Corporate report

NHS screening programmes in England: 2019 to 2020

Updated 16 February 2023

Applies to England

1. Introduction

This data report covers the screening year from 1 April 2019 to 31 March 2020.

Please be aware that these data cover some of the time period during the COVID-19 pandemic at the end of March 2020. Therefore provider performance should be interpreted with caution. In addition, some providers were justifiably unable to make timely data returns or validate their data during this period.

From 1 April 2019 to 31 March 2020:

• the NHS screened 3.2 million people for cervical abnormalities
• the NHS screened over 2.9 million people for bowel cancer
• the NHS performed over 500,000 tests for fetal anomalies during pregnancy
• the NHS tested 2.1 million women for abnormalities in breast tissue
• the NHS screened over 617,000 babies for 15 conditions*
• 222,000 men were screened for an abdominal aortic aneurysm
• over 660,000 pregnant women were screened for HIV, hepatitis B, syphilis, sickle cell and thalassaemia
• 2.3 million people with diabetes had routine eye screening
• 421,000 people required testing and treatment following positive screening test results

*The 15 newborn conditions screened for are:

• congenital cataracts
• congenital heart disease
• developmental dysplasia of the hip
• cryptorchidism (undescended testes)
• permanent deafness
• sickle cell disease
• cystic fibrosis (CF)
• congenital hypothyroidism (CHT)
• phenylketonuria (PKU)
• medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
• maple syrup urine disease (MSUD)
• isovaleric acidaemia (IVA)
• glutaric aciduria type 1 (GA1)
• homocystinuria (HCU)
• thalassaemia – there is no routine screening for beta thalassaemia major, but most cases are detected and reported during newborn screening

2. NHS Abdominal Aortic Aneurysm (AAA) Screening Programme

AAA screening is offered to men when they turn 65 (cohort). Men aged 65 and over are most at risk of AAAs, and screening can help spot a swelling in the aorta at an early stage. Men aged over 65 who have not had AAA screening can contact their local service to arrange a test (self-referrals).

76.1% coverage of 2019 to 2020 screening cohort

Measure	Value
Eligible for screening (2019 to 2020 cohort [footnote 1])	291,904
Offered screening	288,429
Tested (2019 to 2020 cohort [footnote 1])	222,177
Tested (self-referrals)	7,412
Coverage (self-referrals)	88.9%
AAAs detected (cohort)	2,033
Incidence (cohort)	0.92%
AAAs detected (self-referrals)	283
Incidence (self-referrals)	3.82%
Men on surveillance at end of year	14,907
Referrals to surgery	875
Elective AAA repairs	587
Deaths from elective repairs	11
Ruptures	30
Deaths from ruptures	25

Data source: AAA SMaRT

Date extracted: 20 July 2020

Some figures for AAA have been affected by the COVID-19 pandemic at the end of March 2020. Due to the COVID-19 pandemic response, validation of quarter 4 (Q4) data was voluntary. For more information about the effect of COVID-19 on AAA screening, see the AAA screening standards report for 2019 to 2020.

3. NHS Bowel Cancer Screening Programme (BCSP)

Bowel cancer screening is offered to men and women aged 60 to 74 (cohort), every 2 years. People over the invitation age range are not invited, but can request screening every 2 years (self-refer). Bowel cancer screening looks for polyps and early stage cancer. Removing polyps reduces the risk of bowel cancer developing.

Note that this data relates to FOBt testing.^{[footnote 2]}

65.9% of people invited to participate were adequately screened

Measure	Value
Number of people invited [footnote 3]	4,482,784
Number of people adequately screened [footnote 4]	2,953,975
Number of people definitively requiring further tests following FOBt [footnote 5]	58,684
Positivity in 2019 to 2020	1.99%
Number of people diagnosed with cancer [footnote 6]	4,209
Number of people diagnosed with high risk adenomas [footnote 6]	7,687
Number of people diagnosed with intermediate risk adenomas [footnote 6]	8,279
Number of people diagnosed with low risk adenomas [footnote 6]	9,745
Number of people with irregular findings, after further tests [footnote 6] [footnote 7]	10,908
Number of people with a usual finding, after further tests [footnote 6]	4,332

Data source: Bowel Cancer Screening IT system (BCSS), OBIEE reporting tool, national reports, FOBt Screening, fiscal year: 2019 to 2020

Data extracted: 29 March 2021

This data relates to the invited population only. Episodes originating from requests for screening or attendance at programme surveillance tests are excluded.

Making comparisons between the screening year 2019 to 2020 data and previous years needs to be treated with caution. This is because from April 2019, a new type of bowel cancer screening home testing kit stated to be rolled out. Both old and new test kit types are referred to as faecal occult blood test kits (FOBt kits). The old test kit was a guaiac kit (or gFOBt kit) and the new kit is a faecal immunochemical test kit (sometimes referred to as the ‘FIT’ kit).

There are many benefits to using the FIT kit, including increased uptake in groups with low participation rates such as men, ethnic minority populations and people in more deprived areas.

There is international and English programme pilot data to show that the new kit type increases screening participation and is a more sensitive test at the programme’s chosen threshold.

This means that the screening year 2019 to 2020 data shows more people adequately screened, more people requiring (and undergoing) further tests, and an increase in uptake and positive results when compared to previous years.

4. NHS Breast Screening Programme (BSP)

Breast screening is offered to women between the ages of 50 up to their 71st birthday (cohort), every 3 years. Women over the invitation age range are not invited, but can request screening every 3 years by contacting their local screening service (self-referrals). Breast screening detects cancers at an early stage when effective treatment is more likely.

82.9% of women aged 50 to <71 years old were invited within 36 months of their previous screening, or previous invitation if they did not attend

68.7% of eligible women invited attended for screening

Measure	Number
Number of women tests (all ages)	2,123,603
Number of women referred to assessment (all ages)	76,440
Number of women diagnosed with cancer (all ages)	17,771
Number of women diagnosed with small invasive cancer (all ages)	7,092

NHS Digital is responsible for publishing official statistics for the NHS Breast Screening Programme.

5. NHS Cervical Screening Programme (CSP)

Cervical screening is offered to women from the ages of 25 to 64 (cohort). Women aged 25 to 49 are invited every 3 years, and women aged 50 to 64 are invited every 5 years. Cervical screening detects types of human papillomavirus (HPV) that can cause abnormal cells in the cervix. Removing these abnormal cells can prevent cervical cancer developing.

70.2% of women aged 25 to 49 years were screened adequately within the previous 3.5 years (coverage)

76.1% of women aged 50 to 64 years were screened adequately within the previous 5.5 years (coverage)

Measure	Number
Number of eligible women [footnote 8]	15,467,216
Number of women invited for screening in year	4,631,798
Number of women tested	3,195,862
Number of screen positive women [footnote 9]	155,966
Referrals for colposcopy/gynaecology	191,563

NHS Digital is responsible for publishing official statistics for the NHS Cervical Screening Programme.

There was a national campaign in March 2019 encouraging women and people with a cervical to consider attending for cervical screening. In December 2019 the primary cervical screening test changed from cytology to HPV testing. Both these factors may have contributed to the difference in uptake in 2019 to 2020 and 2018 to 2019.

6. NHS Diabetic Eye Screening (DES) Programme

Diabetic eye screening is offered yearly to people aged 12 or over who have diabetes (cohort). Screening detects diabetic retinopathy, which can cause sight loss if left undiagnosed and untreated.

81.5% of people with diabetes who were offered screening completed testing

Measure	Number
Eligible people with diabetes known to programme	3,539,321
Offered screening (routine digital screening)	2,818,335
Tested (routine digital screening)	2,297,871
New registrations to programmes	299,022
Urgent referrals (R3A)	8,934
Routine referrals to HES (R2M1, R2M0, R1M1)	48,018
Routine referrals to DS (R2M1, R2M0, R1M1)	37,957
Routine referrals to HES and DS (R2M1, R2M0, R1M1)	85,917†

^†Some manual corrections made by individual services resulting in the sum of routine referrals to HES and DS not being equal to the total routine referrals.

Data source: Programme performance reports and quarter 4 quarterly submission.

Data collected June 2020.

R1 = Background retinopathy; R2 = Pre-proliferative retinopathy; R3A = Active proliferative retinopathy; R3S = stable treated proliferative retinopathy; M0 = No maculopathy; M1= Maculopathy.

7. NHS Fetal Anomaly Screening Programme (FASP)

Fetal anomaly screening is offered to eligible pregnant women at various points during the pregnancy (cohort). The tests are to detect the presence or chance of a range of conditions (see ‘Conditions screened for’ in the FASP programme overview).

During the COVID-19 pandemic, the FASP encouraged maternity services to continue screening where safe to do so. The lockdown period started only 8 days before the end of March 2020, so only a marginal effect on the data is seen.

84.0% screening coverage for Down’s syndrome, Edwards syndrome and Patau’s syndrome (T21/T18/T13)

99.1% screening coverage for fetal anomaly ultrasound

Measure	Value
Number of tests performed	500,165
Number of women at higher chance	15,473
Number of sonographers going through DQASS [footnote 10]	2,455
DQASS % red flags	1.1%
DQASS % red4 flags	1.1%
DQASS % amber flags	33.8%
DQASS % green flags	61.6%
DQASS % no flags	2.4%

Data source: Down’s syndrome Screening Quality Assurance Support Service (DQASS)

For more information on FASP standards data, see the antenatal FASP screening standards report for 2019 to 2020.

8. NHS Infectious Diseases in Pregnancy Screening (IDPS) Programme

Infectious diseases in pregnancy screening is offered to pregnant women (cohort), to detect HIV, hepatitis B and syphilis. Detection and treatment reduces the chance of passing on an infection to the baby, a partner or other family members.

During the COVID-19 pandemic, the IDPS programme encouraged maternity service to continue screening where safe to do so. The lockdown period started only 8 days before the end of March 2020, so only a marginal effect on the data is seen.

99.8% IDPS screening coverage (HIV, hepatitis B and syphilis)

8.1 HIV

Measure	Value
Eligible women [footnote 11]	662,885
Tested women [footnote 11]	661,248
Results reported within 8 working days [footnote 12]	99.3%
Number of positive results [footnote 12]	783
Screen positive women attending screening assessment within 10 working days [footnote 12]	90.7%

8.2 Hepatitis B

Measure	Value
Eligible women [footnote 11]	662,886
Tested women [footnote 11]	661,281
Results reported within 8 working days [footnote 12]	99.2%
Number of positive results	2,482
Women with hepatitis B (new positive or high infectivity) seen for specialist assessment within 6 weeks [footnote 11]	85.3%
Screen positive women attending screening assessment within 10 working days [footnote 11]	86.9%
Babies born to hepatitis B positive women received first dose of vaccination < 24 hours [footnote 12]	98.5%
Babies born to hepatitis B positive women receiving immunoglobulin (if required) < 24 hours [footnote 12]	95.7%

8.3 Syphilis

Measure	Value
Eligible women [footnote 11]	655,523
Tested women [footnote 11]	653,962
Results reported within 8 working days [footnote 12]	99.2%
Number of positive results [footnote 12]	999
Screen positive women attending screening assessment within 10 working days [footnote 12]	88.6%

Data source: maternity services (England)

For more information on IDPS standards data, see the antenatal screening standards report for 2019 to 2020.

9. NHS Newborn and Infant Physical Examination (NIPE) Screening Programme

Newborn and infant physical examination screening is offered for babies at 72 hours, and again between 6 and 8 weeks of age (cohort). The examination looks for problems with the baby’s eyes, heart, hips and testes.

There was some disruption to the screening programme in March 2020 due to COVID-19.

96.2% screening coverage by 72 hours

Screening type	Measure	Value
All	Eligible babies [footnote 13]	580,440
All	Eligible babies tested by 72 hours	558,581
Eyes	Number of babies with positive eye screening test	948
Eyes	Timely assessment of eye referrals	47.6%
Eyes	Number of babies identified with abnormalities of eyes	141
Hips	Number of babies with positive hip screening test	5,307
Hips	Timely assessment by hip ultrasound	24.2%
Hips	Number of babies with positive hip screening test and identified with hip abnormalities	833
Hips	Number of babies with hip risk factors	46,707
Hips	Timely assessment of babies with hip risk factors	44.0%
Hips	Number of babies with hip risk factors and identified with hip abnormalities	1,875
Testes	Number of male babies identified with bilateral undescended testes	1,329
Testes	Proportion of male babies identified with bilateral undescended testes and seen by a specialist within 24 hours of newborn examination	46.1%
Testes	Number of male babies identified with bilateral undescended testes abnormalities	394
Testes	Number of male babies identified with unilateral undescended testes	4,983
Heart	Number of babies with positive heart screening test	9,159
Heart	Number of babies identified with heart abnormalities	428

Data source is Smart 4 NIPE (S4N) / PMS.

Data extracted: 30 March 2021.

We have identified quality issues with the data submitted from S4N. Data is incomplete and may not reflect a full and accurate assessment of activity. There was not full national coverage of the IT system in screening year 2019 to 2020 so not all outcome data was entered on the system during that period.

10. NHS Newborn Blood Spot (NBS) Screening Programme

Newborn blood spot screening is offered for babies up until their first birthday, with the exception of testing for cystic fibrosis which is only offered up until 8 weeks of age (cohort). Screening takes place for 9 conditions (see tables in sections 10.1 to 10.9 below and data for sickle cell disease in section 12 below). Newborn blood spot screening identifies conditions which can be treated to improve a baby’s health, and can help prevent severe disability or even death.

Due to the COVID-19 pandemic at the end of screening year 2019 to 2020, newborn screening laboratories were instructed to relax blood spot acceptance criteria on samples that would normally have been rejected, and also to accept day 4 samples. Together these factors may have affected the performance but the effect was limited to the lockdown period of 8 days at the end of March 2020.

10.1 Overview

97.9% of babies were tested and recorded on the Child Health Information System (CHIS) at 17 days

There were 953 babies who tested positive for a NBS-screened condition, and a further 54 babies were clinically diagnosed before screening.

10.2 Cystic fibrosis (CF)

Measure	Number
Babies tested	615,809
Total screened positive (including babies clinically diagnosed before screening)	281
Screened positive 1st sample (excludes 29 babies clinically diagnosed before screening)	122
Babies for whom age is recorded at appointment	120
Screened positive 1st sample and 1st appointment within 28 days	116
Screened positive 2nd sample (excludes 2 babies clinically diagnosed before screening)	97
Babies for whom age is recorded at appointment	64
Screened positive 2nd sample and 1st appointment within 35 days	49
Carriers detected by the screening pathway	137

10.3 Congenital hypothyroidism (CHT)

Measure	Number
Babies tested	617,331
Total number of babies screened positive for CHT (including babies clinically diagnosed before screening)†	514
Screened positive 1st sample (excludes 3 babies clinically diagnosed before screening)	289
Babies for whom we have age at appointment data	274
Screened positive 1st sample and 1st appointment within 14 days	256
Screened positive 2nd sample (excludes 9 babies clinically diagnosed before screening)	214
Babies for whom age is recorded at appointment	198
Screened positive 2nd sample and 1st appointment within 21 days	173

^† Excludes 36 pre-term babies.

10.4 Phenylketonuria (PKU)

Measure	Number
Babies tested	617,655
Babies screened positive (excludes 6 babies clinically diagnosed before screening)	75
Babies for whom age is recorded at appointment	59
Screened positive and 1st appointment within 14 days	55

10.5 Medium chain acyl-coA dehydrogenase deficiency (MCADD)

Measure	Number
Babies tested	617,636
Babies screened positive (excludes 10 babies clinically diagnosed before screening)	41
Babies for whom age is recorded at appointment	39
Screened positive and 1st appointment within 14 days	37

10.6 Isovaleric acidemia (IVA)

Measure	Number
Babies tested	617,655
Babies screened positive (excluded no babies clinically diagnosed before screening)	24
Babies for whom age is recorded at appointment	24
Screened positive and 1st appointment within 14 days	24

10.7 Glutaric aciduria type 1 (GA1)

Measure	Number
Babies tested	617,655
Babies screened positive (excludes 2 babies clinically diagnosed before screening)	11
Babies for whom age is recorded at appointment	9
Screened positive and 1st appointment within 14 days	9

10.8 Homocystinuria (HCU)

Measure	Number
Babies tested	617,655
Babies screened positive (excludes no babies clinically diagnosed before screening)	3
Babies for whom age is recorded at appointment	3
Screened positive and 1st appointment within 14 days	2

10.9 Maple syrup urine disease (MSUD)

Measure	Number
Babies tested	617,655
Babies screened positive (excludes no babies clinically diagnosed before screening)	4
Babies for whom age is recorded at appointment	3
Screened positive and 1st appointment within 14 days	3

Data source: Newborn screening laboratories and Child Health.

11. NHS Newborn Hearing Screening Programme (NHSP)

Newborn hearing screening is offered to babies ideally within the first 4 to 5 weeks after birth (cohort). The test can be carried out up to the age of 3 months. Screening identifies permanent moderate, severe and profound deafness, and hearing impairment. Early detection enables interventions to improve language, speech and communication skills as the baby develops.

There was significant disruption to the screening programme in March 2020 due to COVID-19. This affected coverage and audiology assessment.

97.8% of babies with completed screening process by 4 weeks corrected age (hospital programmes – well babies, NICU babies) or by 5 weeks corrected age (community programmes – well babies)

Measure	Value
Number of eligible babies	607,664
Number of babies for whom screening process was completed by 3 months corrected age	600,571
Proportion of babies for whom screening process was completed by 3 months corrected age	99.1%
Proportion of babies for whom the screen is declined	0.15%
Proportion of well babies who do not show a clear response in both ears at OAE1 (hospital model)	22.1%
Proportion of well babies who do not show a clear response in both ears at OAE 1 (community model)	12.8%
Number of babies referred for diagnostic audiological assessment	14,036
Proportion referred for diagnostic audiological assessment from hospital model	2.4%
Proportion referred for diagnostic audiological assessment from community model	1.7%
Proportion of babies with a no clear response result in one or both ears or other result that requires an immediate onward referral for audiological assessment who are offered audiological assessment within the required timescale	93.1%
Proportion of babies with a no clear response result in one or both ears or other result that requires an immediate onward referral for audiological assessment who receive audiological assessment within the required timescale	83.6%
Number of babies with a confirmed hearing impairment in both ears by 6 months of age	484

Above figures exclude babies born or currently in Wales at time of data collection.

Data source: Smart 4 Hearing (S4H) / PMS

Data extracted: 30 March 2021.

12. NHS Sickle Cell and Thalassaemia (SCT) Screening Programme

Sickle cell and thalassaemia screening includes antenatal screening for pregnant women (ideally at 10 weeks’ gestation) and screening for fathers (if the baby’s mother is a genetic carrier). Sickle cell screening via newborn blood spot screening for babies takes place one week after birth (cohort). Antenatal SCT screening means parents can find out if they are carriers of the sickle cell or thalassaemia gene, and may therefore have passed it on to their baby.

There is no routine screening for babies at risk of inheriting thalassaemia major. However, most cases of beta thalassaemia major should be detected during newborn screening, but thalassaemia carriers are not.

During the COVID-19 pandemic, the SCT programme encouraged maternity services to continue screening as usual or within technical guidance. The lockdown period started only 8 days before the end of March 2020, so only a marginal effect on the data is seen.

12.1 Antenatal screening

99.7% screening coverage

Measure	Value
Tested women [footnote 13]	660,638
Proportion of women tested by 10 weeks [footnote 13]	59.6%
Pregnant women that screened positive [footnote 14]	13,108
Rate of screen positive results [footnote 13] [footnote 14]	1 in 47
Proportion of fathers tested [footnote 14]	70.4%
At risk couples detected [footnote 14]	771

12.2 Prenatal diagnostic (PND) testing

Measure	Number
PND tests performed [footnote 15]	360
Affected fetal results [footnote 15]	101

12.3 Newborn screening

Measure	Number
Newborn babies screened [footnote 16]	616,755
Screen positive results [footnote 16] [footnote 17]	245
Rate of screen positive results [footnote 16]	1 in 2,517
Carrier results [footnote 16]	7,996

Data source: see notes in tables above.

For more information on SCT standards data, see the antenatal screening standards report for 2019 to 2020.

1. Men registered with a GP in England and born between 1 April 1954 and 31 March 1955 and who have not already been treated for an AAA. ↩ ↩²

2. NHS Bowel Cancer Screening is initially carried out using a home testing kit called a faecal occult blood test kit, or ‘FOBt kit’ for short. The kit is designed to look for small amounts of blood in participant’s poo, that wouldn’t normally be noticeable by eye. Finding blood doesn’t mean cancer has been detected, but means further tests, such as a colonoscopy, are usually advised. ↩

3. One invite per screening subject episode. A subject can have multiple episodes during their ‘bowel cancer screening lifetime’. Number of people invited does not include requests for screening such as over-age self-referrals, later responders or opt back-in episodes. ↩

4. Of those invited and adequately screened, the number with a FOBt outcome. Some screening subjects will need to return more than one test kit within an episode to achieve a definitive FOBt outcome. ↩

5. Of those invited and adequately screened, the number with a FOBt episode outcome of ‘further tests are needed’. All people with the outcome ‘further tests are needed’ are booked an appointment with a specialist screening practitioner (SSP) to discuss their test kit episode result and assess their fitness for further diagnostic tests, such as colonoscopy. ↩

6. The episode outcomes presented here are for the invited population only, for the specified screening year. Specifically, those invited who adequately participated in FOBt screening, were found to need further tests and went on to have a (one or more) diagnostic test within the screening episode. Episode outcomes are calculated from the findings of potentially multiple endoscopic or radiological tests within the screening episode. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

7. Irregular findings can be for non-neoplastic diagnosis (such as diverticular disease, haemorrhoids, inflammatory bowel disease), non-adenomatous polyp (such as hyperplastic, inflammatory, Peutz-Jeghers polyp), non-neoplastic and non-adenomatous polyp diagnosis, or where radiological testing showed no polyps, but no histological confirmation was possible. ↩

8. Registered female population for ages 25 to 64 minus any women ceased for clinical reasons. ↩

9. Number of adequate tests minus number of negative samples. ↩

10. DQASS is the Down’s syndrome Screening Quality Assurance Support Service. Flags are assigned to a dataset of nuchal translucency (NT) and crown rump length (CRL) measurements. Flags indicate bias of the dataset. Green flag: NT bias ≤ 0.10mm. Amber flag: NT bias 0.11mm - 0.40mm. Red flag: NT bias > 0.40mm. Red4 flag: assigned if fewer than 25 paired measurements over 4 cycles. No flag: trainee sonographer has < 25 paired measurements. ↩

11. Figures based on key performance indicator (KPI) data. Exclusions were made where completed data was not submitted for all 4 quarters. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

12. Figures based on annual standards data. Exclusions were made when data was incomplete or missing, not where trusts could not account for their whole cohort. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹

13. Figures based on KPI data. Exclusions were made where completed data was not submitted for all 4 quarters. ↩ ↩² ↩³ ↩⁴

14. Based on provisional antenatal laboratory data (128 of 142 expected returns). Figures may differ to those published in the programme-specific data report for screening year 2019 to 2020. ↩ ↩² ↩³ ↩⁴

15. Based on data submitted by PND laboratories and compiled by the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS). ↩ ↩²

16. Based on provisional newborn laboratory data. Figures may differ to those published in the programme-specific data report for screening year 2019 to 2020. ↩ ↩² ↩³ ↩⁴

17. Screen positive results include babies identified with FS, FSC, FS-other and FE. ↩