The risks and benefit of participating in health screening programmes are not being communicated consistently by either the NHS or private healthcare providers, says a committee of MPs.
The government needs to ensure that a standardised process to produce screening information is introduced and that better communications training is provided to healthcare professionals, adds the Commons Science and Technology Committee, in a new report.
Providing balanced, high-quality information to all potential screening participants must be a well-resourced and nationally-supported priority – not an afterthought undertaken on an ad-hoc basis, the Committee argues.
A recently-revised breast cancer screening leaflet for the 50-70 age group, with a more explicit focus on helping women make an ‘informed choice’ about whether screening is right for them, marks a step in the right direction, it says. However, the panel’s inquiry found that the principles followed to revise this leaflet have not been applied to the communications developed by other NHS screening programmes.
The MPs call for the government advisory group, the UK National Screening Committee (UK NSC), to take steps immediately to devise and implement a standard process for producing information that facilitates informed choice.
They also recommend clarification of what ‘informed choice’ means for potential screening participants so that different screening programmes can be more effectively evaluated on their delivery of it, and for the Office of National Statistics (ONS) to validate the statistics presented in NHS screening information to resolve disagreement and confusion over their accuracy.
Poor communications of the risks and benefits of screening is not a problem confined to the NHS, notes Committee chairman Andrew Miller.
“Concerns were raised during our inquiry about the poor quality of information provided by private health companies offering commercial screening tests. While the NHS must remedy the problems identified by its own screening tests, it also has to deal with those of private companies that effectively privatise the goods of screening and nationalise the bads,” said Mr Miller, Labour MP for Ellesmere Port and Neston.
It is the UK NSC’s responsibility to ensure that screening programmes are only offered where there is robust, high-quality evidence that they will do more harm than good, and at a reasonable cost, say the MPs. They agree that all screening programmes should be grounded in robust evidence and that the evidential barrier to entry should remain high; however, they add, if the UK NSC is to remain an authoritative source of advice, it must become more transparent in the way it makes decisions and evaluates the evidence.
The NHS Health Check programme - which aims to prevent heart disease, stroke, diabetes and kidney disease – was introduced without a rigorous evidence base and was not reviewed by the UK NSC, they say, and express concern that the Health Check programme is wasting resources at a time when the NHS can ill-afford to do so. The UK NSC needs to scrutinise the programme retrospectively, to ascertain its value, they state.
Looking to the future, the report notes that developments in genetic science mean it should soon become possible to target screening programmes directly at those most at risk of certain diseases. “It is imperative that the UK NSC develops its capacity for horizon-scanning and ensures that proven developments in screening are supported and implemented across the NHS,” said Mr Miller.
- Each year, around 11 million people in England are invited to participate in an NHS screening programme, at a total cost of around £348 million for the breast, cervical and bowel cancer screening programmes, with an additional £400 million spent on a suite of non-cancer screening programmes.
