Presentation from the UK NSC conference in December 2016 about the new chair.

1. UK NSC – Challenges and
Vision
Prof. Bob Steele
Professor of Surgery, University of Dundee
Independent Chair, UK NSC

2. UK NSC Chair
• Who I am and how I came to be involved
• Thoughts on Screening and the UK NSC
• Challenges
• Vision for the future

4. 1990

6. Key Areas in Health Screening
Sir Muir Gray
• Systems thinking and quality assurance
• Harm vs Benefit
• Importance of evidence
• Efficacy vs effectiveness and importance of pilots
• Cost effectiveness
• Efficacy and quality relative value
• Importance of the individual’s perspective
• Evidence base for communicating risk
• Informed choice

7. UK National Screening
Committee
• Advises ministers and NHS
– Introducing, continuing, modifying and withdrawing
screening programmes
• Meets 3 times a year
– New recommendations and updates existing ones
– Supported by FMRG and ARG
• Keeps abreast of new evidence

8. Screening in the
UK
Each UK health
department responsible
for setting screening
policy, taking account of
advice from UK NSC

9. To whom do we offer
screening?
• Pregnant women
• Newborn babies
• Children and adults defined by
age or risk

10. What do we screen for?
www.gov.uk/uknsc
(or put “UKNSC” into Google!)
From a wide range of conditions under
consideration(100) there are 30 for which
there is firm evidence that the benefits of
screening outweighs the harm.

11. How is screening kept up to
date?
• By regular review of evidence
– existing proposals
• By responding to new evidence
– existing proposals
– existing programmes
– new programmes
• By evaluating new proposals

12. With whom does UK NSC
work?
• PHE and Health Departments
• Research Funders (e.g. HTA)
• Stakeholders

13. Stakeholders
• National groups representing patients and
carers
• Organisations representing healthcare
professionals
• Standard setting and guideline developing
bodies
– e.g. NICE, SIGN

14. How can stakeholders
contribute?
• Annual call for new proposals
• Suggesting modifications or early updates
• Annual stakeholder meeting
• Consultation on evidence review

15. Why is the work of UK NSC
important?

16. Screening is Popular
• Most people have a negative test
• A few people have a false positive test
• A few people are cured
• A few people are harmed by investigation or
treatment

17. Advising on Screening Policy
• Starting screening
• Stopping screening starting
• Changing screening
• Stopping screening

18. We have to careful with the
interpretation of screening
data

19. Lead-time Bias
Screening
Disease
Progression
Symptoms

20. Length Bias
Screen Screen

21. Selection Bias
Individuals accepting screening tend
to be health conscious

22. Screening RCTs
Population
No screening
offered
Screening
Offered
(including those who
choose not to participate
and those developing
interval disease)
Compare numbers of deaths from disease
(and number of cases)

23. Criteria for Screening
• Effective treatment
• Treatment at early stage better
• Diagnostic and treatment facilities
available
• Suitable test
– Sensitive
– Specific
– Acceptable
• Economically viable
• Benefit outweighs harm
Modified from Wilson
and Jungner,
1968

24. Colorectal
Cancer
Screening
Test Development
(FOBT)
Observational
Clinical Studies
Small-
Scale
RCTs
Population –based
demonstration
pilots
Government
Policy
Decisions
Population
Screening
Implemented
Ongoing research
-improving the test
-improving uptake
Time scale = 25 years
Sensitivity
Specificity
Effectiveness
provenFeasibility
proven

25. What are the challenges for
UK NSC?
• Communication
– Public, Politicians and invitees
• Evidence review
– Existing portfolio
– New proposals
• Working with researchers
• Working with patient groups
• Estimating value

26. No screeningScreening
Cost
Harm
Cost and harm
of treating
disease not
detected

27. Vision for UK NSC
• To continue to provide high quality, evidence-based
independent advice to Government
• To promote the introduction of new, high value programmes
• To ensure that screening in the UK produces net benefit to
the population
• To be responsive to the public and the professions
• To work to ensure that participation in screening in based on
truly informed choice
• To promote good practice in screening internationally

28. Thanks to:
• PHE
• The UK NSC Secretariat
• The Evidence Review Team
• The Committee Members