Agenda item

The Managing Director (MD), North East London Cancer Alliance, and Early Diagnosis Programme Lead (EDPL), North East London Cancer Alliance presented a screening update for Barking and Dagenham.

Since August 2022, Barking and Dagenham had showed improvements in bowel screening coverage, and uptake which increased by 3% within one year. Further, progress on breast screening uptake was recognised, which highlighted a 15% uptake in a service that experiencing the slowest progress due to the impacts of the pandemic. Cervical screening was also heading towards the right direction, showing an increase for both older and younger women who accessed the service. Targeted lung health checks were introduced in July 2022, with a 55% uptake in Barking and Dagenham, which was one of the highest in the country.

It was important to note, however; that the data provided was from the NHSE Futures website which typically presented a lag between reporting and publishing data due to requirements such as the six-month time period to include patients who did not attend appointments, or those who were non-responders. The EDPL also explained that insightful data depended on the recording of those with a serious mental illness (SMIs), patients with learning disabilities, or those who identified as homeless. Methods of recording data could also impact the effectiveness of the data.

Screening improvement projects to target demographics, such as the ‘It’s Not a Game’ campaign were discussed. The availability of self-sampling test kits which were to be introduced in London and extending the age for bowel screenings to make screening more accessible, were also part of these projects.

A series of questions were asked to the MD and EDPL:

·  Regarding issues surrounding low uptake of screening for patients who identified as homeless, Members asked how this would be addressed. The EDPL advised that engagement with GPs was in place to encourage patients to attend; however, there were difficulties in identifying patients for follow-up appointments as homeless patients were not required to provide an address. The Cabinet Member for Adult Social Care and Health Integration suggested that GP pop-ups were also available to support these patients. For patients who were not registered to a GP, ICB PCNs could provide support. Hospitals also recorded details of patients;

·  Efforts to increase the uptake of screenings were discussed. Members questioned why screening improvement projects were targeted towards a particular demographic, which the EDPL explained that targeted campaigns could encourage patients from certain backgrounds to attend screenings through social media coverage, for example. These interventions were based on the deprivation index and helped to identify such groups to understand the reasons for disengagement within some communities through local groups, grassroots organisations and grants to improve and promote screening services;

·  Members recognised potential issues surrounding referrals and the requirement to access the GP for support with private matters. The EDPL recognised that self-sampling would be ideal for patients who wished to have privacy; however,  cervical screening was performed by practise nurses so would not be possible. For cervical screenings, a CNS was available for patients with learning disabilities alongside efforts to work with unpaid carers to promote screening. All patients would also need to be registered with a GP for bowel and breast screening referrals. Referrals and advice for smokers who had targeted lung health checks showed a positive uptake;

·  The Chair highlighted a staffing issue, particularly for specialist staff who were becoming the ageing workforce. Targeted lung health checks required radiographers and radiologists which were very limited, particularly in context of the NHSE target for 1.6 million scans a year. The DM explained that a workforce programme was being developed, as well as NHSE improving its connections with wider NHS teams to influence and manage such issues. Pressures surrounding financial support were also recognised;

·  Members asked about the unavailability of prostrate screening. The EDPL explained that this could be by influenced by NEL and changes could only be made at a national level. However, there were free PSA test kits available for men in NEL over the age of 45, which showed positive results; and

·  The Director of Public Health (DPH) brought forward key issues which focused on patients attending hospitals for diagnoses. Although the two-week referral process helped, patients did not always act on their symptoms, which could not be considered misdiagnosis by the hospital once a patient attended. The DM also considered the availability of rapid diagnostic clinics which were available for BHR, to identify irregular symptoms to be seen by specialists. The Chair recognised the pressures on GPs from the workload of incidental findings from screenings. The DPH explained that this was the safest route to manage increased pressures and noted that GPs in Barking and Dagenham were happy to receive patients following their incidental diagnoses.

The Committee noted the report.