Nationally, the roles and responsibilities for screening programmes are clear: government ministers make policy decisions on advice from the UK National Screening Committee (UK NSC). The NHS in each UK nation is responsible for delivering national screening programmes.
Locally and regionally in England, most screening programmes are commissioned by NHS England (NHSE) and provided by a range of healthcare organisations.
On the face of it, this leaves little role for the public health teams based in local government and led by directors of public health (DsPH). However, DsPH have an overarching responsibility for the health of their population. This covers the full range of public health activity, from helping to make the places we live healthier, to responding to outbreaks of infectious disease, to the delivery of healthcare services. This includes screening programmes.
The Director of Public Health statutory responsibilities describe this role as ‘providing appropriate challenge to arrangements for screening and immunisation programmes, advocating for an emphasis on reducing health inequalities and improving access for underserved groups’.
This role involves:
- acting on behalf of the population to make sure screening programmes are delivered fairly and efficiently and are accessible to everyone in the population we serve
- helping screening commissioners and providers connect with communities who might struggle to access their services
Assurance group brings partners together
Different local authorities will approach this assurance role slightly differently. In Bury, we have set up a screening assurance group. This group brings together commissioners and providers of screening programmes with local primary care and voluntary sector representatives, primary care commissioners, Healthwatch, and the local public health team, which chairs the meeting. The group feeds into the Council’s Health Protection Board.
The screening assurance group’s work in relation to the national NHS screening programmes includes:
- reviewing local statistics on uptake and health equity audit information to spot where programmes might not be meeting local needs
- getting assurance from commissioners and providers about actions to improve uptake and reduce inequalities – a recent example has been advocating for better adjustments to make sure people with a physical or learning disability can access breast screening
- collating evidence on what works to help local commissioners improve uptake of cervical cancer screening and reduce inequalities
- helping to connect commissioners and providers to charities and community organisations that might be able to aid understanding and help tackle barriers to accessing screening
- sharing success stories and challenges, for example general practice-led work to improve uptake of bowel cancer screening in a deprived and ethnically diverse neighbourhood
We also have an important role to play in advising politicians and commissioners on the advisability of screening initiatives and proposals that are not part of UK NSC-recommended national programmes. This includes:
- helping politicians understand what good screening does and does not look like
- monitoring the roll out of breast cancer genetic screening for the local Jewish population and advising local politicians on the evidence, potential benefits, and potential harms
- advising local commissioners, based on national guidance and evidence, on whether to continue delivering year 1 school hearing checks
- providing technical advice and challenge on the merits and risks of local proposals for projects that share many of the features of screening
At its heart, the role of public health teams in screening is about partnership working, bringing together the expertise of a wide range of stakeholders. These relationships are essential to enable the mix of constructive challenge and support described in the director of public health statutory responsibilities.
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