptake generally decreases as deprivation increases (although confidence intervals are not provided). This is particularly the case for breast screening where uptake in the two least deprived quintiles exceeds the 70% minimum uptake target, but falls below this in the other deprivation quintiles. For cervical screening the proportions of eligible women tested is above the 80% target in all but one (more deprived) quintile. The uptake picture across deprivation quintiles for AAA and bowel screening is more mixed. There are also inequities due to other factors such as age and gender; for example, women are more likely to take part in screening than men. Inequities in uptake in Powys are being addressed by the Division at both the strategic and operational level, by working with local partners and service users to target service planning and activity. 4. Improving Performance in Powys during 2015/16 The Powys Public Health Team will deliver a programme of activities during 2015/16, to further improve the local performance of the screening programmes. In addition to working to support the wider work of the National Division, examples include: Making Every Contact Count (MECC): this programme is a priority in the PTHB 2015/18 IMTP. The programme is being developed to train staff (including Annual Report Page 5 of 6 Board
midwives, health visitors and other primary care staff) to deliver advice about the importance of attending screening invites for Life: the Powys team will support the national screening team to raise awareness of screening programmes locally, including through the for Life campaign, during July 2015 Communications: the Powys team will update the screening content on the PTHB website, both internet (public facing) and intranet (staff facing). Links will be provided to the national screening websites through these PTHB sites 5. Recommendation The Board is asked to note the content of this report. Report prepared by: Dr Catherine Woodward DPH and Acting MD Presented By: Dr Catherine Woodward DPH and Acting MD Anna Prothero Senior Public Health Practitioner Ashley Gould Acting Consultant in Public Health Background Papers Financial Consequences Other Resource Implications Consultees As described in the report None specific None specific None specific Annual Report Page 6 of 6 Board