Agenda item

Dr Faiza Khan, Consultant in Public Health Medicine, NHS England (South East) and David Selling, Head of Public Health (Kent, Surrey and Sussex), NHS England were in virtual attendance for this item. 

1.    Dr Khan provided a brief overview of the report including:

1.1.There was a programme for genetic screening and additional capacity was being created in Kent and Medway to screen patients with genetic indicators such as Autoimmune lymphoproliferative syndrome (ALPS).

1.2.Waiting times were an issue due to the increasing number of referrals, especially for colonoscopy and endoscopy, also bowel screening had been extended to younger age groups which meant that more people were being referred to the service.

1.3.It was said that endoscopy services were particularly under pressure and work was ongoing to develop a fit test before referring to endoscopy services.

2.    The Chair advised that Members could request any specific data they would like to receive via the clerk.

3.    A Member raised concerns that a gender-based difference in outcomes was apparent and that without raising staffing levels the backlog would not come down. 

4.    Asked about the cervical screening mislabelling referred to in the report, Dr Khan said that if data such as surname or birth date was incorrect the laboratory would reject the sample. It was noted that the issue was national, and work was ongoing with the laboratories and primary care providers to minimise the instances of mislabelling and rejections. Individuals whose samples were rejected could get re-screened after 3 months. Dr Khan noted that when self-sampling is introduced it would likely reduce mislabelling errors as women would be more likely to complete their own details correctly. 

5.    A Member asked for further information on why cervical cancer screenings had seen a year-on-year drop over the past 10 years, while breast cancer screening had remained steady. It was noted that an uplift had been seen nationally between 2019-20 and 2021-22 but not in Kent. Dr Khan said that research had examined why cervical cancer screenings had dropped and several reasons had been identified including Covid-19, availability of screenings outside working hours, embarrassment, and lack of confidence in the sampling. It was noted that the process of screening had changed, and there was a now a two-stage process (HPV testing followed by cytology when there was a positive reading) which some women perceived as less accurate (which was not the case). Two projects were underway: the first was to offer more appointments outside of working hours and the second was researching barriers to cervical screening in the Gypsy, Roma and Traveller (GRT) communities. It was noted that the latest performance statistics (2022-2023) showed an improvement in the number of breast cancer screenings within the target timescale. Going forward staff recruitment and retention remained an issue. Mr Selling gave further details of upcoming work and research to support and encourage the uptake of cancer screenings. One such project was increasing the use of text messages to remind women of their upcoming appointment and asking them for feedback if they failed to attend.

6.    Mr Selling agreed to provide additional data in a future briefing on the forecasting and benchmarking of cancer targets against Key Performance Indicators (KPIs).

7.    A Member asked about the communication process and follow-ups if individuals missed or did not respond to a breast cancer screening appointment. Dr Khan advised that smart screening was used in the breast cancer unit, which meant appointment slots were overbooked based on the probability of a number of patients not attending. Mixed appointments (fixed time versus wider time slot) were offered for convenience, and reminder texts sent out. ‘Did Not Attend’ (DNA) rates had reduced accordingly.

8.    Mr Selling said work had been ongoing with Royal Mail to prioritise bowel screening samples sent via post and these were now being flagged as priority. The situation with delayed samples had stabilised in the last 6 months but was being closely monitored. He also noted that people were sensitive to traveling distance, and that the mobile units for breast cancer screenings reduced the risk of DNAs.

9.    A Member asked for more detail on the use of text messaging, Mr Selling agreed to provide further information outside of the meeting.

10.The Chair asked for a written briefing on the outstanding questions to be provided at a future meeting. 

11.RESOLVED that the Health Overview and Scrutiny Committee note the report.