The UK National Screening Committee (UK NSC), part of Public Health England, is recognised worldwide as a best practice model for screening policy and implementation.
We look to emerging science to inform our recommendations and while these recommendations (both for and against screening) can make the headlines, we don’t often get the opportunity to dig deeper and share the progressive, expert-led research that happens behind the scenes.
Both the UK NSC and the NHS Screening Programmes commission research, where it is lacking, to ensure they are informed by the latest evidence and technologies. And at the heart of all this is a need to maximise the benefits for those being offered screening while minimising any potential harms.
Innovative screening programmes
The dedicated teams working within the NHS Screening Programmes are a driving force for further improving the screening journey for the individuals concerned - from initial invitation all the way through to treatment and care.
Research into the latest technological advancements is a key part of this. For example, Non-invasive Prenatal Testing (NIPT) is an important new technology that allows women to have testing for some genetic conditions, such as Down’s syndrome, from a simple blood test.
If NIPT is as accurate as studies suggest - and as reliable when given to large numbers of women in an NHS setting - the test could significantly increase the accuracy of identifying which babies have certain genetic conditions. This would reduce the number of women who undergo an invasive test (such as amniocentesis) which carries a small risk of miscarriage, when their baby does not have the condition.
The UK NSC has commissioned a review of NIPT, which incorporates emerging evidence including research led by University College London.
The review, due to be published next year, aims to show the most effective screening method as part of the NHS Fetal Anomaly Screening Programme - for women who are identified as higher risk of having a baby with Down’s syndrome, Edward’s syndrome or Patau’s syndrome.
Research can also tell us whether the things we’ve always done are still worthwhile. For example, the NHS Newborn Hearing Screening Programme ensures babies with a hearing loss are identified shortly after birth, yet in England we still test children’s hearing when they start school. Do we still need to test school age children if the benefits of doing so are unclear?
The number of children identified with a potential hearing problem through school-entry screening is now very low (around 1 child in every 3000 tested). This is thanks to the newborn screening programme and good processes for identifying hearing loss during childhood. So it is very likely that any child with a hearing loss will be identified earlier.
Research (a Health Technology Assessment funded trial), is currently underway to look at the benefits of school-entry hearing screening and this is expected to report in 2015. After that, the UK NSC will be able to fully review the screening policy for childhood hearing.
Research to fill in the gaps
The bacteria Group B streptococcus (GBS) is common in women and is generally harmless. It can be passed to a baby during pregnancy and in some rare cases can lead to serious complications (early onset GBS or EOGBS). The UK NSC does not currently recommend screening for GBS during pregnancy and the 2012 UK NSC review highlighted some outstanding questions over the benefits of possible prevention methods.
To address this, the UK NSC has commissioned a study comparing the different approaches to preventing EOGBS infection in babies. These approaches include the current high risk management strategy used in the UK, and potential screening strategies used elsewhere, the aim being to establish the benefits and any limitations of each by determining:
- the number of babies prevented from getting EOGBS infection
- the overall health outcome for babies with EOGBS infection
- the appropriate use of antibiotic treatment
This research will also provide a forum for experts to discuss important questions that are currently under much debate. The outcome will help provide clarity on this complicated area and inform the next policy review in 2015/16.
World-leading screening policy
To ensure the UK NSC remains across the latest advancements we regularly carry out evaluation of the way we work and how we review the evidence.
Much the same as the policies for the 100+ different conditions we routinely review, the UK NSC itself is independently reviewed every three years. This is currently underway and includes a review of our processes for making policy recommendations, particularly in comparison to other countries to see what we could learn from them and where we can improve.
We look forward to the results and as with everything we do any changes we make will look to bring real benefits to the population and further improve the quality of screening in this country.