Guidance

The local AAA screening service

Updated 1 October 2024

‘The local AAA screening service’

1. Screening cohort

A local AAA screening service must serve an area with a minimum total population of 800,000 people and have a suitable vascular intervention centre for treating patients with detected AAA to receive referrals. The vascular units providing treatment must comply with the requirements recommended by the VSGBI for the treatment of AAA and must provide data on the treatment and outcome of every infra renal AAA operation or intervention on to the National Vascular Registry.

The number of staff employed is a local issue, but for the health and safety of staff and screening subjects it is advised that 2 staff should be employed at each session. It is also important to consider the number of staff recruited and the number of scans they regularly perform to ensure competency.

Men are offered a single scan during the year in which they reach 65. In cases where there is doubt over whether the subject should be invited or not, they should be sent an invitation. Local services should aim to ensure all men eligible for the service are made aware of it and how to access it. This includes those who are not registered with a GP or who find it difficult to access the service in another way. Long-term residents in secure organisations, such as prisons, (ADD LINK) and men who are housebound should be given the opportunity of receiving screening once all factors regarding suitability for scanning and further diagnosis and treatment have been considered.

The local provider should, in the first instance, liaise with the man’s GP to ascertain the housebound circumstances and understand the benefit, if any, from screening and potential treatment. An invitation should not be sent only after a joint decision by the GP and local programme director that the individual would not benefit. This should be documented clearly within the national Screening Management and Referrals Tracking (SMaRT) IT system.

Individuals who undergo male to female gender reassignment retain the male genetic risk of developing AAA in later life. However, the local provider will not receive their demographic data if they have registered as a woman. Individuals who self-refer to the programme and have undergone male to female gender reassignment must be screened as per policy.

Females undergoing gender reassignment will not routinely be invited for screening until they register as a male. At that point, SMaRT will identify them as being male and pick them up along with the rest of the screening cohort.

1.1 Inclusions

All men eligible for NHS care registered with a GP within the commissioned screening programme boundaries are included. Selection is based on year of birth. Men should be offered screening during the year – 1 April to 31 March – in which they turn 65. Men who are resident in England but registered in Wales are also eligible to be screened by the English programme and will be automatically picked up by SMaRT.

It is acceptable to invite men as soon as they have turned 64, which is the start of their 65th year. A facility is also available for men aged over 65 on request – see self-referral process for further details.

Men resident in local prison establishments during their 65th year are included, at the agreement of the relevant NHS regional team and prison service. More information is available in the screening in detained settings guidance (ADD LINK).

Men in their 65th year known to have a small AAA <5.5cm are included. Local services will receive information about these men in the appropriate cohort demographic for that given year. However, they will not be identified as already having a known AAA.

The first scan within the screening programme should be classed as their initial scan and previous surveillance scan measurements from any local service discounted. Other healthcare providers such as the GP and the vascular surgeon whose care the man is under should be notified of the screening attendance when this is known to the local programme. It is advised that the man should remain in the screening programme only and not be scanned under 2 separate services.

1.2 Exclusions

Individuals are normally excluded from the programme if:

• they have previously been diagnosed with an AAA and fall outside the category as defined above
• they have previously undergone surgery for AAA repair
• their GP advises that they should not be screened due to other health concerns
• they have already had a scan through the NHS AAA Screening Programme and the aorta was within normal limits

In rare cases a ‘best interest’ decision may be made to exclude subjects with mental incapacity from the programme. This decision needs to be completed in line with the principles enshrined in the Mental Capacity Act. Decisions should be made on a case by case basis by the local programme in conjunction with the GP, family and commissioner. Men who have asked to be permanently removed from the NHS AAASP are not excluded from screening but do need to be removed from the SMaRT system.

1.3 Ineligible population

Individuals are ineligible for screening if they:

• are under the age of 64
• are female
• have had previous AAA surgery
• are over 65 and on local surveillance for a AAA

2. Screening programme models

The model for the service typically involves ultrasound scanning being undertaken within community healthcare facilities such as community clinics, community hospitals, mobile units, primary care facilities and other community locations to meet the needs of the population. Clinic locations are a local responsibility and some clinics may be held in other suitable locations.

3. Clinical staff

A small core team of clinical staff is required. The following whole time equivalents (WTE) are recommendations but local programme circumstances may dictate different requirements.

3.1 Director/clinical lead (0.2 WTE per 800,000 population)

The director oversees the screening programme, ensuring a continuous high quality service is maintained and takes clinical responsibility including giving support for the programme co-ordinator, particularly in matters involving patient care. They are also responsible for making clinical decisions related to screening subjects up to the point where a referral has been made but also ensuring that appropriate care is given following referral.

The key components of the role are to:

• act as the strategic lead for the local programme with responsibility and authority for leading the service, implementing service developments and negotiating necessary funding and resources
• advise on clinical matters concerning the programme at the request of the screening staff
• take overall responsibility and accountability for the management, quality assurance and clinical governance of all aspects of the local screening programme
• receive, read, disseminate and act upon all reports supplied by the national programme
• monitor that diagnostic and treatment services meet the demand and quality requirements of NAAASP and to make reports to the national programme as required
• be accountable for the timely and complete data entry of all outcomes including post-operative rupture
• take professional responsibility for the programme where appropriate. The director will remain the responsible clinician for men entered into the screening programme up to the point where a referral is made and accepted by the vascular service the man is being referred to, and ensuring that the referral is acted upon appropriately
• ensure the programme tracks the progress of each referral made to a provider of vascular services and ensures action is taken to detect and rectify any delays in the man being seen for assessment or subsequent treatment. The director also needs to ensure that the local programme is aware of all final outcomes for each man referred
• provide management of, and clinical guidance to the senior screening programme staff (senior sonographer and co-ordinator)

3.2 Lead ultrasound clinician (0.1 WTE per 800,000 population)

A consultant sonographer/vascular scientist/radiologist has special responsibility for quality assurance (QA) of screening technicians and the screening process with responsibility for the screening equipment, screening technicians’ accreditation and monitoring of clinical performance (including review of scans identified by SMaRT from screening clinics). This task is often delegated to the clinical skills trainer, but this is a local decision. Any QA concerns should be brought to the attention of the director. The lead ultrasound clinician advises on which ultrasound equipment should be purchased (subject to the specifications of national guidelines) and when it needs to be updated or replaced. See QA ultrasound equipment guidance.

3.3 Consultants in vascular units

You should note that vascular surgeons are not employed by the screening programme and are unlikely to participate in the screening programme as such.

In vascular units, the consultant responsible for the care of the patient will be classed as the “responsible” doctor once the referral is received. They should: * notify the co-ordinator of the local screening programme of the outcome of initial and further outpatient visits and, if indicated, the treatment * submit data for audit purposes on an ongoing basis to the online VSGBI National Vascular Registry (NVR) for all AAA surgery. Failure to do so will mean the vascular consultant is ineligible to participate in taking referrals from NAAASP * provide the screening programme with outcome data as required

4. Screening workforce

The programme should normally consist of staff across 4 roles.

4.1 Ultrasound staff

The screening team normally consists of pairs of screening technicians who will go out to selected screening sites as requested. They are overseen by a clinical skills trainer (CST) who is a senior sonographer/vascular scientist. Technicians’ pair working ensures effective throughput of patients in the clinic. They are required to undergo regular assessment and to renew their accreditation at intervals as per the NAAASP Education and Training Framework. Clinics are held at various locations within the screening programme area and staff are expected to travel to the different locations and move portable screening equipment and supplies.

4.2 Clinical skills trainer (senior sonographer/vascular scientist – 0.1 WTE per 800,000 population)

A senior sonographer/vascular scientist is responsible to the director/clinical lead. This is an advanced practitioner who holds a Consortium for the Accreditation of Sonographic Education (CASE) accredited qualification or full Society of Vascular Technology (SVT) accreditation or equivalent. They must also have completed the national mandatory training for CSTs before their involvement with the screening programme. The CST must maintain the appropriate registration and CPD with the appropriate professional organisation. CSTs may be required to evidence their continual profession development record. CSTs must attend a reaccreditation/update session once every 2 years.

As the first line supervisor of the screening technicians, the CST is responsible for staff training and regular review of staff for quality assurance in addition to undertaking routine equipment quality assurance assessments and ensuring regular maintenance of the ultrasound equipment. CSTs may also run occasional screening clinics to maintain their skills. It is essential that the time required for the CST role is ring-fenced from other clinical duties. They should have extensive experience of training in the workplace. The work within these clinics will include:

• ensuring that men attending clinics are checked in smoothly and efficiently and are aware of the benefits and risks of AAA screening and give informed consent to the procedures
• accurately recording aortic sonographic measurements
• collecting other subject information
• reporting scan results and their implications to patients both verbally and in writing
• preparing copies of the results for GPs
• transferring clinic data to the screening office
• updating SMaRT ### Screening technicians (3 WTE per 800,000)

Screening technicians ensure that men attending clinics are checked in smoothly and efficiently and are aware of the benefits and risks of AAA screening and give informed consent to the procedures. They will accurately record sonographic measurements of the aortic diameter, collect other subject information and report scan results together with any potential implications to subjects both verbally and in writing. They may also prepare copies of the results for GPs, transfer clinic data to the screening office and update SMaRT.

All those undertaking scanning must have attended the nationally approved and accredited training course and passed all the competency requirements of the training. Local services must ensure that screening technicians are reaccredited every 2 years.

4.3 Nurse practitioner (0.1 WTE per full capacity programme – 7,000 scans per year)

The nurse practitioner is responsible to the director and is involved in assessing and counselling men at specific points in the screening process and giving advice on changes in lifestyle as appropriate. Further referral on to other specialists should be made following discussion with the director of the local screening programme. Unless the nurse practitioner has attended the nationally approved and accredited training course and passed all the competency requirements of the training, they are not permitted to scan men.

5. Management, administration and technical staff

5.1 Co-ordinator (1 WTE per 800,000 population)

The co-ordinator is responsible to the director/clinical lead. The primary purpose of the co-ordinator’s role is to direct the day-to-day operational management of the local programme. They oversee the work of the administrator and screening teams and their duties include:

• to act as the professional lead for the day-to-day management, evaluation and quality assurance of the screening process, including the provision of information, screening procedures and any onward referral
• to act as a single point of contact for the entire local programme across multiple professional groups and possible multiple screening facilities within that programme (which might include hospitals, clinics and other screening locations)
• liaison with appropriate staff to ensure that policies and procedures are adhered to across all agencies and professional groups involved in the screening programme
• ensuring that all parties in the local screening programme, as well as other appropriate local staff, are kept fully informed
• to act as the main point of contact for communications from the national programme team (the co-ordinator is expected to disseminate communications to local staff as appropriate)
• liaising with localities or NHS England regional teams to identify new GP practices within the local AAA screening programme area
• locating suitable screening sites
• organising staff rotas
• ensuring all invitations to eligible subjects are sent, including new subjects, men with AAA in the surveillance programme and self-referrals
• reconciliation processes at the end of each year to ensure all men in that cohort have been offered a screening appointment
• ensuring referrals are sent for appropriate subjects to vascular surgeons
• arranging appropriate medical imaging scanning following non-visualised screening outcome
• monitoring fail-safe systems
• monitoring and reporting any serious adverse events to commissioners and quality assurance teams in line with national guidance and taking steps to ensure the safety of staff and patients
• arranging appropriate local QA of images as per national guidance
• ensuring that national screening protocols and procedures are adhered to and national pathway standards met
• leading the screening team on non-clinical matters
• line-managing appropriate members of the screening team, ensuring that regular reviews of screener performance are undertaken and appropriate personal development plans are written and implemented
• responsibility for the recruitment, retention and organisation of the training of the screening team in accordance with national and local policies and procedures
• managing all aspects of the screening equipment, ensuring protocols are followed, service and calibration is completed at the required intervals, and equipment is safely and securely stored

5.2 Administrator (1 WTE per 800,000 population)

The administrator is responsible for the administration of the local programme and is the first point of contact between the screening population and the screening office. The administrator plays a supporting role to the local AAA screening programme and can give members of the public factual information about the benefits of the programme.

5.3 Medical physicist (5 days per year per 800,000 population)

The purpose of this role is to undertake acceptance of new ultrasound machines and to provide independent, regular quality assessments using sophisticated test objects. This specialist will undertake annual assessments on all the ultrasound machines and probes, assisted by the lead ultrasound clinician. They will prepare reports for the director of the local programme.

6. Governance

The provision of AAA screening involves several organisations:

• Department of Health (DH)
• local authorities
• Public Health England (PHE)
• NHS England/Improvement (NHSEI)
• primary care providers
• local screening programme
• diagnostic and treatment services

7. Responsibilities

PHE is responsible for delivery of essential ‘do once’ elements of screening programmes. These include:

• developing, piloting and roll-out to agreed national service specifications of all extensions to existing screening programmes and new screening programmes
• setting and reviewing pathway standards
• reviewing national service specifications and advising on section 7A agreements (under the direction of DH requirements)
• developing education and training strategies
• providing patient information
• determining data sets and management of data, for example to ensure key performance indicators (KPI) are collected
• setting clear specifications for equipment, IT and data
• procuring and supplying the national IT screening management system
• collecting, collating and quality assuring data for screening programmes
• monitoring and analysing implementation of NHS commissioned screening services
• providing advice to DH on priorities and outcomes for the NHS England mandate and section 7a agreement, and to lead on detailed provisions, in particular the 7a agreement on screening
• working with NHS England to optimise coverage

PHE is also responsible for long-term elements, including:

• providing the QA functions for screening programmes
• providing public health expertise and advice on screening at all levels of the system, including specialist public health expertise being available as part of NHS England screening commissioning teams
• ensuring action is taken to optimise access to screening programmes, such as among socio-economically disadvantaged groups

NHS England commissions, on behalf of PHE, the NHS AAA Screening Programme and contracts with providers for provision of these services based on the nationally agreed service specification. It is also responsible for the performance management of providers.

7.1 General practice

The intention of the screening programme is to keep the primary care workload to a minimum. However, GPs should be aware of the programme, so they can take advantage of opportunities to raise awareness among men aged 65 and over in their practice, particularly those with risk factors for AAA such as smoking or family history. Some people receiving invitations may want to discuss the screening process with their GPs. GPs will also be notified by the screening programme of the screen outcome for men registered with their practice, including the referral of men with large aneurysms.

7.2 NHS trusts and screening providers

The chief executive has overall responsibility for the quality of the AAA screening programme tasks undertaken in their organisation. Those organisations contracted to provide screening services have responsibility to ensure that:

• performance against national quality assurance standards is judged as satisfactory by the national programme
• fail-safe procedures operate in accordance with national policy

• they comply with the requirements of the NHS Information Governance Toolkit Those trusts contracted to provide diagnostic and treatment services have responsibility to ensure that:

• appropriate diagnostic investigation and treatment is offered to individuals referred from the screening programme according to the timelines in the pathway standards
• appropriate follow-up procedures are undertaken
• fail-safe procedures operate in accordance with the agreed policy

8. Accommodation

Clinic rooms with appropriate facilities should be identified within the community, ensuring a height adjustable examination couch. Ideally there should also be N3 network access (the NHS secure network) in at least one of the rooms along with a dedicated computer. Consideration should be given to available lighting and patient privacy in any room offered as a clinic room. Ideally the room should allow for subdued lighting with good black out blinds on windows as ultrasound requires control over the level of lighting during scanning.

Screening offices should be secure and large enough to accommodate appropriate staffing levels.

9. Information

The programme must provide information, including:

• publicity - PHE’s regional press office teams can provide support and guidance for publicity in relation to the programme
• leaflets and information - nationally developed and approved information is available to all local AAA screening programmes from the national print supplier. It is the responsibility of the local programme to ensure that information is available to all men and that literature is displayed in appropriate locations. All leaflets, posters and information sheets should be ordered from the national print supplier The national invitation leaflet is designed to ensure that men are informed what screening can and cannot achieve. This, along with the invitation letter, addresses the need to inform subjects about the use made of personal information for audit, as set out in guidelines developed for the programme by the National Information Governance Board (NIGB).

Men should be able to make a genuinely informed choice based on an understanding of why they are attending for screening, the risks involved and associated with a positive result and what happens to their records after being screened. The information will be sent to all men with their invitation for AAA screening.

There are 2 digital leaflets for men who require surveillance – one for those with small aneurysms (3.0 to 4.4cm), who are invited for 12-monthly surveillance appointments, and one for those with medium aneurysms (4.5 to 5.4cm), who are invited for 3-monthly surveillance appointments.

There is also a digital leaflet for men identified with large aneurysms (5.5 cm or greater) who are referred to a vascular consultant.

Letter templates are available to programmes and all local programmes should use these as provided within the SMART IT solution. Minimal changes to the template will be permitted but changes to the core content should not be made.

Further information is available:

• about AAA screening for professionals
• about AAA screening for patients and members of the public
• downloadable PDF and text leaflets, including translated versions of patient information leaflets

10. Screening equipment

Screening equipment consists of portable ultrasound machines. A technical equipment specification has been developed and an approved list of equipment meeting this specification agreed.

It is a requirement that all local providers select equipment from this list. Screening technicians should not undertake screening on any machines other than those approved by the national programme. This includes loan or temporary replacement machines. All local providers should have procedures for storage and transport of ultrasound machines. Cleaning of machines should comply with local policies for infection prevention and control, and equipment manufacturers’ guidance for cleaning and maintenance.

Please note that it is important to reference documents relating to ultrasound and the prevention of work-related musculoskeletal injuries. Documents which reference these guidelines are available via the Society and College of Radiographers’ website. Local providers should make reasonable adjustments to policy and working conditions to reduce the risk of work-related musculoskeletal injuries.

Liability and insurance for equipment loss and damage should be discussed with the local commissioners/trusts.

10.1 Recommended equipment settings

Recommended settings for the Samsung/MIS Ugeo are:

• depth - 12cm
• focus - 6 to 7cm
• gain - 50
• frequency - ‘General’
• harmonic imaging - ‘ON’
• dynamic range - 130
• edge enhancement - 1
• grey map - 6
• compound imaging - ‘ON’

Recommended settings for the Esaote MyLab Alpha are:

• dynamic range - 8
• frequency - ‘Res-L’
• X view - ‘+7’
• M view - 1
• depth - 12
• gain - 53
• persistence - 0
• enhancement - 4
• density - 2
• compound imaging - ‘ON’
• harmonic imaging - ‘ON’

Recommended settings for the GE Logic e are:

• tissue harmonics - ON
• cross-beam (compound imaging) - ON
• dynamic range - 70-80 dB Edge enhancement (setting no. 2)
• grey map - C or D

• power - can be set to 100% Recommended settings for Sonosite M Turbo are:

• tissue harmonics - ON
• “MB” – multi-beam = compound imaging - ON
• dynamic range - ‘-2’

Further information is available in the clinical guidance and scope of practice document. Local providers should be aware there may be periodic updates in equipment set-up related to scanner software upgrades or manufacturers’ recommendations.

10.2 Safety, compliance and quality assurance on ultrasound machines

Compliance with local policies and directives is necessary. All equipment will need to be safety tested and accepted locally following delivery.

You must ensure that all the components belonging to one piece of equipment are clearly labelled. Local providers should colour code each piece of equipment to allow the matching of equipment to each man scanned and easier identification of equipment should problems occur.

Electrical safety testing is required as directed by the local organisation. Regular maintenance (as per the manufacturer’s guidelines) and quality assurance testing to specified levels by qualified personnel is required. The following procedures should be implemented:

• in-depth baseline tests on new equipment
• annual routine tests using specialist equipment
• routine monthly tests to be carried out locally by the senior sonographer or medical physics department and results reported to the screening office
• the integrity of mains cables, transducer cables and the transducer face should be inspected before every clinic - defective equipment should be taken out of service and reported

Further information can be found in the ultrasound equipment quality assurance guidance.

10.3 Equipment review and replacement

A formally agreed review and replacement programme should be in place with providers because of rapid changes in technology and clinical expectations and needs. The Board of the Faculty of Clinical Radiology, Royal College of Radiologists, recommends review of ultrasound equipment at 4 to 6-year intervals. The national programme centre will support and advise local programmes with this process as consistency of equipment use across NAAASP is essential.

11. Workforce education and training

All training is based around a national competency framework. Training, development and information programmes are required for:

• senior practitioners/CSTs - expected to cascade practical training to other staff and offer support and advice and required to clinically support the screening technicians during the initial months of their training within the programme
• nurse practitioners who undertake screening
• screening technicians
• co-ordinators - expected to cascade training to screening and clerical staff

Directors are required to attend information seminars and update events. Information updates will also be required for:

• lead ultrasound clinicians
• medical physicists
• nurse practitioners
• commissioners

It is recommended that all administration personnel, including the co-ordinator, undertake some local IT training to cover rudimentary use of Microsoft Excel and Word, such as the European Computer Driving Licence (ECDL) training. To use and produce performance reports it is recommended that co-ordinators are proficient in the use of Excel.

The training for screening technicians involves a combination of e-learning, self-directed study, on-site clinical skills and competency-based training with the local screening programme. It takes between 3 and 6 months to become an accredited screening technician.

See training documents for further details.

12. Confidentiality and security

Basic principles of information governance include that:

• patient information is confidential and should be entrusted only to those with a justified need to know
• integrity of information must be monitored and maintained to ensure that it is of sufficient quality for use within the purposes it was collected
• awareness and understanding of all staff, regarding their responsibilities, should be routinely assessed and appropriate education and awareness provided
• risk assessment in conjunction with overall priority planning of organisational activity should be undertaken to determine appropriate, effective and affordable information governance controls are in place

Basic principles of storage and transfer of person-identifiable data include that:

• all person-identifiable information should be encrypted when stored or transferred electronically
• non-encrypted memory sticks should not be used to store patient information or ultrasound image files which contain patient information
• storage or transfer of bulk person-identifiable information should not be done without the express permission of the Caldicott Guardian who will maintain a register and should be done via a secure service
• all electronic bulk person-identifiable information must be encrypted to an acceptable level (256-bit Advanced Encryption Standard (AES-256) algorithm plus a strong password – 12 or more characters in length)
• files containing person-identifiable information can be encrypted individually or, in the case of laptops, the hard drives can be encrypted
• images and patient information on the ultrasound scanners should be uploaded to the central image storage system as soon as possible following a clinic. Once the programme is assured the images have all successfully been uploaded, they and any residual patient information should be removed from the scanner

The above principles apply to all forms of mobile/portable computer media and devices including laptops, notebook computers, PDAs, solid-state memory cards, memory sticks, pen drives, USB drives, DVDs, CD-ROMs and so on, as well as all forms of electronic transfer of person-identifiable information including email, FTP, internet submissions, and so on.

Files containing person-identifiable information must be encrypted during full transit from sender to receiver and must be properly protected as stated above when stored on the sender’s and receiver’s computer devices. NHS numbers should not be used in emails between programmes or between programmes and the Northgate Public Services IT service desk unless using nhs.net email addresses to send and receive. The confidential ID number generated for each subject within the IT system should be utilised in such cases. The use of fax machines to send patient information should be avoided.

12.1 Information governance incident reporting

Staff should report all information security breaches or near misses via the incident reporting process - the same process as for reporting clinical incidents.

13. Information technology

Systematic screening requires call and recall information and the capture and management of ultrasound images. Screening programmes must use the software developed through and provided by PHE and ensure that the national minimum dataset is collected. This software solution is known as the SMaRT system.

The SMaRT system consists of several modules.

The identification and collation of screening cohort (Screening Subject Population Index SSPI) module teaches how to identify all men in their 65th year, and to collate a screening cohort for each local screening programme as well as keeping the demographics of the active cohort up to date. Local screening programmes are defined by the list of GP practices to which they are responsible for offering screening. Programmes must keep this list up to date and let the Northgate helpdesk know of any new GP practices in their area or any other changes to the GP practice list. The screening year is from 1 April to 31 March.

The screening management and referral tracking module provides the core functionality for the screening programme, including the administration of call/recall for new and surveillance subjects, management of referrals for those screened positive and collation of audit and performance management data for the programme. The data for the programme is stored in SMaRT. Local screening programmes have access to the subjects for whom they are responsible.

The recording of AAA surgery and outcomes module is used to measure the effectiveness of the screening programme. It is necessary to collate data regarding AAA surgery and outcomes following a positive screen. Assessment information should be entered into SMaRT by the local programme. Surgery outcomes can either be collected via the NVR, in which case an NHS number must be used to allow the linking of the surgery to SMaRT, or directly into SMaRT by the local programme staff.

The call and recall system has been specified by the national programme and is centrally hosted by IT supplier Northgate Public Services. Local installation is not required but appropriate N3 connections must be available via a suitably fast and resilient link.

The following are also required:

• a minimum of 2 administrative computers, including printers to access the system with appropriate support
• telephone system with appropriate voicemail
• a computer attached to each screening location, if possible
• at least one computer which has the “Image Cube” software (provided via SMaRT) installed with an extra Ethernet port to allow the uploading of images
• local network firewall configuration to allow the images to flow to the centralised image storage over the N3 network using secure DICOM (Digital Imaging and Communications in Medicine)

13.1 Data use and consent

The IT system that supports AAA screening is different from most hospital systems in that records are stored in a national system and most of these records relate to subjects who have not sought NHS care. Following Section 251 approval, the NHS AAA Screening Programme receives details of all men during the year they turn 65 from the Health and Social Care Information Centre (HSCIC) system.

The use of a national screening system has huge advantages in monitoring the programme and better understanding the progression and clinical management of AAA. However, men who have been offered screening might not expect that their personal information is being stored or used outside the local screening programme. Therefore, we are legally obliged to seek informed consent before entering or retaining personal information in the national database.

Every subject who attends for screening must be given an opportunity to read the form of words provided on the ‘consent card’, enabling them to understand and consent to screening if they wish to be screened and to the storage and use of personal information. There is no need to obtain a signature, but it is always the screener’s responsibility to ensure that the subject’s consent preferences are accurately recorded. It may be unlawful to store personal information without obtaining appropriate consent.

Consent need only be obtained once for each man, but the rules on consent may change, so in practice it may be easier to present the consent card at each screening encounter so that consent can be reconfirmed. The consent card is available.

13.2 Declined or withdrawn consent

It is important that any man who declines consent for their personal information to be used in this way understands the consequences of their decision. Often explaining why information is needed and affirming that it will only be used within the NHS as part of the care, evaluation and improvement process will reassure the subject that this use of their personal information is appropriate. However, it is important that only legitimate informed consent is recorded within the system.

Subjects may decline consent for any or all of the activities listed on the card. However, a subject declining consent must not be screened other than when he declines consent for use of personal information for research purposes. Screening is a diagnostic procedure that requires the consent of the subject and there is an associated duty of care to record information to evidence what was done and what was found.

If a subject asks for his information to be removed NHS AAA Screening Programme must comply with this request and the national software supplier asked to delete their details permanently. A record of the request and any screening results (if this is after screening) should be held locally.

The following paragraphs must be included in all subject letters as stipulated by the National Information Governance Board for Health and Social Care (NIGB):

“Title - Your personal information (sometimes called personal data) Body text - As you are registered with a GP, you are entitled to AAA screening as part of the NHS programme in England. Your personal information (name, contact details and date of birth) will only be used by the NHS AAA Screening programme to provide a safe screening service. It will not be passed on to third parties other than healthcare professionals directly involved in screening or any subsequent investigations and treatment. As a national NHS screening programme, we are required to record statistics and may also contribute to research linked to abdominal aortic aneurysms or screening programmes. If your data is used for these purposes, we will not identify any of your personal details other than where there is a clear legal basis.

We also share personal information with the Vascular Society of Great Britain and Ireland so that we can monitor mortality from AAA disease and improve the effectiveness of the screening programme.

If you have any concerns or queries about how your information is used or stored, please contact the screening centre on [Insert local number here]”

13.3 Image storage and retrieval

All images taken as part of the screening test process (apart from those taken in medical imaging departments) must be stored on the central image storage system which forms part of SMaRT.

To minimise the risk of data loss, images should be removed from ultrasound machines as soon as possible following image upload.

*[DH}: Department of Health *[DICOM]: Digital Imaging and Communications in Medicine *[DVLA]: Driver and Vehicle Licensing Agency *[ECDL]: European Computer Driving Licence *[HSCIC]: Health and Social Care Information Centre *[IT]: Information technology *[KPI]: Key performance indicators *[NAAASP]: National AAA screening programme *[NHSEI]: National Health Service England/Improvement *[NICE]: National Institute for Health and Clinical Excellence *[NIGB]: National Information Governance Board for Health and Social Care *[NVR]: National vascular registry *[ONS]: Office for National Statistics *[PHE]: Public Health England *[QA]: quality assurance *[SMaRT]: Screening management and referral tracker system (Northgate) *[SOP]: Standard operating procedures *[SVT]: Society of Vascular Technology *[UKNSC]: United Kingdom national screening committee *[VSGBI]: Vascular Society of Great Britain and Ireland *[WTE]: Whole time equivalent