AAA standards report 2020 to 2021
Published 14 April 2022
Applies to England
© Crown copyright 2022
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This publication is available at https://www.gov.uk/government/statistics/abdominal-aortic-aneurysm-screening-standards-report-2020-to-2021/aaa-standards-report-2020-to-2021
This data report presents data against each of the 15 screening standards for screening activity related to abdominal aortic aneurysm (AAA) screening.
The data source used for this report is AAA SMaRT (screening management and referral tracking).
The NHS AAA screening programme (NAAASP) aims to reduce aneurysm-related mortality through early detection, appropriate monitoring and treatment. NAAASP invites men for ultrasound screening during the year (1 April to 31 March) in which they turn 65. Men over 65, who have not previously been screened can self-refer. The programme offers annual or quarterly surveillance for all men who on initial scan are found to have a small or medium aneurysm respectively. Men found to have a large aneurysm are referred into the care of specialised vascular services for diagnosis and treatment.
National AAA standards provide a defined set of measures that providers must meet to make sure services are safe and effective. NAAASP published a set of revised standards in April 2020.
This report is an official statistic. Official statistics are an essential public asset. They provide a window on society, the economy, and on the work and performance of government. They are fundamental to the judgements and decisions made by the public, by government, and by an enormous range of other organisations.
The report is a testament to the hard work of everyone involved in the programme. We would like to thank all those involved in collecting and collating the data, producing the report, and most of all those who deliver the NHS screening services.
During March 2020, all 38 local NHS AAA screening providers stopped inviting men temporarily due to the impact of the coronavirus (COVID-19) pandemic. In order for services to restore and recover in a consistent, safe and planned way, each were asked to provide a restoration plan which was approved by their local NHS England and Improvement (NHSEI) commissioners and agreed by their Public Health England (PHE) screening quality assurance service (SQAS) regional team. Consequently, providers restarted screening at different points in time between June and August 2020.
Restoration plans included enhanced infection prevention and social distancing measures which met national guidance and were approved by each screening provider’s host organisation. These additional requirements aimed to make sure that men taking up the offer of screening could do so as safely as possible. National guidance was for men most at risk of an AAA related death or an AAA rupture to be prioritised. Therefore, men most likely to require a surgical referral were invited first. This was quarterly surveillance men with an AAA 5.0 to 5.4 cm, followed by the rest of the quarterly surveillance cohort, those on annual surveillance, men who had been sent an appointment which had been cancelled, outstanding 2019 to 2020 cohort men and moving on to 2020 to 2021 cohort men.
The essential enhanced safety and social distancing measures necessitated longer appointment times. Some services have experienced reduced availability of staff due to redeployment, shielding and self-isolation and access to venues. This has impacted on the attainment of the standards to varying degrees among the providers.
1. AAA standards
There are national 15 standards included in this report, which are:
- AAA-S01: completeness of offer (initial screen)
- AAA-S02: completeness of offer (annual surveillance scan)
- AAA-S03: completeness of offer (quarterly surveillance scan)
- AAA-S04: coverage (initial screen)
- AAA-S05: coverage (annual surveillance scan)
- AAA-S06: coverage (quarterly surveillance scan)
- AAA-S07: coverage of the initial screen in men living in deciles 1 to 3
- AAA-S08: uptake (initial screen)
- AAA-S09: uptake (annual surveillance scan)
- AAA-S10: uptake (quarterly surveillance scan)
- AAA-S11: non-visualised screens
- AAA-S12: internal quality assurance
- AAA-S13: nurse assessments
- AAA-S14: men seen at specialist assessments within 2 weeks
- AAA-S15: men operated on within 8 weeks
Standards data are published annually. Standard AAA-S04, AAA-S05 and AAA-S06 are also key performance indicators (KPIs), which are published quarterly.
Two thresholds, the acceptable threshold and achievable threshold, are specified for each standard.
Following the PHE screening framework for setting standards, the definitions for the AAA standards were revised in April 2020. Full details of the changes for each standard can be found in the supporting information. One of the main changes was that the timeframe for the proportion of men offered screening, coverage and uptake has reduced from within the screening year plus 3 months to within the screening year plus 2 months.
1.1 Organisation table
Charts in this report display the internal code used by the AAA programme. The table below shows the name of the provider associated with each code.
| Code | Provider | Region |
|---|---|---|
| BBW | Bristol, Bath and Weston AAA Screening Cohort | South |
| BCO | Black Country AAA Screening Cohort | Midlands and East |
| BLM | Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | Midlands and East |
| CAM | Cambridgeshire AAA Screening Cohort | Midlands and East |
| CHM | Cheshire and Merseyside AAA Screening Cohort | North |
| CML | Lancashire and South Cumbria AAA Screening Cohort | North |
| COV | Coventry and Warwick AAA Screening Cohort | Midlands and East |
| CYH | Central Yorkshire AAA Screening Cohort | North |
| DBY | Derbyshire AAA Screening Cohort | Midlands and East |
| DOW | Dorset and Wiltshire AAA Screening Cohort | South |
| ESX | Essex AAA Screening Cohort | Midlands and East |
| FRV | Five Rivers AAA Screening Cohort | Midlands and East |
| GLO | Gloucester and Swindon AAA Screening Cohort | South |
| HAM | Hampshire AAA Screening Cohort | South |
| HFD | Hertfordshire AAA Screening Cohort | Midlands and East |
| HOE | Central England AAA Screening Cohort | Midlands and East |
| HRW | Hereford and Worcester AAA Screening Cohort | Midlands and East |
| KEN | Kent and Medway AAA Screening Cohort | South |
| LEI | Leicester AAA Screening Cohort | Midlands and East |
| LNC | Lincolnshire AAA Screening Cohort | Midlands and East |
| MAN | Manchester AAA Screening Cohort | North |
| NOE | North East and North Cumbria AAA Screening Cohort | North |
| NOL | North London AAA Screening Cohort | London |
| NOR | Norfolk and Waveney AAA Screening Cohort | Midlands and East |
| NOT | Nottinghamshire AAA Screening Cohort | Midlands and East |
| NRH | Northamptonshire AAA Screening Cohort | Midlands and East |
| NSS | North and South Staffordshire AAA Screening Cohort | Midlands and East |
| PEN | Peninsula AAA Screening Cohort | South |
| SDE | South Devon AAA Screening Cohort | South |
| SOM | Somerset and North Devon AAA Screening Cohort | South |
| STW | Shropshire, Telford and Wrekin AAA Screening Cohort | Midlands and East |
| SWL | South London AAA Screening Cohort | London |
| SYB | South Yorkshire and Bassetlaw AAA Screening Cohort | North |
| THV | Thames Valley AAA Screening Cohort | South |
| WSR | West Surrey AAA Screening Cohort | South |
| WSU | Sussex AAA Screening Cohort | South |
| WYO | West Yorkshire AAA Screening Cohort | North |
| YOH | North Yorkshire and Humber AAA Screening Cohort | North |
Data is presented by financial year (1 April 2020 to 31 March 2021) unless stated otherwise.
2. AAA-S01: completeness of offer (initial screen)
Figure 1: percentage of eligible cohort men offered screening within the screening year plus 2 months, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 1a: percentage of eligible cohort men offered screening within the screening year plus 2 months, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 86.5% |
| Black Country AAA Screening Cohort | 52.2% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 70.4% |
| Cambridgeshire AAA Screening Cohort | 50.9% |
| Cheshire and Merseyside AAA Screening Cohort | 44.1% |
| Lancashire and South Cumbria AAA Screening Cohort | 65.6% |
| Coventry and Warwick AAA Screening Cohort | 98.2% |
| Central Yorkshire AAA Screening Cohort | 100.0% |
| Derbyshire AAA Screening Cohort | 73.6% |
| Dorset and Wiltshire AAA Screening Cohort | 70.7% |
| Essex AAA Screening Cohort | 63.9% |
| Five Rivers AAA Screening Cohort | 93.0% |
| Gloucester and Swindon AAA Screening Cohort | 83.8% |
| Hampshire AAA Screening Cohort | 80.1% |
| Hertfordshire AAA Screening Cohort | 89.6% |
| Central England AAA Screening Cohort | 60.3% |
| Hereford and Worcester AAA Screening Cohort | 56.9% |
| Kent and Medway AAA Screening Cohort | 87.2% |
| Leicester AAA Screening Cohort | 99.3% |
| Lincolnshire AAA Screening Cohort | 78.3% |
| Manchester AAA Screening Cohort | 43.5% |
| North East and North Cumbria AAA Screening Cohort | 59.9% |
| North London AAA Screening Cohort | 75.4% |
| Norfolk and Waveney AAA Screening Cohort | 58.7% |
| Nottinghamshire AAA Screening Cohort | 99.6% |
| Northamptonshire AAA Screening Cohort | 74.6% |
| North and South Staffordshire AAA Screening Cohort | 60.8% |
| Peninsula AAA Screening Cohort | 99.0% |
| South Devon AAA Screening Cohort | 99.7% |
| Somerset and North Devon AAA Screening Cohort | 99.7% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 82.1% |
| South London AAA Screening Cohort | 48.6% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 83.2% |
| Thames Valley AAA Screening Cohort | 75.2% |
| West Surrey AAA Screening Cohort | 54.3% |
| Sussex AAA Screening Cohort | 96.2% |
| West Yorkshire AAA Screening Cohort | 55.4% |
| North Yorkshire and Humber AAA Screening Cohort | 48.0% |
The provider level data showed that:
- Central Yorkshire AAA Screening Cohort had the highest outcome
- Manchester AAA Screening Cohort had the lowest outcome
- 8 out of 38 screening providers met the acceptable threshold of greater than or equal to (≥) 95.0%
- 1 out of 38 screening providers met the achievable threshold of ≥ 99.9%
There were 298,034 men aged 65 eligible for AAA screening between 1 April 2020 and 31 March 2021; 70.7% of those eligible men were offered an initial screen within the screening year plus 2 months. The reasons for not being invited include:
- incorrect contact details
- deferring screening
- opting out of the screening programme receiving personal details for screening
- offered after 31 May 2021
- not offered
There were 30 providers this year who did not meet the acceptable threshold. This is mainly due to the pause and restoration of local screening services as described above. There were 8 providers that also had a large number of men to invite and screen from the 2019 to 2020 cohort prior to the COVID-19 pandemic. This has further impacted on their performance for the 2020 to 2021 cohort.
Figure 2: percentage of eligible cohort men offered screening according to the standard definition, by region, England, 1 April 2013 to 31 March 2021
Offer of the initial screen to men in each cohort year was stable between 2013 to 2014 and 2018 to 2019. The percentage of men invited dropped below the achievable threshold in 2019 to 2020, which was in part due to the suspension of invitations to cohort men between April and June 2020. The performance for eligible 2020 to 2021 cohort men dropped further still due to the reasons affecting restoration outlined above.
3. AAA-S02: completeness of offer (annual surveillance scan)
Figure 3: percentage of annual surveillance appointments due where there is an offered appointment within 6 weeks of the due date, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 3a: percentage of annual surveillance appointments due where there is an offered appointment within 6 weeks of the due date, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 84.6% |
| Black Country AAA Screening Cohort | 70.3% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 87.1% |
| Cambridgeshire AAA Screening Cohort | 72.7% |
| Cheshire and Merseyside AAA Screening Cohort | 98.3% |
| Lancashire and South Cumbria AAA Screening Cohort | 67.1% |
| Coventry and Warwick AAA Screening Cohort | 86.3% |
| Central Yorkshire AAA Screening Cohort | 85.2% |
| Derbyshire AAA Screening Cohort | 84.0% |
| Dorset and Wiltshire AAA Screening Cohort | 86.3% |
| Essex AAA Screening Cohort | 75.6% |
| Five Rivers AAA Screening Cohort | 72.5% |
| Gloucester and Swindon AAA Screening Cohort | 84.0% |
| Hampshire AAA Screening Cohort | 61.6% |
| Hertfordshire AAA Screening Cohort | 78.9% |
| Central England AAA Screening Cohort | 55.0% |
| Hereford and Worcester AAA Screening Cohort | 76.3% |
| Kent and Medway AAA Screening Cohort | 75.6% |
| Leicester AAA Screening Cohort | 71.2% |
| Lincolnshire AAA Screening Cohort | 70.8% |
| Manchester AAA Screening Cohort | 62.1% |
| North East and North Cumbria AAA Screening Cohort | 80.3% |
| North London AAA Screening Cohort | 71.0% |
| Norfolk and Waveney AAA Screening Cohort | 79.6% |
| Nottinghamshire AAA Screening Cohort | 76.6% |
| Northamptonshire AAA Screening Cohort | 69.7% |
| North and South Staffordshire AAA Screening Cohort | 87.7% |
| Peninsula AAA Screening Cohort | 74.5% |
| South Devon AAA Screening Cohort | 75.5% |
| Somerset and North Devon AAA Screening Cohort | 78.9% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 75.9% |
| South London AAA Screening Cohort | 46.6% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 80.8% |
| Thames Valley AAA Screening Cohort | 74.1% |
| West Surrey AAA Screening Cohort | 74.6% |
| Sussex AAA Screening Cohort | 76.7% |
| West Yorkshire AAA Screening Cohort | 78.7% |
| North Yorkshire and Humber AAA Screening Cohort | 70.5% |
The provider level data showed that:
- Cheshire and Merseyside AAA Screening Cohort had the highest outcome
- South London AAA Screening Cohort had the lowest outcome
- 1 out of 38 screening providers met the acceptable threshold of ≥ 95.0%
- 0 out of 38 screening providers also reached the achievable threshold of ≥ 99.0%
Between 1 April 2020 and 31 March 2021 there were 12,972 annual surveillance appointments due and 9,698 had an offer within 6 weeks of their due date (74.8%). As with the invitations for the initial screen, invitations for the annual surveillance screen have been impacted by the COVID-19 pandemic.
The impact was greatest in quarter 1 and quarter 2 while screening was paused and then restoring. For quarter 3 (October to December 2020), 97.8% of appointments were offered within 6 weeks of the due date. For quarter 4 (January to March 2021), 96.4% of appointments were offered within 6 weeks of the due date, suggesting progress towards pre COVID-19 achievement of the screening standard.
As outlined above, there are a number of factors that continue to impact on providers’ ability to offer appointments within the timeframe. Some GP practices also limited the number of appointments to be held in any one day (due to enhanced safety measures). Men were also being called prior to attending to confirm that they were not experiencing symptoms of COVID-19. This resulted in appointments being cancelled and changed at short notice so that providers could not invite other men to attend those appointment times. However, this provided a safe environment for those men attending.
4. AAA-S03: completeness of offer (quarterly surveillance scan)
Figure 4: percentage of quarterly surveillance appointments due where there is an offered appointment within 4 weeks of the due date, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 4a: percentage of quarterly surveillance appointments due where there is an offered appointment within 4 weeks of the due date, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 72.2% |
| Black Country AAA Screening Cohort | 70.2% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 73.9% |
| Cambridgeshire AAA Screening Cohort | 69.1% |
| Cheshire and Merseyside AAA Screening Cohort | 98.5% |
| Lancashire and South Cumbria AAA Screening Cohort | 66.0% |
| Coventry and Warwick AAA Screening Cohort | 65.9% |
| Central Yorkshire AAA Screening Cohort | 80.4% |
| Derbyshire AAA Screening Cohort | 75.4% |
| Dorset and Wiltshire AAA Screening Cohort | 82.8% |
| Essex AAA Screening Cohort | 64.5% |
| Five Rivers AAA Screening Cohort | 72.1% |
| Gloucester and Swindon AAA Screening Cohort | 77.9% |
| Hampshire AAA Screening Cohort | 70.3% |
| Hertfordshire AAA Screening Cohort | 67.5% |
| Central England AAA Screening Cohort | 62.0% |
| Hereford and Worcester AAA Screening Cohort | 69.6% |
| Kent and Medway AAA Screening Cohort | 69.8% |
| Leicester AAA Screening Cohort | 83.0% |
| Lincolnshire AAA Screening Cohort | 67.0% |
| Manchester AAA Screening Cohort | 66.9% |
| North East and North Cumbria AAA Screening Cohort | 69.1% |
| North London AAA Screening Cohort | 67.5% |
| Norfolk and Waveney AAA Screening Cohort | 86.8% |
| Nottinghamshire AAA Screening Cohort | 74.1% |
| Northamptonshire AAA Screening Cohort | 64.6% |
| North and South Staffordshire AAA Screening Cohort | 84.5% |
| Peninsula AAA Screening Cohort | 73.3% |
| South Devon AAA Screening Cohort | 70.7% |
| Somerset and North Devon AAA Screening Cohort | 75.6% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 61.7% |
| South London AAA Screening Cohort | 86.1% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 68.1% |
| Thames Valley AAA Screening Cohort | 71.0% |
| West Surrey AAA Screening Cohort | 63.8% |
| Sussex AAA Screening Cohort | 75.0% |
| West Yorkshire AAA Screening Cohort | 69.1% |
| North Yorkshire and Humber AAA Screening Cohort | 71.1% |
The provider level data showed that:
- Cheshire and Merseyside AAA Screening Cohort had the highest outcome
- Shropshire, Telford and Wrekin AAA Screening Cohort had the lowest outcome
- 1 out of 38 screening providers met the acceptable threshold of ≥ 95.0%
- 0 out of 38 screening providers also reached the achievable threshold of ≥ 99.0%
Between 1 April 2020 and 31 March 2021 there were 8,366 quarterly surveillance appointments due and 6,110 had an offer within 4 weeks of their due date (73.0%). Invitations for the quarterly surveillance screen has been impacted by the pandemic but the restoration of quarterly surveillance was prioritised as these men were at greatest risk of having an aneurysm that may require surgery.
The impact was greatest in quarter 1 while screening was paused and then restoring. For quarter 2 (July to September 2020) 74.5% of appointments were offered within 4 weeks of the due date. This rose to 85.5% in quarter 3 (October to December 2020) and 97.5% in quarter 4 (January to March 2021).
As with annual surveillance, men were also being called prior to attending to confirm that they have not been experiencing symptoms of COVID-19. This resulted in appointments being cancelled and changed at short notice so that providers could not invite other men to attend those appointment times. However, this provided a safe environment for those men attending.
5. AAA-S04: coverage (initial screen)
Figure 5: coverage – percentage of eligible cohort men conclusively tested within the screening year plus 2 months, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 5a: coverage – percentage of eligible cohort men conclusively tested within the screening year plus 2 months, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 67.6% |
| Black Country AAA Screening Cohort | 42.0% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 56.1% |
| Cambridgeshire AAA Screening Cohort | 38.8% |
| Cheshire and Merseyside AAA Screening Cohort | 31.1% |
| Lancashire and South Cumbria AAA Screening Cohort | 50.8% |
| Coventry and Warwick AAA Screening Cohort | 79.2% |
| Central Yorkshire AAA Screening Cohort | 81.2% |
| Derbyshire AAA Screening Cohort | 57.8% |
| Dorset and Wiltshire AAA Screening Cohort | 58.8% |
| Essex AAA Screening Cohort | 51.3% |
| Five Rivers AAA Screening Cohort | 77.6% |
| Gloucester and Swindon AAA Screening Cohort | 68.1% |
| Hampshire AAA Screening Cohort | 66.7% |
| Hertfordshire AAA Screening Cohort | 69.6% |
| Central England AAA Screening Cohort | 39.1% |
| Hereford and Worcester AAA Screening Cohort | 46.5% |
| Kent and Medway AAA Screening Cohort | 70.0% |
| Leicester AAA Screening Cohort | 79.3% |
| Lincolnshire AAA Screening Cohort | 62.5% |
| Manchester AAA Screening Cohort | 26.8% |
| North East and North Cumbria AAA Screening Cohort | 47.4% |
| North London AAA Screening Cohort | 49.9% |
| Norfolk and Waveney AAA Screening Cohort | 47.9% |
| Nottinghamshire AAA Screening Cohort | 83.6% |
| Northamptonshire AAA Screening Cohort | 58.9% |
| North and South Staffordshire AAA Screening Cohort | 49.6% |
| Peninsula AAA Screening Cohort | 84.6% |
| South Devon AAA Screening Cohort | 87.2% |
| Somerset and North Devon AAA Screening Cohort | 87.2% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 69.1% |
| South London AAA Screening Cohort | 30.0% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 67.0% |
| Thames Valley AAA Screening Cohort | 60.7% |
| West Surrey AAA Screening Cohort | 44.6% |
| Sussex AAA Screening Cohort | 78.2% |
| West Yorkshire AAA Screening Cohort | 43.5% |
| North Yorkshire and Humber AAA Screening Cohort | 39.0% |
The provider level data showed that:
- Somerset and North Devon AAA Screening Cohort had the highest outcome
- Manchester AAA Screening Cohort had the lowest outcome
- 9 out of 38 screening providers met the acceptable threshold of ≥ 75.0%
- 2 out of 38 screening providers also reached the achievable threshold of ≥ 85.0%
Nationally 55.0% of eligible men were conclusively tested within the screening year plus 2 months. As described above for the offer of the initial screen, performance this year has been affected by the pause in invitations and subsequent restoration of screening. Despite these challenges, the following providers had an increase in coverage between 2019 to 2020 and 2020 to 2021:
- Leicester AAA Screening Cohort
- Five Rivers AAA Screening Cohort
- Nottinghamshire AAA Screening Cohort
- Peninsula AAA Screening Cohort
- Somerset and North Devon AAA Screening Cohort
- South Devon AAA Screening Cohort
Figure 6: percentage of aneurysms detected in eligible cohort men, England, 1 April 2013 to 31 March 2021
Between 1 April 2020 and 31 March 2021, 1,542 eligible cohort men tested were found to have an aneurysm of 3.0cm or greater (0.94%, 95% confidence intervals 0.89% to 0.99%). This varied from 0.62% in North London and South London to 1.64% in Five Rivers. This is the first time in the past 8 years that there has been an increase in the percentage of aneurysms detected in eligible cohort men. However, it is not significantly higher than 2019 to 2020 (0.92%, 95% confidence intervals 0.88% to 0.96%). This has to be interpreted with caution given that completeness of offer and coverage for 2020 to 2021 was lower than previous years.
Figure 7: coverage – percentage of eligible cohort men conclusively tested according to the standard definition, by region, England, 1 April 2013 to 31 March 2021
As the percentage of men offered screening has decreased in 2019 to 2020 and 2020 to 2021, so has the coverage of the initial screen in eligible cohort men. Only those providers who met standard 1 at the acceptable or achievable threshold were able to meet standard 4 at the acceptable or achievable threshold.
6. AAA-S05: coverage (annual surveillance scan)
Figure 8: coverage – percentage of annual surveillance appointments due where there is a conclusive test within 6 weeks of the due date, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 8a: coverage – percentage of annual surveillance appointments due where there is a conclusive test within 6 weeks of the due date, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 70.0% |
| Black Country AAA Screening Cohort | 63.6% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 78.8% |
| Cambridgeshire AAA Screening Cohort | 62.0% |
| Cheshire and Merseyside AAA Screening Cohort | 78.2% |
| Lancashire and South Cumbria AAA Screening Cohort | 59.6% |
| Coventry and Warwick AAA Screening Cohort | 73.4% |
| Central Yorkshire AAA Screening Cohort | 74.7% |
| Derbyshire AAA Screening Cohort | 76.0% |
| Dorset and Wiltshire AAA Screening Cohort | 68.9% |
| Essex AAA Screening Cohort | 60.3% |
| Five Rivers AAA Screening Cohort | 67.6% |
| Gloucester and Swindon AAA Screening Cohort | 73.4% |
| Hampshire AAA Screening Cohort | 52.6% |
| Hertfordshire AAA Screening Cohort | 54.5% |
| Central England AAA Screening Cohort | 47.3% |
| Hereford and Worcester AAA Screening Cohort | 67.5% |
| Kent and Medway AAA Screening Cohort | 63.4% |
| Leicester AAA Screening Cohort | 60.4% |
| Lincolnshire AAA Screening Cohort | 63.1% |
| Manchester AAA Screening Cohort | 53.0% |
| North East and North Cumbria AAA Screening Cohort | 71.9% |
| North London AAA Screening Cohort | 57.0% |
| Norfolk and Waveney AAA Screening Cohort | 69.4% |
| Nottinghamshire AAA Screening Cohort | 70.2% |
| Northamptonshire AAA Screening Cohort | 61.8% |
| North and South Staffordshire AAA Screening Cohort | 64.7% |
| Peninsula AAA Screening Cohort | 64.9% |
| South Devon AAA Screening Cohort | 70.2% |
| Somerset and North Devon AAA Screening Cohort | 71.3% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 67.8% |
| South London AAA Screening Cohort | 39.9% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 72.8% |
| Thames Valley AAA Screening Cohort | 66.0% |
| West Surrey AAA Screening Cohort | 63.2% |
| Sussex AAA Screening Cohort | 62.4% |
| West Yorkshire AAA Screening Cohort | 73.2% |
| North Yorkshire and Humber AAA Screening Cohort | 63.6% |
The provider level data showed that:
- Bedfordshire, Luton and Milton Keynes AAA Screening Cohort had the highest outcome
- South London AAA Screening Cohort had the lowest outcome
- 0 out of 38 screening providers met the acceptable threshold of ≥ 85.0%
- 0 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%
Of the 12,972 annual surveillance appointments due between 1 April 2020 to 31 March 2021, 64.3% had a conclusive test within 6 weeks of the due date. This varied from 39.9% in South London to 78.8% in Bedfordshire, Luton and Milton Keynes. The performance for 2020 to 2021 is 26.6 percentage points lower than the performance for 2019 to 2020. As with standard 2, this will be impacted by the pause of invitations between April and June 2020 and it will have been impacted further by the provider’s ability to offer timely appointments.
Annual surveillance coverage rose from 74.5% in quarter 2 (July to September 2020) to 86.1% in quarter 3 (October to December 2020). Coverage did drop to 81.7% in quarter 4 (January to March 2021), which was due predominantly due to men cancelling or not attending appointments. Anecdotal feedback from providers suggested this was due to men wanting to wait until they had their second dose of the vaccine.
7. AAA-S06: coverage (quarterly surveillance scan)
Figure 9: coverage– percentage of quarterly surveillance appointments due where there is a conclusive test within 4 weeks of the due date, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 9a: coverage – percentage of quarterly surveillance appointments due where there is a conclusive test within 4 weeks of the due date, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 67.5% |
| Black Country AAA Screening Cohort | 67.8% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 65.8% |
| Cambridgeshire AAA Screening Cohort | 59.1% |
| Cheshire and Merseyside AAA Screening Cohort | 84.1% |
| Lancashire and South Cumbria AAA Screening Cohort | 63.5% |
| Coventry and Warwick AAA Screening Cohort | 60.0% |
| Central Yorkshire AAA Screening Cohort | 73.7% |
| Derbyshire AAA Screening Cohort | 68.6% |
| Dorset and Wiltshire AAA Screening Cohort | 66.1% |
| Essex AAA Screening Cohort | 54.2% |
| Five Rivers AAA Screening Cohort | 68.5% |
| Gloucester and Swindon AAA Screening Cohort | 74.2% |
| Hampshire AAA Screening Cohort | 61.2% |
| Hertfordshire AAA Screening Cohort | 36.3% |
| Central England AAA Screening Cohort | 56.7% |
| Hereford and Worcester AAA Screening Cohort | 63.0% |
| Kent and Medway AAA Screening Cohort | 65.7% |
| Leicester AAA Screening Cohort | 70.8% |
| Lincolnshire AAA Screening Cohort | 63.6% |
| Manchester AAA Screening Cohort | 60.1% |
| North East and North Cumbria AAA Screening Cohort | 65.0% |
| North London AAA Screening Cohort | 60.5% |
| Norfolk and Waveney AAA Screening Cohort | 76.1% |
| Nottinghamshire AAA Screening Cohort | 70.5% |
| Northamptonshire AAA Screening Cohort | 62.6% |
| North and South Staffordshire AAA Screening Cohort | 65.0% |
| Peninsula AAA Screening Cohort | 66.7% |
| South Devon AAA Screening Cohort | 68.1% |
| Somerset and North Devon AAA Screening Cohort | 71.0% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 53.2% |
| South London AAA Screening Cohort | 79.6% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 64.6% |
| Thames Valley AAA Screening Cohort | 68.1% |
| West Surrey AAA Screening Cohort | 59.1% |
| Sussex AAA Screening Cohort | 61.7% |
| West Yorkshire AAA Screening Cohort | 64.2% |
| North Yorkshire and Humber AAA Screening Cohort | 67.3% |
The provider level data showed that:
- Cheshire and Merseyside AAA Screening Cohort had the highest outcome
- Hertfordshire AAA Screening Cohort had the lowest outcome
- 0 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
- 0 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%
Of the 8,366 quarterly surveillance appointments due between 1 April 2020 to 31 March 2021, 65.8% had a conclusive test within 4 weeks of the due date. This varied from 36.3% in Hertfordshire to 84.1% in Cheshire and Merseyside. The performance for 2020 to 2021 is 26.0 percentage points lower than the performance for 2019 to 2020.
As with the annual surveillance men, there were very few men screened in quarter 1 (April to June 2020) due to the pause in screening. Due to the quarterly nature of the appointments this meant that there were no appointments subsequently due in quarter 2. However, overdue men from quarter 1 would have been invited in quarter 2, although this activity is not captured within the definitions of the standards.
Coverage for the quarterly surveillance scan was 91.6% in quarter 3 (October to December 2020). Coverage did drop to 88.8% in quarter 4 (January to March 2021), which was predominantly due to men cancelling or not attending appointments. It was also affected by the Hertfordshire provider cancelling their quarterly surveillance clinics due to concerns of the risk of men catching COVID-19 while attending for screening. The clinics were reinstated and the men invited but this occurred outside of the timeframe for the standard.
8. AAA-S07: coverage of the initial screen in men living in deciles 1 to 3
Figure 10: coverage – percentage of men in the eligible cohort who were tested and who lived in a lower super output area (LSOA) classed as decile 1 to 3 in the English indices of deprivation (IoD) 2019, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 10a: coverage – percentage of men in the eligible cohort who were tested and who lived in a lower super output area (LSOA) classed as decile 1 to 3 in the English indices of deprivation (IoD) 2019, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 59.3% |
| Black Country AAA Screening Cohort | 37.4% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 48.1% |
| Cambridgeshire AAA Screening Cohort | 27.7% |
| Cheshire and Merseyside AAA Screening Cohort | 31.2% |
| Lancashire and South Cumbria AAA Screening Cohort | 41.9% |
| Coventry and Warwick AAA Screening Cohort | 73.5% |
| Central Yorkshire AAA Screening Cohort | 75.7% |
| Derbyshire AAA Screening Cohort | 50.2% |
| Dorset and Wiltshire AAA Screening Cohort | 48.9% |
| Essex AAA Screening Cohort | 43.7% |
| Five Rivers AAA Screening Cohort | 66.2% |
| Gloucester and Swindon AAA Screening Cohort | 59.0% |
| Hampshire AAA Screening Cohort | 57.9% |
| Hertfordshire AAA Screening Cohort | 61.2% |
| Central England AAA Screening Cohort | 38.6% |
| Hereford and Worcester AAA Screening Cohort | 41.1% |
| Kent and Medway AAA Screening Cohort | 67.1% |
| Leicester AAA Screening Cohort | 68.2% |
| Lincolnshire AAA Screening Cohort | 61.1% |
| Manchester AAA Screening Cohort | 27.5% |
| North East and North Cumbria AAA Screening Cohort | 45.5% |
| North London AAA Screening Cohort | 47.4% |
| Norfolk and Waveney AAA Screening Cohort | 35.6% |
| Nottinghamshire AAA Screening Cohort | 78.4% |
| Northamptonshire AAA Screening Cohort | 50.4% |
| North and South Staffordshire AAA Screening Cohort | 38.1% |
| Peninsula AAA Screening Cohort | 79.9% |
| South Devon AAA Screening Cohort | 85.1% |
| Somerset and North Devon AAA Screening Cohort | 81.6% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 66.7% |
| South London AAA Screening Cohort | 26.3% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 63.6% |
| Thames Valley AAA Screening Cohort | 52.6% |
| West Surrey AAA Screening Cohort | 51.5% |
| Sussex AAA Screening Cohort | 68.6% |
| West Yorkshire AAA Screening Cohort | 36.5% |
| North Yorkshire and Humber AAA Screening Cohort | 34.6% |
The provider level data showed that:
- South Devon AAA Screening Cohort had the highest outcome
- South London AAA Screening Cohort had the lowest outcome
- 5 out of 38 screening providers met the acceptable threshold of ≥ 75.0%
- 1 out of 38 screening providers also reached the achievable threshold of ≥ 85.0%
This standard is being reported for the first time this year and should be reviewed alongside standards 1 and 4. The standard aims to provide services, SQAS and commissioners with information on coverage for men living in deprived areas. It has been found that men who live in deprived areas are less likely to attend for screening but are more likely to have an aneurysm. These men, are therefore, an important group to target to make sure they can make a personal informed choice regarding screening and that services are accessible to them. The availability of venues in areas of deprivation during the pandemic may have been particularly adversely affected.
Nationally for 2020 to 2021, 47.4% of men living in areas classified as IoD deciles 1 to 3 had a conclusive screen. This contrasts with 55.0% for the overall cohort. There will be a variety of reasons for this difference in coverage. However, it may have been further impacted by the pandemic. The difference may in part due to when and if providers offered men screening in different areas. In general screening is offered in community locations so men do not have to travel far for appointments. Providers will screen in different locations throughout the year. However, not all men in the 2020 to 2021 cohort were offered screening by 31 May and this may have led to an inequality in the offer which has then been reflected in the coverage.
The availability of venues in areas of deprivation during the pandemic may also have been particularly adversely affected. There may be additional reasons such as a reluctance to use public transport to attend screening appointments. Conversely many men were called prior to their appointment to check for COVID symptoms, which could have acted as a reminder, boosting attendance.
There were 9 providers who met the acceptable or achievable threshold for coverage in the overall cohort (see table below).
| Provider | Standard 4 | Standard 7 |
|---|---|---|
| Five Rivers | 77.6% | 66.2% |
| Sussex | 78.2% | 68.6% |
| Coventry and Warwick | 79.2% | 73.5% |
| Leicester | 79.3% | 68.2% |
| Central Yorkshire | 81.3% | 75.7% |
| Nottinghamshire | 83.6% | 78.4% |
| Peninsula | 84.6% | 79.9% |
| South Devon | 87.2% | 85.1% |
| Somerset and North Devon | 87.2% | 81.6% |
Of these 9, 5 also met standard 7 at the acceptable or achievable threshold. There were 7 providers whose achievement for standard 7 was not significantly different to their performance for standard 4 (see table below).
| Provider | Standard 4 | Standard 7 |
|---|---|---|
| Central England | 39.1% | 38.6% |
| Cheshire and Merseyside | 31.1% | 31.2% |
| Lincolnshire | 62.5% | 61.1% |
| Manchester | 26.8% | 27.5% |
| Shropshire, Telford and Wrekin | 69.1% | 66.7% |
| South Devon | 87.2% | 85.1% |
| West Surrey | 44.6% | 51.5% |
9. AAA-S08: uptake (initial screen)
Figure 11: uptake – percentage of eligible men offered screening who are conclusively tested within the screening year plus 2 months, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 11a: uptake – percentage of eligible men offered screening who are conclusively tested within the screening year plus 2 months, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 78.1% |
| Black Country AAA Screening Cohort | 80.5% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 79.7% |
| Cambridgeshire AAA Screening Cohort | 76.2% |
| Cheshire and Merseyside AAA Screening Cohort | 70.5% |
| Lancashire and South Cumbria AAA Screening Cohort | 77.4% |
| Coventry and Warwick AAA Screening Cohort | 80.6% |
| Central Yorkshire AAA Screening Cohort | 81.3% |
| Derbyshire AAA Screening Cohort | 78.5% |
| Dorset and Wiltshire AAA Screening Cohort | 83.2% |
| Essex AAA Screening Cohort | 80.4% |
| Five Rivers AAA Screening Cohort | 83.4% |
| Gloucester and Swindon AAA Screening Cohort | 81.3% |
| Hampshire AAA Screening Cohort | 83.2% |
| Hertfordshire AAA Screening Cohort | 77.7% |
| Central England AAA Screening Cohort | 64.9% |
| Hereford and Worcester AAA Screening Cohort | 81.7% |
| Kent and Medway AAA Screening Cohort | 80.3% |
| Leicester AAA Screening Cohort | 79.9% |
| Lincolnshire AAA Screening Cohort | 79.8% |
| Manchester AAA Screening Cohort | 61.7% |
| North East and North Cumbria AAA Screening Cohort | 79.0% |
| North London AAA Screening Cohort | 66.2% |
| Norfolk and Waveney AAA Screening Cohort | 81.5% |
| Nottinghamshire AAA Screening Cohort | 83.9% |
| Northamptonshire AAA Screening Cohort | 78.9% |
| North and South Staffordshire AAA Screening Cohort | 81.5% |
| Peninsula AAA Screening Cohort | 85.5% |
| South Devon AAA Screening Cohort | 87.4% |
| Somerset and North Devon AAA Screening Cohort | 87.4% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 84.2% |
| South London AAA Screening Cohort | 61.7% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 80.5% |
| Thames Valley AAA Screening Cohort | 80.7% |
| West Surrey AAA Screening Cohort | 82.1% |
| Sussex AAA Screening Cohort | 81.3% |
| West Yorkshire AAA Screening Cohort | 78.4% |
| North Yorkshire and Humber AAA Screening Cohort | 81.2% |
The provider level data showed that:
- Somerset and North Devon AAA Screening Cohort had the highest outcome
- Manchester AAA Screening Cohort had the lowest outcome
- 33 out of 38 screening providers met the acceptable threshold of ≥ 75.0%
- 3 out of 38 screening providers also reached the achievable threshold of ≥ 85.0%
The following services did not meet the acceptable threshold:
- Cheshire and Merseyside AAA Screening Cohort
- Central England AAA Screening Cohort
- Manchester AAA Screening Cohort
- North London AAA Screening Cohort
- South London AAA Screening Cohort
Figure 12: uptake – percentage of men offered screening who are conclusively tested within the initial screening year plus 2 months, by region, England, 1 April 2013 to 31 March 2021
Nationally, uptake was 77.8% for the screening year plus 2 months. Uptake is similar to 2019 to 2020 (77.0%). This year uptake may have been affected by men’s willingness to attend appointments during the pandemic. Uptake across the London region has been particularly affected over the past 4 years as a result of re-commissioning of services and the subsequent impact of the pandemic. At a provider level, 11 have had a decrease in uptake by more than 1% from 2019 to 2020 to 2020 to 2021. Encouragingly, 18 providers have had an increase in uptake of more than 1%. The largest was in the Five Rivers provider, increasing by 10.6% to 83.4% in 2020 to 2021.
10. AAA-S09: uptake (annual surveillance scan)
Figure 13: uptake – percentage of annual surveillance appointments offered where there is a conclusive test within 6 weeks of the due date, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 13a: uptake – percentage of annual surveillance appointments offered where there is a conclusive test within 6 weeks of the due date, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 82.7% |
| Black Country AAA Screening Cohort | 90.5% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 90.4% |
| Cambridgeshire AAA Screening Cohort | 85.2% |
| Cheshire and Merseyside AAA Screening Cohort | 79.5% |
| Lancashire and South Cumbria AAA Screening Cohort | 88.8% |
| Coventry and Warwick AAA Screening Cohort | 85.0% |
| Central Yorkshire AAA Screening Cohort | 87.7% |
| Derbyshire AAA Screening Cohort | 90.5% |
| Dorset and Wiltshire AAA Screening Cohort | 79.8% |
| Essex AAA Screening Cohort | 79.8% |
| Five Rivers AAA Screening Cohort | 93.2% |
| Gloucester and Swindon AAA Screening Cohort | 87.4% |
| Hampshire AAA Screening Cohort | 85.4% |
| Hertfordshire AAA Screening Cohort | 69.1% |
| Central England AAA Screening Cohort | 86.0% |
| Hereford and Worcester AAA Screening Cohort | 88.5% |
| Kent and Medway AAA Screening Cohort | 83.9% |
| Leicester AAA Screening Cohort | 84.8% |
| Lincolnshire AAA Screening Cohort | 89.1% |
| Manchester AAA Screening Cohort | 85.4% |
| North East and North Cumbria AAA Screening Cohort | 89.6% |
| North London AAA Screening Cohort | 80.3% |
| Norfolk and Waveney AAA Screening Cohort | 87.2% |
| Nottinghamshire AAA Screening Cohort | 91.6% |
| Northamptonshire AAA Screening Cohort | 88.7% |
| North and South Staffordshire AAA Screening Cohort | 73.8% |
| Peninsula AAA Screening Cohort | 87.2% |
| South Devon AAA Screening Cohort | 93.0% |
| Somerset and North Devon AAA Screening Cohort | 90.3% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 89.4% |
| South London AAA Screening Cohort | 85.7% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 90.1% |
| Thames Valley AAA Screening Cohort | 89.1% |
| West Surrey AAA Screening Cohort | 84.7% |
| Sussex AAA Screening Cohort | 81.3% |
| West Yorkshire AAA Screening Cohort | 93.1% |
| North Yorkshire and Humber AAA Screening Cohort | 90.2% |
The provider level data showed that:
- Five Rivers AAA Screening Cohort had the highest outcome
- Hertfordshire AAA Screening Cohort had the lowest outcome
- 10 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
- 0 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%
Of the 9,698 annual surveillance appointments that were offered within 6 weeks of the due date, 86.0% had a conclusive test within the 6 weeks. Uptake of the annual surveillance appointment was introduced as a standard from April 2015. As with standards 1b and 2b, they were developed and piloted during the year, with 1 April 2016 to 31 March 2017 being the first year the data was reported on.
Uptake of the annual surveillance screen has decreased this year compared to 2019 to 2020 (92.2%). This decrease is partially due to the pause in screening between April and June 2020 but is also due to an increase in men choosing to delay or defer their appointment. There have also been incidences of clinics having to be cancelled and rescheduled due to staffing and venue availability.
Encouragingly, 6 providers had an increase in annual surveillance uptake between 2019 to 2020 and 2020 to 2021. Of these, the largest was for the Nottinghamshire provider (4.8% increase to 91.6% in 2020 to 2021).
11. AAA-S10: uptake (quarterly surveillance scan)
Figure 14: uptake – percentage of quarterly surveillance appointments offered where there is a conclusive test within 4 weeks of the due date, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 14a: uptake – percentage of quarterly surveillance appointments offered where there is a conclusive test within 4 weeks of the due date, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 93.6% |
| Black Country AAA Screening Cohort | 96.5% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 89.0% |
| Cambridgeshire AAA Screening Cohort | 85.4% |
| Cheshire and Merseyside AAA Screening Cohort | 85.4% |
| Lancashire and South Cumbria AAA Screening Cohort | 96.2% |
| Coventry and Warwick AAA Screening Cohort | 91.1% |
| Central Yorkshire AAA Screening Cohort | 91.7% |
| Derbyshire AAA Screening Cohort | 91.0% |
| Dorset and Wiltshire AAA Screening Cohort | 79.8% |
| Essex AAA Screening Cohort | 84.1% |
| Five Rivers AAA Screening Cohort | 95.1% |
| Gloucester and Swindon AAA Screening Cohort | 95.3% |
| Hampshire AAA Screening Cohort | 87.0% |
| Hertfordshire AAA Screening Cohort | 53.8% |
| Central England AAA Screening Cohort | 91.4% |
| Hereford and Worcester AAA Screening Cohort | 90.6% |
| Kent and Medway AAA Screening Cohort | 94.2% |
| Leicester AAA Screening Cohort | 85.2% |
| Lincolnshire AAA Screening Cohort | 94.9% |
| Manchester AAA Screening Cohort | 89.9% |
| North East and North Cumbria AAA Screening Cohort | 94.0% |
| North London AAA Screening Cohort | 89.6% |
| Norfolk and Waveney AAA Screening Cohort | 87.7% |
| Nottinghamshire AAA Screening Cohort | 95.1% |
| Northamptonshire AAA Screening Cohort | 96.8% |
| North and South Staffordshire AAA Screening Cohort | 76.9% |
| Peninsula AAA Screening Cohort | 90.9% |
| South Devon AAA Screening Cohort | 96.2% |
| Somerset and North Devon AAA Screening Cohort | 93.8% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 86.2% |
| South London AAA Screening Cohort | 92.5% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 94.9% |
| Thames Valley AAA Screening Cohort | 96.0% |
| West Surrey AAA Screening Cohort | 92.6% |
| Sussex AAA Screening Cohort | 82.2% |
| West Yorkshire AAA Screening Cohort | 92.9% |
| North Yorkshire and Humber AAA Screening Cohort | 94.7% |
The provider level data showed that:
- Northamptonshire AAA Screening Cohort had the highest outcome
- Hertfordshire AAA Screening Cohort had the lowest outcome
- 24 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
- 8 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%
The following services did not meet the acceptable threshold:
- Bedfordshire, Luton and Milton Keynes AAA Screening Cohort
- Cambridgeshire AAA Screening Cohort
- Cheshire and Merseyside AAA Screening Cohort
- Dorset and Wiltshire AAA Screening Cohort
- Essex AAA Screening Cohort
- Hampshire AAA Screening Cohort
- Hertfordshire AAA Screening Cohort
- Leicester AAA Screening Cohort
- Manchester AAA Screening Cohort
- North London AAA Screening Cohort
- Norfolk and Waveney AAA Screening Cohort
- North and South Staffordshire AAA Screening Cohort
- Shropshire, Telford and Wrekin AAA Screening Cohort
- Sussex AAA Screening Cohort
Nationally, 90.0% of quarterly surveillance appointments offered within 4 weeks of the due date had a conclusive test result within 4 weeks. Uptake of the quarterly surveillance appointments nationally has been decreasing since 2018 to 2019. However, it has increased in the London region by 3.8% to 91.4% in 2020 to 2021. There were 16 providers with an increase in uptake of more than 1% between 2019 to 2020 and 2020 to 2021. The largest increase was a 6.6% increase in Nottinghamshire to 95.1%.
12. AAA-S11: non-visualised screens
Figure 15: test – percentage of screening encounters where aorta could not be visualised, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 15a: test – percentage of screening encounters where aorta could not be visualised, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 1.4% |
| Black Country AAA Screening Cohort | 0.4% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 1.0% |
| Cambridgeshire AAA Screening Cohort | 1.3% |
| Cheshire and Merseyside AAA Screening Cohort | 1.5% |
| Lancashire and South Cumbria AAA Screening Cohort | 1.3% |
| Coventry and Warwick AAA Screening Cohort | 1.8% |
| Central Yorkshire AAA Screening Cohort | 0.3% |
| Derbyshire AAA Screening Cohort | 0.8% |
| Dorset and Wiltshire AAA Screening Cohort | 1.3% |
| Essex AAA Screening Cohort | 2.5% |
| Five Rivers AAA Screening Cohort | 3.6% |
| Gloucester and Swindon AAA Screening Cohort | 1.0% |
| Hampshire AAA Screening Cohort | 0.5% |
| Hertfordshire AAA Screening Cohort | 0.8% |
| Central England AAA Screening Cohort | 2.2% |
| Hereford and Worcester AAA Screening Cohort | 2.0% |
| Kent and Medway AAA Screening Cohort | 0.3% |
| Leicester AAA Screening Cohort | 0.7% |
| Lincolnshire AAA Screening Cohort | 0.9% |
| Manchester AAA Screening Cohort | 4.9% |
| North East and North Cumbria AAA Screening Cohort | 0.1% |
| North London AAA Screening Cohort | 1.0% |
| Norfolk and Waveney AAA Screening Cohort | 0.5% |
| Nottinghamshire AAA Screening Cohort | 1.9% |
| Northamptonshire AAA Screening Cohort | 0.8% |
| North and South Staffordshire AAA Screening Cohort | 0.2% |
| Peninsula AAA Screening Cohort | 1.1% |
| South Devon AAA Screening Cohort | 1.4% |
| Somerset and North Devon AAA Screening Cohort | 0.5% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 1.2% |
| South London AAA Screening Cohort | 2.0% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 0.4% |
| Thames Valley AAA Screening Cohort | 0.6% |
| West Surrey AAA Screening Cohort | 1.8% |
| Sussex AAA Screening Cohort | 1.6% |
| West Yorkshire AAA Screening Cohort | 0.9% |
| North Yorkshire and Humber AAA Screening Cohort | 0.4% |
The provider level data showed that:
- Manchester AAA Screening Cohort had the highest outcome
- North East and North Cumbria AAA Screening Cohort had the lowest outcome
- 36 out of 38 screening providers met the acceptable threshold of ≤ 3.0%
- 19 out of 38 screening providers also reached the achievable threshold of ≤ 1.0%
The following services did not meet the acceptable threshold:
- Five Rivers AAA Screening Cohort
- Manchester AAA Screening Cohort
Screening providers should aim to minimise the percentage of screens that cannot be visualised. Therefore, the lower the value the better for this standard. Nationally 1.13% of cohort screens were non-visualised, which is similar to last year (1.14% for 2019 to 2020). This is the lowest level of non-visualised screens nationally since the full roll out of the programme in 2013 to 2014.
Figure 16: test – percentage of screening encounters where aorta could not be visualised, by region, England, 1 April 2013 to 31 March 2021
Over the past 5 years, the percentage of non-visualised screens has been decreasing across England; however, there has been significant variation between the providers. There were 17 providers whose percentage of non-visualised scans decreased between 2019 to 2020 and 2020 to 2021. The largest decrease was in Shropshire, Telford and Wrekin, 2.35% in 2019 to 2020 decreasing to 1.20% in 2020 to 2021. The largest increases were in Manchester (2.99% in 2019 to 2020 to 4.86% in 2020 to 2021) and Five Rivers (1.39% in 2019 to 2020 to 3.57% in 2020 to 2021). Both providers have audited their non-visualised scans to determine the causes of the increase.
13. AAA-S12: internal quality assurance
Figure 17: test – percentage of abnormal screens (aorta ≥3.0 to <5.5cm) reviewed ≤21 calendar days of the initial screen date, by provider, England, 1 April 2020 to 31 March 2021
Figure 17a: test – percentage of abnormal screens (aorta ≥3.0 to <5.5cm) reviewed ≤21 calendar days of the initial screen date, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 69.6% |
| Black Country AAA Screening Cohort | 100.0% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 100.0% |
| Cambridgeshire AAA Screening Cohort | 76.9% |
| Cheshire and Merseyside AAA Screening Cohort | 100.0% |
| Lancashire and South Cumbria AAA Screening Cohort | 100.0% |
| Coventry and Warwick AAA Screening Cohort | 82.6% |
| Central Yorkshire AAA Screening Cohort | 68.1% |
| Derbyshire AAA Screening Cohort | 97.3% |
| Dorset and Wiltshire AAA Screening Cohort | 100.0% |
| Essex AAA Screening Cohort | 78.1% |
| Five Rivers AAA Screening Cohort | 80.4% |
| Gloucester and Swindon AAA Screening Cohort | 61.3% |
| Hampshire AAA Screening Cohort | 81.8% |
| Hertfordshire AAA Screening Cohort | 95.0% |
| Central England AAA Screening Cohort | 61.8% |
| Hereford and Worcester AAA Screening Cohort | 100.0% |
| Kent and Medway AAA Screening Cohort | 95.7% |
| Leicester AAA Screening Cohort | 100.0% |
| Lincolnshire AAA Screening Cohort | 93.9% |
| Manchester AAA Screening Cohort | 44.8% |
| North East and North Cumbria AAA Screening Cohort | 44.1% |
| North London AAA Screening Cohort | 90.0% |
| Norfolk and Waveney AAA Screening Cohort | 100.0% |
| Nottinghamshire AAA Screening Cohort | 92.5% |
| Northamptonshire AAA Screening Cohort | 78.9% |
| North and South Staffordshire AAA Screening Cohort | 70.4% |
| Peninsula AAA Screening Cohort | 87.5% |
| South Devon AAA Screening Cohort | 100.0% |
| Somerset and North Devon AAA Screening Cohort | 94.6% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 81.0% |
| South London AAA Screening Cohort | 70.0% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 100.0% |
| Thames Valley AAA Screening Cohort | 100.0% |
| West Surrey AAA Screening Cohort | 71.4% |
| Sussex AAA Screening Cohort | 94.6% |
| West Yorkshire AAA Screening Cohort | 42.1% |
| North Yorkshire and Humber AAA Screening Cohort | 100.0% |
The provider level data showed that:
-
12 services had the highest outcome:
- Black Country AAA Screening Cohort
- Bedfordshire, Luton and Milton Keynes AAA Screening Cohort
- Cheshire and Merseyside AAA Screening Cohort
- Lancashire and South Cumbria AAA Screening Cohort
- Dorset and Wiltshire AAA Screening Cohort
- Hereford and Worcester AAA Screening Cohort
- Leicester AAA Screening Cohort
- Norfolk and Waveney AAA Screening Cohort
- South Devon AAA Screening Cohort
- South Yorkshire and Bassetlaw AAA Screening Cohort
- Thames Valley AAA Screening Cohort
- North Yorkshire and Humber AAA Screening Cohort
- West Yorkshire AAA Screening Cohort had the lowest outcome
- 35 out of 38 screening providers met the acceptable threshold of ≥ 60.0%
- 15 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%
The following services did not meet the acceptable threshold:
- Manchester AAA Screening Cohort
- North East and North Cumbria AAA Screening Cohort
- West Yorkshire AAA Screening Cohort
This is the first year that NAAASP has measured the time taken for images of aorta with a suspected small or medium aneurysm (aorta measurement ≥3.0 to <5.5cm) to be reviewed by a clinical skills trainer or quality assurance lead. The images are reviewed to confirm whether the man should move into the surveillance pathway and be referred for nurse assessment if he has a small or medium sized aneurysm or be reassured if no aneurysm is found (aorta <3.0cm).
Nationally 85.0% of the 1,338 men with a small or medium size aneurysm had their images reviewed within 21 days of the scan taking place. There was large variation in performance across the country, ranging from 42.1% in West Yorkshire to 12 providers where all of the images were reviewed within 21 days.
14. AAA-S13: nurse assessments
Figure 18: test – percentage of men who had a small or medium aneurysm detected (aorta ≥3.0cm to <5.5cm) at initial screen and the number of men who had a medium aneurysm detected (≥4.5cm to <5.5cm) at the annual surveillance scan who had a nurse assessment ≤12 weeks of their conclusive scan, by provider, England, 1 April 2020 to 31 March 2021
Figure 18a: test – percentage of men who had a small or medium aneurysm detected (aorta ≥3.0cm to <5.5cm) at initial screen and the number of men who had a medium aneurysm detected (≥4.5cm to <5.5cm) at the annual surveillance scan who had a nurse assessment ≤12 weeks of their conclusive scan, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 53.2% |
| Black Country AAA Screening Cohort | 72.5% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 62.5% |
| Cambridgeshire AAA Screening Cohort | 61.1% |
| Cheshire and Merseyside AAA Screening Cohort | 63.1% |
| Lancashire and South Cumbria AAA Screening Cohort | 88.4% |
| Coventry and Warwick AAA Screening Cohort | 90.2% |
| Central Yorkshire AAA Screening Cohort | 47.4% |
| Derbyshire AAA Screening Cohort | 94.3% |
| Dorset and Wiltshire AAA Screening Cohort | 89.9% |
| Essex AAA Screening Cohort | 89.7% |
| Five Rivers AAA Screening Cohort | 80.3% |
| Gloucester and Swindon AAA Screening Cohort | 55.1% |
| Hampshire AAA Screening Cohort | 30.7% |
| Hertfordshire AAA Screening Cohort | 57.4% |
| Central England AAA Screening Cohort | 47.8% |
| Hereford and Worcester AAA Screening Cohort | 88.1% |
| Kent and Medway AAA Screening Cohort | 83.6% |
| Leicester AAA Screening Cohort | 90.5% |
| Lincolnshire AAA Screening Cohort | 78.3% |
| Manchester AAA Screening Cohort | 37.8% |
| North East and North Cumbria AAA Screening Cohort | 94.8% |
| North London AAA Screening Cohort | 64.6% |
| Norfolk and Waveney AAA Screening Cohort | 81.4% |
| Nottinghamshire AAA Screening Cohort | 70.4% |
| Northamptonshire AAA Screening Cohort | 30.3% |
| North and South Staffordshire AAA Screening Cohort | 71.4% |
| Peninsula AAA Screening Cohort | 75.7% |
| South Devon AAA Screening Cohort | 84.2% |
| Somerset and North Devon AAA Screening Cohort | 46.2% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 41.2% |
| South London AAA Screening Cohort | 24.6% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 70.0% |
| Thames Valley AAA Screening Cohort | 62.2% |
| West Surrey AAA Screening Cohort | 43.8% |
| Sussex AAA Screening Cohort | 81.7% |
| West Yorkshire AAA Screening Cohort | 57.6% |
| North Yorkshire and Humber AAA Screening Cohort | 82.0% |
The provider level data showed that:
- North East and North Cumbria AAA Screening Cohort had the highest outcome
- South London AAA Screening Cohort had the lowest outcome
- 29 out of 38 screening providers met the acceptable threshold of ≥ 50.0%
- 14 out of 38 screening providers also reached the achievable threshold of ≥ 80.0%
The following services did not meet the acceptable threshold:
- Central Yorkshire AAA Screening Cohort
- Hampshire AAA Screening Cohort
- Central England AAA Screening Cohort
- Manchester AAA Screening Cohort
- Northamptonshire AAA Screening Cohort
- Somerset and North Devon AAA Screening Cohort
- Shropshire, Telford and Wrekin AAA Screening Cohort
- South London AAA Screening Cohort
- West Surrey AAA Screening Cohort
This is the first year that NAAASP has measured the percentage of men attending a nurse assessment following either the detection of a small or medium aneurysm (aorta ≥3.0 to <5.5cm) at initial screen or moving from a small to medium size aneurysm (aorta ≥4.5 to <5.5cm) on surveillance. Men with aneurysms require close monitoring, support and secondary prevention to help reduce their overall vascular risk and improve outcomes. The nurse assessment appointment should occur shortly after finding the small or medium aneurysm to reduce anxiety. Nurse specialists assess men for vascular risk factors and give advice about health and lifestyle to reduce their risk. It also provides the man with an opportunity to ask questions about the condition.
Nationally 68.2% of the 2,220 men eligible for a nurse assessment attended an appointment. Overall, coverage of the nurse assessment was highest in the Midlands and East region and lowest in London. At a provider level it ranged from 24.6% in South London to 94.8% in North East and North Cumbria. In South London the pause in screening created a backlog of men requiring a nurse assessment. While appointments are being offered, the majority are currently not within the 12 week timescale. The provider is taking steps to address this. The North East and North Cumbria provider follows a different model to the other screening providers and offers telephone nurse assessments routinely due to the large geographical area of the service. Their screening technicians have been trained to obtain blood pressure, height and weight measurements so these do not need to be measured by the nurse directly.
15. AAA-S14: men seen at specialist assessments within 2 weeks
Figure 19: referral – percentage of men with aorta ≥5.5cm seen by vascular specialist within 2 weeks, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 19a: referral – percentage of men with aorta ≥5.5cm seen by vascular specialist within 2 weeks, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 100.0% |
| Black Country AAA Screening Cohort | 100.0% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 88.9% |
| Cambridgeshire AAA Screening Cohort | 100.0% |
| Cheshire and Merseyside AAA Screening Cohort | 100.0% |
| Lancashire and South Cumbria AAA Screening Cohort | 100.0% |
| Coventry and Warwick AAA Screening Cohort | 100.0% |
| Central Yorkshire AAA Screening Cohort | 100.0% |
| Derbyshire AAA Screening Cohort | 96.3% |
| Dorset and Wiltshire AAA Screening Cohort | 93.8% |
| Essex AAA Screening Cohort | 82.4% |
| Five Rivers AAA Screening Cohort | 91.7% |
| Gloucester and Swindon AAA Screening Cohort | 100.0% |
| Hampshire AAA Screening Cohort | 100.0% |
| Hertfordshire AAA Screening Cohort | 71.4% |
| Central England AAA Screening Cohort | 60.0% |
| Hereford and Worcester AAA Screening Cohort | 93.3% |
| Kent and Medway AAA Screening Cohort | 96.4% |
| Leicester AAA Screening Cohort | 66.7% |
| Lincolnshire AAA Screening Cohort | 100.0% |
| Manchester AAA Screening Cohort | 85.7% |
| North East and North Cumbria AAA Screening Cohort | 95.0% |
| North London AAA Screening Cohort | 100.0% |
| Norfolk and Waveney AAA Screening Cohort | 75.0% |
| Nottinghamshire AAA Screening Cohort | 91.7% |
| Northamptonshire AAA Screening Cohort | 80.0% |
| North and South Staffordshire AAA Screening Cohort | 86.7% |
| Peninsula AAA Screening Cohort | 100.0% |
| South Devon AAA Screening Cohort | 82.8% |
| Somerset and North Devon AAA Screening Cohort | 96.2% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 100.0% |
| South London AAA Screening Cohort | 97.1% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 100.0% |
| Thames Valley AAA Screening Cohort | 95.7% |
| West Surrey AAA Screening Cohort | 95.7% |
| Sussex AAA Screening Cohort | 97.2% |
| West Yorkshire AAA Screening Cohort | 46.7% |
| North Yorkshire and Humber AAA Screening Cohort | 92.6% |
The provider level data showed that:
-
14 services had the highest outcome:
- Bristol, Bath and Weston AAA Screening Cohort
- Black Country AAA Screening Cohort
- Cambridgeshire AAA Screening Cohort
- Cheshire and Merseyside AAA Screening Cohort
- Lancashire and South Cumbria AAA Screening Cohort
- Coventry and Warwick AAA Screening Cohort
- Central Yorkshire AAA Screening Cohort
- Gloucester and Swindon AAA Screening Cohort
- Hampshire AAA Screening Cohort
- Lincolnshire AAA Screening Cohort
- North London AAA Screening Cohort
- Peninsula AAA Screening Cohort
- Shropshire, Telford and Wrekin AAA Screening Cohort
- South Yorkshire and Bassetlaw AAA Screening Cohort
- West Yorkshire AAA Screening Cohort had the lowest outcome
- 27 out of 38 screening providers met the acceptable threshold of ≥ 90.0%
- 22 out of 38 screening providers also reached the achievable threshold of ≥ 95.0%
The following services did not meet the acceptable threshold:
- Bedfordshire, Luton and Milton Keynes AAA Screening Cohort
- Essex AAA Screening Cohort
- Hertfordshire AAA Screening Cohort
- Central England AAA Screening Cohort
- Leicester AAA Screening Cohort
- Manchester AAA Screening Cohort
- Norfolk and Waveney AAA Screening Cohort
- Northamptonshire AAA Screening Cohort
- North and South Staffordshire AAA Screening Cohort
- South Devon AAA Screening Cohort
- West Yorkshire AAA Screening Cohort
Of the 832 men appropriately referred for surgery, 757 (91.0%) were seen for their first specialist assessment within 2 weeks of their last conclusive scan. For the men who were not seen in 2 weeks, just over half (57.3%) were due to hospital factors while 25.3% were due to patient choice. Hospital factors includes delays due to COVID-19, delays in testing, clinic capacity and consultant availability amongst other reasons. The remainder were due to comorbidities that prevented attendance.
Figure 20: referral – percentage of men with aorta ≥5.5cm seen by vascular specialist within 2 weeks, by region, England, 1 April 2013 to 31 March 2021
Nationally the percentage of men seen for a specialist assessment within 2 weeks (14 days) of their last conclusive scan was similar to the previous screening year (91.4%). There was a large increase in the performance of the standard in the London region, increasing from 74.6% in 2019 to 2020 to 98.1% in 2020 to 2021. However, there was a decrease in the Midlands and East region from 90.8% in 2019 to 2020 to 84.5% in 2020 to 2021. The North Yorkshire and Humber, Nottinghamshire and Thames Valley providers increased their performance to meet the acceptable threshold. The Black Country, Derbyshire, Gloucester and Swindon, Hampshire, North London, Peninsula and South London providers increased their performance to meet the achievable threshold.
16. AAA-S15: men operated on within 8 weeks
Figure 21: referral – percentage of men with aorta ≥5.5cm deemed fit for intervention and not declining, operated on by a vascular specialist within 8 weeks, by screening provider, England, 1 April 2020 to 31 March 2021
Figure 21a: referral – percentage of men with aorta ≥5.5cm deemed fit for intervention and not declining, operated on by a vascular specialist within 8 weeks, in alphabetical order of provider name
| Provider | Performance |
|---|---|
| Bristol, Bath and Weston AAA Screening Cohort | 15.4% |
| Black Country AAA Screening Cohort | 62.5% |
| Bedfordshire, Luton and Milton Keynes AAA Screening Cohort | 11.1% |
| Cambridgeshire AAA Screening Cohort | 11.1% |
| Cheshire and Merseyside AAA Screening Cohort | 19.0% |
| Lancashire and South Cumbria AAA Screening Cohort | 61.9% |
| Coventry and Warwick AAA Screening Cohort | 9.1% |
| Central Yorkshire AAA Screening Cohort | 20.0% |
| Derbyshire AAA Screening Cohort | 17.4% |
| Dorset and Wiltshire AAA Screening Cohort | 8.3% |
| Essex AAA Screening Cohort | 7.1% |
| Five Rivers AAA Screening Cohort | 13.6% |
| Gloucester and Swindon AAA Screening Cohort | 40.0% |
| Hampshire AAA Screening Cohort | 27.3% |
| Hertfordshire AAA Screening Cohort | 40.0% |
| Central England AAA Screening Cohort | 3.1% |
| Hereford and Worcester AAA Screening Cohort | 46.7% |
| Kent and Medway AAA Screening Cohort | 4.5% |
| Leicester AAA Screening Cohort | 20.0% |
| Lincolnshire AAA Screening Cohort | 9.1% |
| Manchester AAA Screening Cohort | 31.2% |
| North East and North Cumbria AAA Screening Cohort | 23.1% |
| North London AAA Screening Cohort | 17.6% |
| Norfolk and Waveney AAA Screening Cohort | 52.2% |
| Nottinghamshire AAA Screening Cohort | 30.0% |
| Northamptonshire AAA Screening Cohort | 5.6% |
| North and South Staffordshire AAA Screening Cohort | 15.4% |
| Peninsula AAA Screening Cohort | 50.0% |
| South Devon AAA Screening Cohort | 52.9% |
| Somerset and North Devon AAA Screening Cohort | 21.1% |
| Shropshire, Telford and Wrekin AAA Screening Cohort | 10.0% |
| South London AAA Screening Cohort | 40.0% |
| South Yorkshire and Bassetlaw AAA Screening Cohort | 0.0% |
| Thames Valley AAA Screening Cohort | 50.0% |
| West Surrey AAA Screening Cohort | 25.0% |
| Sussex AAA Screening Cohort | 5.6% |
| West Yorkshire AAA Screening Cohort | 0.0% |
| North Yorkshire and Humber AAA Screening Cohort | 20.0% |
The provider level data showed that:
- Black Country AAA Screening Cohort had the highest outcome
- 2 services had the lowest outcome:
- South Yorkshire and Bassetlaw AAA Screening Cohort
- West Yorkshire AAA Screening Cohort
- 2 out of 38 screening providers met the acceptable threshold of ≥ 60.0%
- 0 out of 38 screening providers also reached the achievable threshold of ≥ 80.0%
Nationally, as at 30 July 2021, from the 832 men who were appropriately referred, 145 men were unsuitable for surgery and 32 men declined surgery. Men who were unsuitable for surgery may have had a comorbidity that required treatment prior to the AAA repair, such as cancer treatment, or the risk of surgery was greater than the risk of rupture. These men may go on to have treatment in the future if they become suitable for surgery.
24.1% of the men who were appropriately referred, did not decline and were suitable for surgery, were operated on within 8 weeks. The average wait time for surgery was 112 days (range 1 to 459 days). The pandemic accounted for the majority of hospital delays due to pausing and reduction of elective surgeries. The pandemic also impacted on the treatment of comorbidities prior to AAA surgery due to delays in other parts of the hospital system and there were delays in obtaining custom made stents.
88.8% (n=572) of appropriately referred men who did not decline and were suitable for surgery underwent an elective repair. Nationally, just over half of the surgical interventions were open repairs but there was significant variation across the country (range 0% to 100%). The post-operative 30 day mortality for elective repairs was 1.41% overall (2.6% for open repairs and 0% for EVAR).
Figure 22: referral – percentage of men with aorta ≥5.5cm deemed fit for intervention and not declining, operated on by a vascular specialist within 8 weeks, by region, England, 1 April 2013 to 31 March 2021
Nationally, the percentage of men operated on within 8 weeks reached a peak in 2015 to 2016. Performance has since dipped before increasing again in 2018 to 2019 only to fall again from 2019 to 2020 onwards. The timeliness of surgical repair for AAA has been affected by several factors including the general increased demand for hospital services and winter pressures which have led to delays in elective surgeries. In 2019 to 2020 and 2020 to 2021 there was also a significant impact from COVID-19. Vascular services are working to restore elective operations but there has been a significant backlog to deal with, which has led to increasing waiting times.
17. Outcomes
There were 32 AAA ruptures during the screening year, 29 of which were fatal. There were 14 deaths in men on surveillance (2.3% of the deaths in surveillance) and 15 deaths in men referred for surgery. For the men referred to surgery, 8 had been turned down for surgery due to comorbidities or had declined the operation and 7 died while waiting for surgery. Of the 7, 5 died after waiting more than 8 weeks for surgery and of those 4 were referred in the 2019 to 2020 screening year. In the 2019 to 2020 screening year 4 men died while waiting for surgery, all within 8 weeks of referral. In 2018 to 2019, 2 men died while waiting for surgery and both were within 8 weeks of referral.
18. Recommendations
18.1 Recommendations on coverage
Recommendation 1
Providers are encouraged to review the inequalities guidance for best practice on increasing coverage.
Recommendation 2
Providers should use the deprivation and ethnic group report to better understand coverage within their area.
Recommendation 3
Providers are encouraged to submit any subsequent interventions to reduce inequalities.
Recommendation 4
Providers should review the accessibility and number of screening sites to maximise the opportunity for men to attend screening.
Recommendation 5
Providers should develop local standard operating procedures to show how vulnerable men are supported and when appointments should be sent out.
18.2 Recommendations on uptake
Recommendation 1
Providers who have not met the acceptable threshold for AAA-S01 must work with commissioners to agree a recovery plan which sets out how men will be offered an opportunity to be screened.
Recommendation 2
Providers must offer men who do not turn up to their first appointment a second appointment within the initial screening year so they do not miss out on the opportunity to be screened.
Recommendation 3
Providers should develop local standard operating procedures to show how vulnerable men are supported and when appointments should be sent out.
Recommendation 4
Providers must make sure that the process for booking annual surveillance appointments enables appointments to be within 6 weeks either way of the due date.
Recommendation 5
Providers must make sure that the process for booking quarterly surveillance appointments enables appointments to be within 4 weeks either way of the due date.
Recommendation 6
Providers must routinely review the SMaRT alert screen for those due to be screened.
Recommendation 7
Providers should review service accessibility for surveillance men to improve uptake (including clinic venues, geographical locations and numbers, hours and days clinics are planned).
Recommendation 8
Providers are encouraged to review the inequalities guidance for best practice on increasing uptake.
Recommendation 9
Providers are encouraged to submit any subsequent interventions to reduce inequalities.
Recommendation 10
Providers should use the deprivation and ethnic group report to better understand uptake within their area.
18.3 Recommendations on test
Recommendation 1
Providers should use the monthly screener report to review individual technicians’ non-visualised figures.
Recommendation 2
Providers must make sure equipment is checked and maintained in line with national guidance. The clinical skills trainer must undertake 4 monthly observations of screeners.
Recommendation 3
The provider should make sure that there is good communication between the service and trust medical imaging and/or vascular laboratory including timely feedback of results.
18.4 Recommendations on diagnosis and intervention
Recommendation 1
The provider should ensure there is good communication with the vascular service to enable men to be tracked throughout the screening pathway to identify and resolve potential avoidable delays to treatment.