Non-cancer screening

There are a number of screening programmes that cover diseases other than cancer. Many of these programmes involve screening babies and young children, though some are specific to adulthood. This section in particular covers three specific programmes: NHS Health checks, Diabetic Retinopathy screening and the AAA screening.

NHS Healthchecks

The aim of the National Healthchecks programme is to detect whether someone is at high risk for heart disease, stroke, type 2 diabetes, chronic kidney disease or dementia. People who are eligible for a check will be those aged between 40-75 years, invited by their GPs once every five years for a face to face check-up with a nurse or healthcare assistant.

At the check-up, body weight and blood pressure readings taken, a series of lifestyle questionnaires administered, and a blood test is taken for cholesterol and for diabetes. People’s results are then analysed and their specific risks calculated, for example their risk of having a heart attack in the next 10 years. Depending on the risks identified through the check-up health promotion advice and services are offered.

Diabetic eye screening

As part of the national NHS Diabetic Eye Screening Programme (NHS DESP), an annual eye check is offered to all people with diabetes over the age of 12. The eye check involves testing of the retina to identify early signs of diabetic retinopathy. If allowed to develop, diabetic retinopathy can lead to blindness and so early detection of changes in the retina is key to preventing this complication.

Abdominal Aortic Aneurysm (AAA) Screening

An abdominal aortic aneurysm (AAA) is a swelling of the main blood vessel that runs through the abdomen. Timely detection and treatment of abdominal aortic aneurysms prevents later problems with rupture and bleeding, and can be life-saving. The condition is more common in men aged over 65 and so this is the group that is offered the screeeing test which involves an ultrasound scan of the abdomen.

What do we know?

Chronic diseases such as heart disease, stroke, diabetes and chronic kidney disease are a significant cause of death and disability in Britain. Importantly, these conditions are largely associated with lifestyle factors that can be modified to reduce the risk of disease, and in many cases disease may be prevented.

Diabetic retinopathy is a complication of diabetes which occurs when high blood sugar levels damage the small blood vessels at the back of the eye. While it can remain symptomless for many years, in some cases it may progress to cause blindness. Diabetic eye disease is the leading cause of sight loss in those aged under 65.

Abdominal aortic aneurysms affect 5 to 9% of the population aged over 65. Although only some of these will result in rupture, if a rupture does occur then the condition can be quickly fatal. Of those that do rupture there is a mortality rate of up to 90% (Source: Assar et al 2009). Risk factors for AAA are similar to those of other vascular diseases (diseases that affect the blood vessels). Importantly some risk factors can be modified such as smoking and high blood pressure.

Facts, Figures and Trends

NHS Health checks

NHS Health Checks is a mandated service commissioned by Public Health departments in local government. The goal of the scheme is to ensure that 20% of the eligible population are invited for screening each year over five years.

Over the last two years (2013/14-2014/15) in Slough, NHS Health Checks have been offered to 34% of the eligible population. This is significantly lower than the England average of 38% as well as the average for the South East.

Of those people offered a health check, however, 60% take up that offer and receive screening. This is significantly better than the England average of 49% uptake.

Of the 16 GP practices in Slough Health Checks are offered at all practices except one as well as three local pharmacies. Further details on local NHS Health Checks are available via the council web page.

Diabetic eye screening

Over 2012/2013, only 75% of those who were offered diabetic eye screening in Slough attended a screening appointment. This is lower than the national average of 79% and the South East average of 80.5%, however was an improvement on the previous year’s uptake of 70%.

AAA screening

Over 2014/2015 99% of men eligible for AAA screening (men aged 65) in Slough were offered a screening appointment, This is slightly less than the 100% achieved in the previous year, however, remains significantly better than the England average of 97%.

Despite this high rate of offers, the proportion of people taking up the offer and receiving AAA screening in Slough over 2014/15 was 68.7% which is lower than the England uptake of 79.5% and the Thames Valley average uptake of 77%.

National and local strategies (current best practices)

NHS Health checks

The full suite of programme materials and literature for the National Health Check programme can be found on their website.

Information specifically for local authorities is available in NHS Health checks Best Practice Guidance. This outlines the legal duties that exist for local authorities to make arrangements:

  • for each eligible person aged 40-74 to be offered a NHS Health Check once in every five years and for each person to be recalled every five years if they remain eligible
  • for the risk assessment to include specific tests and measurements
  • to ensure the person having their NHS Health Check is told their cardiovascular risk score, and other results are communicated to them
  • for specific information and data to be recorded and, where the risk assessment is conducted outside the person’s GP practice, for that information to be forwarded to the person’s GP

Slough has a diverse, multicultural and mobile population that are hard to reach. As a result there is an annual planned programme of outreach to local mosques, temples and churches as well as support for small practices that do not have the manpower to screen all their eligible patients.

Diabetic Eye Screening programme

All documentation and guidance relating to the implementation of the diabetic eye screening programme are available on the government website.

AAA screening

All documentation and guidance relating to the on the abdominal aortic aneurysm screening programme are available on the government website.

A toolkit produced by the AAA Screening Programme is due for publication that estimates how screening uptake and AAA incidence vary between ethnic groups and enables authorities to map the data to provide a visual method for examining variation across the country.

What is this telling us?

Though there have been recent local improvements, there is still a need to increase uptake across all three non-cancer screening programmes considered in this chapter.

Though local intelligence on demographics of those not attending for screening is not yet available, national data tells us that those at highest risk of disease are generally the least likely to attend screening.

What are the key inequalities?

As with almost every area of preventative health, those who are least likely to engage with services are predominantly those at highest risk of disease.

Following a workshop on reducing inequalities in screening hosted by Public Health England in late 2015, a plan to tackle inequalities in screening is currently being compiled.

What are unmet needs/service gaps?

Need to increase uptake across all three programmes, though the greatest need is to increase reach of the service, and therefore uptake, in high risk populations of Slough.

In terms of the chronic diseases screened for in these programmes the high risk groups are those from deprived areas and from black and minority groups, in particular those with lifestyle risk factors such as smokers, those who are overweight or have a poor diet.

Recommendations for other organisations

  • To record referrals from Health Checks to treatment services in order to monitor progress
  • To continue improving uptake of diabetic eye screening
  • To implement the Public Health England plan to reduce AAA screening inequalities once published

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