Transparency data

UK NSC minutes June 2022

Updated 2 February 2023

These minutes are final.

The meeting was held at 39 Victoria Street, London, and online on 24 June 2022.

1. Attendees

1.1 Members

• Professor Sir Mike Richards – Chair
• Dr Graham Shortland – Consultant Paediatrician, Cardiff and Vale University Health Board, Noah’s Ark Children’s Hospital for Wales (Vice-Chair)
• Professor Natalie Armstrong – implementation scientist
• Eleanor Cozens – patient and public voice (PPV)
• Greg Fell – public health expert
• Professor Chris Hyde – Public Health Specialist, University of Exeter
• Professor Anneke Lucassen – Professor of Genomic Medicine, University of Oxford and Consultant Clinical Geneticist (present for first half of meeting)
• Dr Bethany Shinkins – test expert
• Professor Anne-Marie Slowther – Reader in Clinical Ethics, Warwick Medical School, University of Warwick
• Dr Ros Given-Wilson – Chair of the Adult Reference Group (ARG)
• Dr Sharon Hillier – Chair of the Fetal Maternal and Child Health (FMCH) Group
• Professor Sian Taylor-Phillips – Chair of the Research Methodology Group (RMG) and Data Scientist

1.2 Observers

• Prof Niall O’Higgins – Chair of the National Screening Advisory Committee, Ireland
• Evette Wade – Republic of Ireland
• Kate O’Flaherty – Republic of Ireland
• Nick Hicks – National Co-ordinating Centre for HTA
• Roberta James – Programme lead, SIGN
• Dr Sarah Byron – CHTE Programme Director, NICE
• Martin Allaby – Consultant in Public Health and Evidence-based Healthcare, NICE
• Deborah Tomalin – Director of Public Health Commissioning and Operations, NHS England
• Professor Steve Powis – National Director, NHS England
• Ciaran Osbourne – Transformation Lead, Early Diagnosis Programmes (Cancer), NHS England
• Dr Meng Khaw – Public Health Director, Public Health Wales
• Gareth Brown – Director of Screening, NHS National Services Scotland
• Dr Tracy Owen – Consultant in Public Health Public, Health Agency Northern Ireland
• Professor Zosia Miedzybrodzka – Clinical Lead of the Scottish Genomics Network

1.3 Invitees

• Dr Julia Geppert – Research Fellow at University of Warwick (attendance for tyrosinaemia)
• Peter Auguste – Research Fellow in Health Economics at University of Warwick

1.4 UK Health Department officials

• Daniel Gascoigne – Department of Health and Social Care (DHSC)
• Nimisha De Souza – DHSC
• Dr Heather Payne – Senior Medical Officer for Maternal and Child Health, Welsh Government
• Laura McGlynn – Scottish Government
• Dr Carol Beattie – Northern Ireland

1.5 Secretariat

• Prof Anne Mackie – Director of Programmes, UK NSC
• John Marshall – UK NSC Evidence Lead
• Dr Farah Seedat – UK NSC Evidence Review Manager
• Dr Cristina Visintin – UK NSC Evidence Review Manager
• Paula Coles – Senior Information Scientist
• Silvia Lombardo – UK NSC Evidence Review Manager
• Anne Stevenson – National Lead for Screening Feasibility, Evaluation and Development
• Mike Harris – Screening Inequalities Lead, OHID Screening
• Liz Rochelle – Development Manager, OHID Screening
• Dr David Elliman – Clinical lead for NHS Newborn and Infant Physical Examination Programme and NHS Newborn Blood Spot Screening Programme
• Zeenat Mauthoor – Secretariat Expert Committee and Policy Liaison Manager

1.6 Apologies from members

• None

2. Welcome and apologies

The chair, Prof Mike Richards, welcomed everyone to the first UK NSC meeting under its new expanded remit to consider population, targeted and risk stratified screening. As the meeting was held in a hybrid format a round of introductions did not take place but members were asked to introduce themselves before speaking.

The meeting was attended by all 12 members and was therefore quorate.

The committee noted apologies from 2 devolved government reps, Dr Tasmin Sommerfield (Scotland) and Dr Tracy Owen (Northern Ireland). Deputies were in attendance.

3. Call for any new declarations of interests

Prof Richards informed the committee that following his appointment as chair of the UK NSC he had stepped down from his role as chair of the clinical advisory group for GRAIL and would no longer participate in the Age X trial management group.

No new interests were raised by members.

Action 1: UK NSC secretariat to update the UK NSC’s register of interests’ table.

4. UK NSC expanded remit and adoption of CMOs recommendations

Following the 2019 review of adult screening programmes in England the Chief Medical Officer (CMO) for England convened a small task group to examine the findings of the report. The group developed a set of recommendations for the expanded remit of the UK NSC which were agreed by the 4 CMOs and presented to the UK NSC. The UK NSC reviewed the recommendations alongside documentation that describes how the UK NSC plans to implement each recommendation. It was noted that the documentation for recommendation 5 (feasibility) was still under development and further detail was required on the documentation for recommendation 6a and 6b (stakeholders and Patient and Public Voice (PPV) engagement). It was agreed that papers relating to recommendation 5, 6a and 6b would be shared with the committee.

The chair thanked the screening team and secretariat for the huge amount of effort put in to develop the documents presented. The UK NSC agreed to accept and adopt the CMOs’ recommendations for the expanded remit of the UK NSC and keep this under regular review. A summary of adoption and documentation for each recommendation would be published as part of the UK NSC’s transparency data in due course.

Action 2: UK NSC secretariat to share and present CMO recommendation 5 (feasibility) at the November UK NSC meeting.

Action 3: UK NSC secretariat to seek further comments on documentation relating to recommendations 6a and 6b from PPV member.

Action 4: UK NSC secretariat to publish a summary report of adoption of CMOs’ recommendations alongside the publication of the papers.

5. Minutes of the last meeting

The vice chair presented this item to the committee as he was present at the March meeting. The committee and those in attendance at the 7 March 2022 meeting approved the minutes as a true and accurate record of the meeting.

Seven action points were identified:

• Secretariat to set up a meeting to discuss lung cancer consultation comments ahead of the UK NSC June meeting – completed
• Secretariat to add evidence maps as the first step in the evidence review process – in hand, publication of this process to be available in due course
• Secretariat to commission 3 evidence maps following the 2021/22 annual call for topics – in hand. Secretariat to commission 3 evidence maps (metachromatic leukodystrophy (MLD), neonatal diabetes and anorectal malformations) following the 2021/22 annual call for topics – in hand. Following additional information on an additional submission (craniosynostosis), the UK NSC noted that the FMCH group agreed that all 4 annual call proposals should be progressed.
• Report on international consensus on informed choice to be shared more widely and the UK NSC to be updated accordingly – in hand. The UK NSC requested for an update to be provided at the November meeting.
• The UK NSC to engage with stakeholders following the consultation on cytomegalovirus (CMV) – in hand. The committee requested that an update on this work be provided at the November meeting.
• The statement on page 6 of the enhanced risk-based screening for colorectal cancer evidence map to be amended due to time bias – completed
• The committee agreed to archive thyroid disease in adults and this condition will only be looked at again upon receipt of further evidence of benefit of screening/treatment effectiveness via the annual call for topics – completed

Action 5: Numbering of the March minutes to be addressed.

Action 6: Update on the report for international consensus on informed choice to be presented at the November meeting.

Action 7: Stakeholder work following CMV consultation to be provided at the November meeting.

6. Matters arising – Director’s update

6.1 In-service evaluations update: Non-invasive prenatal testing (NIPT)

A verbal update was provided by Prof Anne Mackie confirming that all is progressing well with the England roll out. A formal report is to be presented at the March 2023 meeting. The UK NSC was informed that a confidential presentation was delivered at the May FMCH meeting which included an update from Wales on its roll out of NIPT.

Action 8: An interim formal report on NIPT to be added to the UK NSC March 2023 agenda

6.2 In-service evaluations update: Severe combined immunodeficiency (SCID)

A verbal update was provided to the committee. It was agreed that a formal report should be presented at the March 2023 meeting. A confidential update was shared with the FMCH group in May as outlined in the circulated and confidential paper.

Action 9: An interim formal report on SCID to be added to the UK NSC March 2023 agenda.

7. FMCH group report

FMCH Chair and UK NSC member Dr Sharon Hillier presented a summary report following the FMCH group meeting on the 12 May 2022. The UK NSC noted that:

• work to establish a newborn blood spot task group was under way and would take forward workstreams related to generating evidence for the programme. The group would be chaired by Dr David Elliman and would report to the FMCH group
• on receipt of further information on the annual call proposal for craniosynostosis, FMCH agreed that this should be commissioned as an evidence map. This meant that the UK NSC is to commission 4 evidence maps (MLD, neonatal diabetes, craniosynostosis and anorectal malformations) following the 2021 to 2022 annual call for topics
• the group had a presentation from colleagues in Wales following the publication of its paper entitled ‘Implementation of non-invasive prenatal testing within a national UK antenatal screening programme: Impact on women’s choices’.
• an evidence map on human T-cell lymphotropic virus (HTLV) had been reviewed by the group and was agreed to move to public consultation phase
• at the time of the meeting the UK NSC had 2 live FMCH consultations:
  • autism (closed on 4 July 2022)
  • iron deficiency anaemia in children (closed 3 August)

7.1 Post meeting note

Public consultation on autism closed on 4 July 2022.

UK NSC opened its 3-month public consultation on HTLV in July (to close on 6 October).

8. Screening for tyrosinaemia in newborns (evidence summary)

This item was presented by John Marshall and Prof Sian Taylor Phillips.

Detailed information is provided in the coversheet and should be read in conjunction with the interim modelling report.

Tyrosinaemia type 1, or TYR1, is a very rare genetic condition. It prevents the body from breaking down a substance called tyrosine found in food. This leads to the build-up of toxic levels of substances in the blood. If left untreated, TYR1 can lead to severe complications such as damage to the liver, kidneys and the nervous system before the age of 10 years. There is no cure for TYR1, but treatment, using a special diet and a drug called nitisinone, can help prolong life.

In 2017, the UK NSC recommended that population screening for TYR1 in newborns should not be introduced. This was because:

• the accuracy of the screening tests was unclear
• it was unclear whether earlier treatment would be beneficial

To help address the concerns from the 2017 review the UK NSC commissioned a modelling exercise to inform the future review of TYR1 that explored the uncertainties from the previous review. The research question that drove this was: ‘What is the cost effectiveness of adding TYR1 screening using tandem mass spectrometry measurements of succinylacetone (SUAC) to the current newborn blood spot programme compared with current practice (no universal TYR1 screening)?’

In summary, the main findings from the model were that:

• there are remaining uncertainties in model inputs including test accuracy estimates
• screening would increase the number of babies detected before symptoms develop – 7 were detected in the modelled scenario compared with 4 in current practice where incidental detection of TYR1 is found as a result of screening for phenylketonuria (PKU)
• there would be fewer false positive results if incidental detection from PKU screening is replaced with SUAC-based screening
• the benefit to screen-detected babies would be receiving nitisinone and dietary management early to avoid liver disease and reduce the risk of needing a liver transplant
• screening would result in an incremental gain of 24 quality adjusted life years (QALYs), approximately 8 QALYS per screen-detected baby compared with current practice
• the base case incremental cost effectiveness ratio (ICER) for TYR1 screening was £61,756, but this was uncertain. In probabilistic sensitivity analysis (a technique used to quantify the level of uncertainty), screening was found to be very likely to be cost effective at a willingness to pay threshold of £100,000.

A 3-month public consultation was hosted on the UK NSC website. Stakeholders were invited to comment on the relatively high ICER in particular. The consultation was extended due to the lack of initial responses from stakeholders and closed after 5 comments had been received. Most consultation comments supported introducing newborn screening for TYR1 at the higher ICER, stating that the model did not report on important uncaptured benefits such as avoidance of parental anxiety and patients’ experience.

Comments also indicated that NICE’s use of Health Technology Evaluation modifiers allowed flexibility in its approach when looking at QALYs. This enables NICE to justify a higher willingness to pay threshold. The model carried out various scenario analyses that indicated that TYR1 would be most likely to be cost effective if a willingness to pay threshold of £100,000 is used. The committee noted that the FMCH group was in favour of a recommendation to implement newborn screening for TYR1.

In discussion, the UK NSC agreed it should in future look at defining willingness to pay thresholds. In the absence of such guidance and pending further consideration, the committee relied on the threshold of £20,000 to £30,000 set by NICE as this was a commonly used standard.

Members expressed concern that the discussion about willingness to pay thresholds in TYR1 would set a precedent and this needed to be carefully considered. Members decided further work was needed to explore cost effectiveness thresholds and opportunity costs for screening programmes to assist with the decision-making process. They were aware of differences between the UK NSC’s approach and that taken by NICE, for example on evaluations of highly specialised technologies (HSTs).

In relation to screening for TYR1 a number of options were suggested, including revisiting the model to see if the ICER of £61,756 could be reduced to be closer to the £20,000 to £30,000 threshold. The paper of Speikerkoetter et al (2021), shared by Metabolic Support UK (MSUK) through the public consultation, highlighted 2 potential factors that might reduce the model’s ICER. Firstly, the paper suggests that the rate of adverse cognitive and neurodevelopmental events may be lower than assumed in the model. Secondly it suggests the liver transplantation rate in those presenting with TYR1 when already symptomatic might be lower than assumed in the model. This affects costs and cost effectiveness because liver transplantation was assumed to remove the need for, and cost of, lifelong nitisinone treatment. The paper had not been considered for incorporation in the model but it had been suggested that it could be as part of a future update.

The committee also suggested other options to explore. These included finding:

• a mechanism to negotiate the price of nitisinone with the manufacturers
• an approach to testing which combines TYR1 with other conditions

In the longer term, the committee agreed that a consistent approach to cost effectiveness thresholds used in screening would need to be considered. In this regard the discussion highlighted that attention would need to be given to the place of opportunity cost in the decision-making process.

While further modelling is undertaken, the committee said it would be helpful for feasibility work on the screening offer to be done to help the UK NSC and the 4 UK countries understand what is required to implement a national TYR1 screening programme.

The UK NSC agreed that screening for TYR1 looked promising. Before making a final recommendation, members asked for further work on the TYR1 cost effectiveness evaluation to be carried out urgently. This revised work will be shared with the FMCH group before the UK NSC makes its recommendation.

It was agreed that the FMCH group should consider the feasibility element of TYR1 screening with the secretariat.

Action 10: JM to speak to modellers to update the TYR1 cost effectiveness model.

Action 11: UK NSC members to send any suggested modifications to the TYR1 cost effectiveness model to ZM by 12 July. ZM to then share with modellers.

Action 12: Updated TYR1 model to be shared with FMCH and UK NSC for further consideration.

Action 13: FMCH to explore and propose feasibility considerations for TYR1 screening, with assistance from the secretariat.

Action 14: UK NSC to look into agreeing cost effectiveness thresholds and guidance as part of wider work to develop the new committee processes.

9. Adult Reference Group (ARG) report

ARG chair and UK NSC member, Dr Ros Given Wilson, presented a summary report of the developments following the ARG meeting on the 19 May 2022. The update included a discussion of the UK health departments’ response to the UK NSC’s 2019 recommendation to extend cervical screening intervals from 3 to 5 years. Scotland and Wales have both since implemented this change (March 2020 and January 2022 respectively). The group also reviewed the comments received so far on the targeted lung cancer consultation, which was on the UK NSC’s agenda.

10. Targeted lung cancer screening in people aged 55 to 74 years with a history of smoking (evidence summary and interim cost effectiveness)

Detailed information is provided in the coversheet and should be read in conjunction with the evidence summary and interim cost effectiveness model.

Lung cancer is the first condition under the UK NSC’s new remit for consideration as a targeted screening programme. Lung cancer is an important health problem that is a cause of many deaths worldwide. People who smoke tobacco are much more likely to develop lung cancer than those who do not. The decision to consider lung cancer as a targeted screening candidate was because recent studies looking at lung cancer screening in high-risk people, such as in the US National Lung Screening Trial (NLST) and the Dutch–Belgian lung-cancer screening trial, Nederlands–Leuvens Longkanker Screenings Onderzoek (NELSON) showed benefit. The introduction of a national targeted screening programme would have the potential to prevent thousands of deaths from lung cancer.

As part of the UK NSC’s work to look at lung cancer as a targeted screening programme, the UK NSC commissioned an evidence summary on this topic following the publication of the NELSON trial in 2020. The UK NSC’s evidence summary addressed 2 questions. The first question concerned the clinical effectiveness of screening programmes to detect lung cancer using low dose computed tomography (LDCT) in people with an increased risk, compared to no screening. The second question asked what the acceptability was in screening programmes for lung cancer using LDCT in individuals at an increased risk. In addition to these 2 questions, 3 additional contextual questions were posed to help provide background on the topic. They looked at the epidemiology, accuracy and cost effectiveness of a targeted lung screening programme.

The 2020 to 2021 evidence summary identified 9 randomised control trials in 3 systematic reviews which focused on smokers. Although there was some variation in the studies, all agreed that there is high quality randomised controlled trial evidence indicating screening for lung cancer in high-risk people reduces lung cancer mortality.

When considering the acceptability of a targeted lung cancer screening programme, studies indicated that, overall, lung screening was acceptable with 50% of people invited taking up the offer to participate in screening. From the studies examined, there was also clinical support stating that the introduction of a targeted programme would need to be well resourced and supported by good guidance. There was also support in the published literature for the introduction of a targeted lung cancer programme if shown to be cost effective. The committee noted, however, that it was not clear from the studies what the best strategy would be to set up a lung cancer screening programme that would save most lives and do the least harm.

To examine the cost effectiveness of a targeted screening programme the UK NSC and the National Institute for Health and Care Research (NIHR) commissioned the University of Exeter to update its 2016 HTA cost effectiveness model. The 2016 model indicated that a single LDCT screen could be cost effective at the conventional willingness to pay threshold used by NICE of £30,000 per QALY. However, there was significant uncertainty requiring further modelling work. Due to the number of assumptions that the model needed to revisit, including the redevelopment of the natural history component and taking into account additional pressures of the pandemic, a full and final report was not completed in time for the UK NSC to consult on but an interim report incorporating changes in costs and other important parameters was produced.

While updating the model, it was identified that the results from the initial model may have overestimated the number of late-stage cancers while underestimating early stage cancers in the screening arm. Consequently, the benefits of a targeted lung cancer screening programme may not have been fully captured. Given the interest in lung screening, the UK NSC consulted on both the evidence summary as well as on the interim report using the updated data estimates. The revised model had implemented some major adjustments on costings, lung cancer mortality, disutility value and diagnostic pathway parameters. These updates resulted in significant improvements to the estimated cost effectiveness. The model indicated that all LDCT strategies explored looked to be more cost effective than no screening at a willingness to pay threshold of £20,000 per QALY gained. This is consistent with other UK estimates.

The UK NSC held a 3-month public consultation that invited stakeholders to comment on the consultation documents with particular attention to several points made on the coversheet as well as on the proposed recommendation:

• to offer a national targeted lung cancer screening programme to people aged 55 to 74 years with a history of smoking
• that smoking cessation should be an integral part of the screening programme
• that work to design an implementation strategy should draw on the NHS England (NHS E) targeted lung health check (TLHC) programme

A total of 321 comments were received. Although the consultation ended after the ARG meeting, a summary of comments to date was presented at the ARG meeting in May. The ARG chair reported to the committee that, based on comments available at the time and on review of the evidence, the ARG was confident that a targeted lung cancer programme would be cost effective. Therefore, ARG supported the proposal to offer a targeted lung cancer screening programme to people aged 55 to 74 with a history of smoking, while recognising the importance of needing a comprehensive offer that includes smoking cessation. ARG recommended that implementation be started using the NHS E TLHC pathway.

The public consultation closed on 8 June and an extraordinary meeting was held on 15 June to discuss comments received before this topic was brought to the UK NSC for a recommendation. The vice chair provided a verbal summary of the points made at the extraordinary meeting that are outlined in the coversheet in appendix 2.

The UK NSC thanked those involved in developing and overseeing the various workstreams on lung cancer and expressed its gratitude to all who had taken time to participate in the consultation and share their experiences.

Responses were overwhelmingly from individuals who had been diagnosed with lung cancer or who had experience of the disease through family members or friends. Of those who had been affected by lung cancer through tobacco smoking there was support for a targeted screening programme.

Interestingly the committee noted the striking number of comments from individuals who had experience of lung cancer but not as a result of being a tobacco smoker, as well as the number of comments that were submitted by people below the proposed age bracket.

Members of the committee drew attention to numerous other comments, such as how non-smokers diagnosed with lung cancer can be inadvertently stigmatised and that this can lead to misrecognition of risk factors and symptoms and how more public and professional educational campaigns are needed to raise awareness of the condition in non-smokers.

From a clinical and operational perspective, the UK NSC acknowledged concerns expressed through the consultation that echoed the findings from the evidence summary. These were around resourcing, costs, infrastructure and implications for related services such as smoking cessation, as well as the handling of other conditions, such as incidental findings and the need to improve the diagnostic pathway. Thinking ahead, the UK NSC also touched on areas that would benefit from further scrutiny, such as harms, incidental findings and the need to consider at what point such a programme ceases to be cost effective if the prevalence of smoking continues to fall.

The chair summarised that the committee was supportive of the proposed recommendations. It was clear that it must be implemented in a way that emphasised the interface with, and availability of, smoking cessation services. The UK NSC stated that it would be beneficial if the TLHC programme could share detailed work with the UK NSC and devolved governments to help all understand resources and costings involved to assist with implementation planning. NHS E colleagues in attendance agreed that this could be arranged.

The chair noted that further work is required to optimise the programme pathway. There is a critical interaction for this programme in relation to inequalities. It should help to reduce inequalities by targeting those at risk of lung cancer but there is good reason to think that, within that group, those at highest risk might be least likely to take up the offer. There was work to do to set good delivery standards for the programmes in this area, learn from best practice in the English programme and stimulate new research.

The UK NSC recommended that a targeted screening programme for lung cancer should be introduced for people aged 55 to 74 identified as being at high risk of lung cancer. The targeted lung cancer programme should utilise the TLHC programme as a practical starting point for the implementation of the programme, with consideration of alignment with smoking cessation services within and beyond the eligible population. The UK NSC also recommended that further modelling work is needed to help:

• further refine its recommendations
• address implementation challenges
• determine the optimum protocols and pathway for the implementation of screening across the UK

It also recommended that a lung task group should be established to help oversee the details of these further recommendations and feasibility considerations and report to the ARG on developments.

Action 15: A lung task group to be established, reporting to the ARG, that will consider the details of the UK NSC’s recommendation to introduce and implement a targeted lung cancer screening programme to people aged 55 to 74 identified as being at high risk of lung cancer. It will further iterate the model to allow optimisation of the pathway and facilitate discussions across the UK NHSs to assist with understanding resourcing and assist with UK wide planning.

11. Screening for primary hypertension in children and young people

Cristina Visintin presented this item to the UK NSC.

Detailed information is provided in the coversheet and should be read in conjunction with the evidence map.

Hypertension is also known as high, raised or elevated blood pressure. Elevated blood pressure in children and young people is considered a serious health problem, particularly with the increasing levels of obesity. There are 2 classifications for hypertension in children and young people, primary and secondary. Primary, or essential, hypertension has no apparent cause but has been linked with numerous factors including obesity, low birth weight, family history, physical activity level, ethnicity and gender. Secondary hypertension is caused by an underlying condition such as kidney disease. Primary hypertension is more common in adolescents and is usually asymptomatic.

The UK NSC last reviewed the evidence to screen for this condition in 2018 and recommended that a population screening programme should not be introduced. This was because:

• it was not known how many children have hypertension in the UK and the long-term effects this would have on their health
• an accurate test was not available for screening children and young people
• it was not known how to avoid the early signs of ill health and longer-term disease in adults

In 2022, the UK NSC commissioned an evidence map as part of its regular review cycle. The UK NSC evidence map only considered screening for primary hypertension in children and young people through 4 questions from gaps since the 2018 review:

• the association between primary hypertension and the risk of adverse outcomes
• diagnostic accuracy of screening tests
• the effectiveness of pharmacological, non-pharmacological and combinations of interventions for preventing hypertension and their effectiveness in preventing long-term effects
• the effectiveness of a screening strategy at preventing hypertensive disorders in later life

The evidence map concluded that further work should not be commissioned at this time. New evidence had been published since the last review on the association between primary hypertension in children and young people and the risk of adverse outcomes. However, there was limited new evidence on the remaining 3 questions. The evidence map concluded it was unlikely that further work would lead to a change in the UK NSC’s position.

Following a 3-month public consultation, 3 comments were received that supported the conclusions of the evidence map. These were shared with the UK NSC’s FMCH group, which supported the findings of the evidence map and agreed with the consultation comments. These included the Royal College of Paediatrics and Child Health (RCPCH) highlighting the significant resource and workforce challenges that would be posed by a positive screening recommendation.

The UK NSC acknowledged that primary hypertension in children and young people is a serious health problem. However, lack of evidence on the effectiveness and benefits of a population screening programme prevented it from being able to recommend a screening programme. The committee made no further comments.

Based on the findings of the evidence map, the UK NSC recommended that:

• no further work on screening for primary hypertension in children and young people should be commissioned at the present time
• the topic should be reconsidered during its next regular review

The UK NSC upholds its recommendation that a systematic population screening for primary hypertension in children and young people should not be recommended in the UK.

12. Any other business

No items were raised.

13. Next meeting

Wednesday, 9 November 2022.