key: cord-1049973-lxcr561b
authors: Armitage, Richard C.; Morling, Joanne R.
title: The impact of COVID-19 on national screening programmes in England
date: 2021-07-29
journal: Public Health
DOI: 10.1016/j.puhe.2021.07.022
sha: deb3528b0b2c4dd7f9840dc0a4c40e4c63f0135d
doc_id: 1049973
cord_uid: lxcr561b

Objectives To review the trends in adult national screening programme performance in England prior to and during the COVID-19 pandemic and consider the future implications. Study design Quantitative, longitudinal. Methodology Publicly available data on quarterly uptake of the five adult screening programmes in England were obtained from Public Health England (PHE). Trends from 2017 to 2021 were reviewed and discussed. Results From 2019-2020 Q4 there were substantial reductions in performance in four of the five national screening programmes that were not in keeping with recent trends. Conclusion The reductions in screening performance coincide with the arrival of the COVID-19 pandemic in England, and may be explained by the temporary suspension of national screening programmes, and the inability or unwillingness of invitees to partake in screening once the programmes had been restored. Due to the delay in publication of the analysed data, further COVID-19 lockdowns in recent months make it probable that the current true screening performance figures are substantially lower than those presented in this paper. The impact on screening programme performance is likely to be detrimental to patient outcomes, meaning remedial action is urgently required.

 The current true screening performance figures are likely to be substantially lower than those presented in this paper due to additional national lockdowns.

 The impact on screening programme performance is likely to be detrimental to patient outcomes, meaning remedial action is urgently required, such as increasing capacity to provide screening appointments, and strong communication to eligible patients from primary care and public health professionals.

The UK's National Health Service (NHS) provides five national screening programmes for adults: abdominal aortic aneurysm (AAA), diabetic eye, bowel cancer, breast cancer, and cervical cancer. 1 The COVID-19 pandemic arrived in England in January 2020, and triggered the first national lockdown on 23 March 2020. This resulted in all programmes being significantly impacted and facing substantial alterations to their processes and delivery. For example, whilst home faecal occult blood testing for bowel cancer screening could safely continue, the capacity of second-line colonoscopy was significantly reduced. As the country moves towards a new postpandemic normalcy it is essential that the consequences on health service delivery and patient outcomes are recognised, understood and remedied. As such, we aimed to track performance trends in NHS screening programmes in England prior to and during the COVID-19 pandemic. Publicly available data from Public Health England were obtained from the five national screening programmes, 2  Bowel cancer screening uptake: up-take leave fell slightly in 2019-2020 Q4, however 2020-2021 Q1 data is unavailable and by 2020-2021 Q2 and Q3 performance had normalised.

The observed reductions in screening performance may be explained by the temporary suspension of national screening programmes during the early stages of the pandemic in England, 3 and the inability or unwillingness of invitees to partake in screening once the programmes had been restored (such as due to shielding requirements in the extremely clinically vulnerable, fear of contagion, and anxiety around overburdening the NHS 4 ). Substantial reductions in performance were observed across the four screening programmes that require in-person attendance and contact with a clinician, while no meaningful reduction was noted in the sole screening programme that involves the use of home testing kits in the initial stage J o u r n a l P r e -p r o o f (bowel cancer screening), suggesting invitee reluctance to attend in-person screening plays a significant role in the observed results.

While the most recent data available at the time of writing refers to 2020-2021 Q3, England has experienced numerous additional months of COVID-19 lockdowns since this quarter.

Although national screening programmes were not repeatedly suspended during subsequent lockdowns, it is likely that invitees were unable or unwilling to attend screening during these periods for the same reasons as mentioned above. It is therefore probable that the current true screening performance figures are substantially lower than those presented in this paper.

While barriers exist to achieving accurate estimations, it is likely that the potential impact on both health service delivery and patient outcomes is highly significant. 

NHS screening programmes: KPI reports

NHS Cancer Programme: Cancer Services Recovery Plan

Cancer Nursing Practice. Women put off cervical screening during COVID-19 pandemic

NHS screening programmes: KPI reports

NHS screening programmes: KPI reports 2020 to 2021