Screening Among Adults and the NHS Health Check

This topic area covers statistics and information relating to uptake of screening programmes including the NHS Health Check among adults in Hull including local strategic need and service provision. Further information relating to Screening and Vaccinations Among Children and Young People is available within Health Factors within Children and Young People. There is also a screening programme for chlamydia and further information on this is given within Sexually Transmitted Infections under Health Factors under Adults.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• There are a number of screening programmes in place in the UK which aim to detect conditions before the person experiences symptoms and enables earlier treatment to prevent severe disease and increase survival.
• All the screening programmes were suspended for at least 2-3 month from March 2020 due to the COVID-19 pandemic. Furthermore, it is possible that fewer people were willing to attend due to shielding and self-isolation once the services resumed. It is also possible that staff absences related to COVID-19 and/or backlogs could have impacted on the uptake rates. In general, uptake rates have not yet recovered to previous levels. The exception is for bowel cancer screening which is undertaken within the home. Uptake rates for bowel cancer have remained relatively constant, but increased during the COVID-19 pandemic and have continued to increase perhaps due to increased awareness of this specific cancer through the media.
• In the three years to 31 March 2022, 65.1% of women aged 53-70 years were screened for breast cancer in Hull (65.21% in England). The uptake had been around 71% in Hull prior to the COVID-19 pandemic.
• In the last 3.5 years, the percentage of women aged 20-49 years screened for cervical cancer in 2022 was marginally higher in Hull compared to England (68.2% versus 67.6%), although uptake was slightly lower in Hull compared to England among women aged 50-64 who had been screened in the last 5.5 years (73.4% versus 74.6%). The uptake had been around 72% among women aged 20-49 years and around 75% among women aged 50-64 years in Hull prior to the pandemic.
• In 2022, uptake for screening for bowel cancer among persons aged 60-74 years was lower in Hull (66.1%) compared to England (70.3%). The uptake rate in Hull has ben around 55% between 2015 and 2019, but increased slightly to around 60% in 2020 and 2021 and increased further in 2022 to the highest level since the screening programme began.
• In 2021/22, uptake for screening for abdominal aortic aneurysm among men aged 65 years was lower in Hull (51.3%) compared to England (70.3%). The rate had been around 80% prior to the pandemic. The rate in 2020/21 for Hull as also around 50% and similar to the rate for England, however, the rate in England appears to have recovered slightly whereas the uptake rate in Hull remained unchanged between 2020/21 and 2021/22.
• Among the eligible population aged 40-74 years, over the last five financial years 2017/18 to 2021/22, the percentage invited for an NHS Health Check in Hull was 33.9% in Hull which was just over half that of England at 63.3%. A similar percentage in Hull compared to England (45.7% versus 44.8%) had an NHS Health Check of those invited. Overall, of all the eligible population, 15.5% had an NHS Health Check in Hull compared to 28.4% across England. The percentage of the eligible population receiving an NHS Health Check in Hull has approximately halved over the last four years (since the five year period 2013/14-2017/18) when it was 31.1%.

The Population Affected – Why Is It Important?

Throughout the life course, there are several screening programmes including screening for antenatal and newborns, abdominal aortic aneurysm (AAA), diabetic retinopathy, breast cancer, cervical cancer and bowel cancer.

Antenatal screening and screening for newborns aims to identify conditions which may require support whereas most of the screening programmes in adults can detect the condition before the person experiences symptoms, and thus can be treated earlier to prevent the disease developing or increase survival. There is also the NHS Health Check programme which “aims to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia”. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions or have certain risk factors, will be invited (once every five years) to have a check to assess their risk of these conditions, and will be given support and advice to help them reduce or manage that risk.

Cancer Research UK have produced an infographic detailing the benefits of Breast Cancer Screening. The Independent UK Panel on Breast Cancer Screening estimated that among 1,000 women aged 50-70 without any symptoms, five lives would be saved due to breast cancer screening.

The Office for Health Improvement & Disparities (formerly Public Health England) provide information on Bowel Cancer Screening programme. For every 100 people screened using the guaiac fecal occult blood test (gFOBt), two will have an abnormal result which may require follow-up by colonoscopy. One in every 300 people screened is estimated to have cancer.

The Office for Health Improvement & Disparities (formerly Public Health England) estimate that if all eligible women attended cervical screening regularly, then 83% of cervical cancer deaths could be prevented. For every 100 women being screened, it is estimated that four women would require colposcopy or referral for further investigation.

There are many barriers to screening as shown in following infographic below. These barriers have been identified for all cancer screening programmes.

Some barriers are associated with embarrassment for cancer screening, whereas other barriers are more practical, including time pressures to manage appointments with busy day-to-day life. The percentage of women who take part in cervical cancer screening has fallen over the last decade, particularly among younger women.

Participation in screening programmes can significantly improve quality of life and save lives by diagnosing and treating disease earlier. Cancer screening programmes are recognised to significantly improve prognosis, with early detection meaning treatment can be provided at the early stages of the disease.

The Hull Picture

The Office for Health Improvement & Disparities’ Fingertips provides uptake rates of most of the screening programmes for adults at local authority level. Further information is also available at Clinical Commissioning Group (CCG) level for Hull and represents the patients registered with Hull GPs who have taken up screening, and this information is also available at individual General Practice level.

The uptake rates will differ slightly as those based on local authority level are given as the numbers screened within each calendar year (with data ending with the 31 March) and are given out of the estimated resident population in the relevant age group for screening. The uptake rates at CCG level are given as the numbers screened within each financial year and are given out of the registered population (the number of patients registered with Hull GPs). The estimated resident population is around 260,000 people whereas the registered population is over 300,000 population with around 10% of patients registered with Hull GPs living in East Riding of Yorkshire. As screening uptake rates are lower among more deprived communities, it is possible that screening uptake rates are higher among East Riding of Yorkshire residents, and this could influence the uptake rates at practice level particularly among a small number of Hull practices where a relatively high percentage of East Riding of Yorkshire residents are registered as patients in that practice. For more information on the differences between the resident and registered population, see Population Estimates under Population.

Breast Cancer

During 2022, the uptake rate of breast screening among women aged 53-70 years was 65.1% which was similar to England (65.21%). The uptake rate is given as the percentage of eligible women who have had a test with a recorded result at least once in the last 36 months (3 years) over the calendar year (based on data ending with 31 March). Eligible women are women aged 53-70 years who are resident in the area who are eligible for breast screening excluding those whose recall has been ceased for clinical reasons (e.g. due to previous bilateral mastectomy).

However, there is a difference in the trends over time between Hull and England. The rate in Hull has been improving since 2013 when it was 68.6%, in contrast, there has been a decrease for England over this period. Despite the gradual increase in Hull over time, the uptake rate has been consistently lower than England prior to the COVID-19 pandemic.

The percentages in 2021 and 2022 were affected by the COVID-19 pandemic. Breast screening services were paused for around three months (March to June 2020) and most Breast Screening Units continued with or had restarting screening very high risk women by mid-April with all recommencing activity between April and September 2020 (with the majority starting July 2020). However, there were backlogs compounded by workforce issues and fewer women presenting for breast screening perhaps due to shielding and self-isolation.

The indicator measures the number of women screened who were eligible over a three year period so the percentage screened did not fall as much as it might have if the indicator was measured over one year. However, it does mean that the percentage is also relatively low for the three year period ending 31 March 2022 as it was for the the three year period ending 31 March 2021, and furthermore the data for next year 2023 will also be affected.

In Hull, the uptake rate for 2021 did not decrease as much as it did in England so the percentage in Hull was statistically significantly higher than England for the first time. However, the percentage for England recovered in 2022 and the percentage in Hull is similar to England for 2022.

The take-up rate at sub-Integrated Care Board (ICB) level is slightly lower at 62.4% for Hull (03F) for 2021/22 compared to the uptake rate reported based on residents of Hull. The indicator also relates to the percentages screened adequately out of the numbers eligible within the last three years. Around 9% of patients registered with Hull GPs live in East Riding of Yorkshire, and the uptake rate among East Riding of Yorkshire residents fell by a similar margin relative to England (i.e. by a larger margin than the decrease for Hull) so it is possible that this influenced the uptake rate reported at sub-ICB level.

Note the second indicator presented relates to screening within six months out of those screened in the last year, but it does not specifically state this within Fingertips (and the label cannot be changed). Slightly more women in Hull attended their breast screening appointment within six months of invitation for 2021/22 compared to England but the percentage was the lowest across other sub-ICBs within Humber and North Yorkshire ICB.

The uptake rate among patients registered with Hull GPs was quite static at around 67% between 2009/10 and 2013/14, before increasing slightly between 2013/14 and 2017/18. There have been decreases between 2019/20 and 2021/22 due to the COVID-19 pandemic.

Note that this indicator presented relates to screening within six months out of those screened in the last year but it does not specifically state this within Fingertips (and the label cannot be changed).

The percentage of female patients 50-70 years who take up breast cancer screening in the last year and the percentage who do so within six months of their invitation is available at practice level for all of Hull’s GPs is available on Fingertips. The percentage remained relatively constant between 2012/13 and 2018/19 at around 70% for Hull, but decreased between 2018/19 and 2021/22. The lower percentages in 2019/20 and 2020/21 could be influenced by the COVID-19 lockdown as screening services were temporarily suspended during the first lockdown which commenced at the end of March 2020. It would have made it more difficult to attend within six months for any breast screening appointments where letters were sent out in the early part of 2020 (within the financial year 2019/20). This would also be the case for 2020/21 and 2021/22. The percentage of Hull women attending their appointment within six months for both these years is similar to England.

Fingertips presents information on the percentage uptake of breast screening at practice level for women aged 50-70 years (opens an external website), although as at August, the information is based on the 32 GP practices in Hull prior to April 2023 (there are now 29 practices with B81002 and B81095 merging with B81074 in April 2023, and Y02344 merging with B81112 in May 2023).

Practices serving more deprived populations (in terms of the average Index of Multiple Deprivation 2019 score of their practice patients) and with an older average age of their patients may be more likely to have lower uptake rates so the IMD score (and rank out of Hull’s 29 practices as at July 2023) and average age of patients (and rank) are given. The average IMD score of patients ranges from 19.9 (least deprived) to 52.9 (most deprived), and the average age of the patients ranges from 29.9 to 46.5 years for the 29 Hull practices (as at July 2023). The ranks are given as 1 for the practice serving the patients with the highest IMD score (most deprived) and 1 for practices with the lowest average age of patients (youngest patients).

Practices with the lowest rates tend to be those with younger patient populations and practices serving patients from slightly more deprived areas for breast screening. The practices serving patients with the second, third and sixth highest deprivation scores and the practices with the third, fourth, fifth and sixth youngest patient populations have uptake rates lower than 60% for breast cancer screening.

Uptake for breast cancer screening ranges from 36.1% (Haxby – Calvert & Newington) to 80.5% (Laurbel Surgery).

For 2021/22, the percentages are lowest for the following practices with these practices having fewer than 60% of women undertaking breast cancer screening:

• B81675 – Haxby – Calvert & Newington – 36.1% (IMD score 42.0, IMD rank 13, average age 35.4 years, age rank 3)
• B81032 – Wilberforce Surgery – 51.2% (IMD score 48.8, IMD rank 6, average age 36.0 years, age rank 5)
• B81119 – Goodheart Surgery – 51.2% (IMD score 46.2, IMD rank 8, average age 37.7 years, age rank 9)
• B81112 – James Alexander Family Practice (combined with Yo2344) – 54.0% (IMD score 43.5, IMD rank 10, average age 38.0 years, age rank 10)
• B81631 – Raut Partnership – 54.6% – (IMD score 42.2, IMD rank 12, average age 38.5, age rank 12)
• B81017 – CHCP – City Centre – 55.1% (IMD score 51.2, IMD rank 2, average age 35.6 years, age rank 4)
• B81052 – Princes Medical Centre – 57.7% (IMD score 38.2, IMD rank 17, average age 37.6 years, age rank 8)
• B81048 – Modality Hull – 58.2% (IMD score 31.1, IMD rank 23, average age 39.8 years, age rank 14)
• B81018 – Orchard 2000 – 58.9% (IMD score 51.0, IMD rank 3, average age 37.0 years, age rank 6)

Cervical Cancer

During 2022, the percentage of women aged 25-49 who had had screening for cervical screening within the last 3.5 years was higher in Hull than England, but among women aged 50-64 years who had attended within the last 5.5 years was statistically significantly lower in Hull compared to England.

The percentage is given out of the number eligible for screening and resident in the area at a given point in time, and excludes those without a cervix (based on data ending with 31 March).

Among women aged 25-49 years, the percentage has been decreasing over time in Hull at a similar rate of decrease to England, although the rate of decrease in Hull has been slightly greater than England in 2021 and 2022. Despite this, the uptake rate in Hull has been consistently statistically significantly higher than England between 2012 and 2022.

Whilst the rate has been consistently decreasing, the fall in 2021 and 2022 was greater due the COVID-19 pandemic.

Based on analysis presented in the Journal of Medical Screening, routine invitations for cervical screening were reduced between April and June 2020 with the number of samples received by laboratories in England reduced by 91%, 85% and 43% during April, May and June 2020 respectively compared to 2018 (used as a baseline). On average, there were 12.6% more samples between August 2020 and April 2021 over the same months in 2018. Nevertheless, cumulatively by April 2021, the number of samples received by laboratories in England was 6.4% fewer than in 2018 (over the same months).

As screening uptake rates are reported as the percentage screened in the last 3.5 years, the rates are not as badly affected as they would have been if they had been produced on the basis of women who were eligible within a single year.

In contrast, for women aged 50-64 years, the percentage attending cervical screening has been consistently lower than England and the region, and has for the majority of the time between 2011 and 2020 has also been statistically significantly lower than England. Again, in contrast to younger women, the rate has consistently decreased since 2012 although the change between 2018 and 2020 was relatively small.

However, the COVID-19 pandemic did influence the uptake rates, although in contrast to Hull women aged 25-49 years and women aged both 25-49 and 50-64 years, the uptake rates in Hull increased between 2021 and 2022 for women aged 50-64 years. Nevertheless, the uptake rate of cervical screening among women in Hull aged 50-64 years is statistically significantly lower than England for 2022.

The uptake rates should be less affected for women aged 50-64 years compared to women aged 25-49 years as they are reported in relation to the number of women attending screening in the last 5.5 years rather than in the last 3.5 years as for women aged 25-49 years.

A similar pattern occurs when examining the percentage uptake of cervical screening among patients registered with Hull GPs when the data is presented at sub-Integrated Care Board level with the percentage in Hull (03F) being higher than England for women aged 25-49 years and lower for women aged 50-64 years. Uptake rates are slightly higher when presented out of population registered with Hull GPs as around 9% of all patients registered with Hull GPs live in East Riding of Yorkshire where screening rates tend to be higher.

Whilst the percentage of women aged 25-49 years screened for cervical cancer has been decreasing in Hull since 2013/14 the decrease in the last couple of years prior to the pandemic, it had levelled off and increased slightly. However, with the COVID-19 pandemic, the uptake rates are the lowest they have been.

Among women aged 50-64 years registered with Hull GPs, the percentages attending cervical screening within the last 5.5 years was similar to England between 2009/10 and 2018/19, although the rate has fallen in Hull by slightly more than it has for England since then.

Fingertips presents information on the percentage uptake of cervical screening at practice level for women aged 25-49 years (opens an external website), although as at August, the information is based on the 32 GP practices in Hull prior to April 2023 (there are now 29 practices with B81002 and B81095 merging with B81074 in April 2023, and Y02344 merging with B81112 in May 2023).

Practices with the lowest rates tend to be those with younger patient populations and practices serving patients from slightly more deprived areas for cervical screening. The practices with the first, third, fourth and fifth youngest average age of patients and practices serving patients with the second, fifth and sixth highest deprivation scores have rates below 60% for cervical cancer screening among women aged 25-49 years.

Uptake for cervical cancer screening among women aged 25-49 years ranges from 41.5% (Newland Health Centre) to 83.5% (Laurbel Surgery).

Among women aged 25-49 years, the practices with the lowest rates for 2021/22 were as follows all having the percentage uptake is 60% or lower (with average Index of Multiple Deprivation 2019 score and age of their practice patients ranked out of 29):

• B81104 – Newland Health Centre – 41.5% (IMD score 25.9, IMD rank 27, average age 29.9 years, age rank 1)
• B81675 – Haxby – Calvert & Newington – 56.6% (IMD score 42.0, IMD rank 13, average age 35.4 years, age rank 3)
• B81058 – Sydenham House Group Practice – 57.6% (IMD score 49.6, IMD rank 5, average age 40.6 years, age rank 19)
• B81017 – CHCP – City Centre – 58.0% (IMD score 51.2, IMD rank 2, average age 35.6 years, age rank 4)
• B81032 – Wilberforce Surgery – 59.8% (IMD score 48.8, IMD rank 6, average age 36.0 years, age rank 5)

Fingertips presents information on the percentage uptake of cervical screening at practice level for women aged 50-64 years (opens an external website), although as at August, the information is based on the 32 GP practices in Hull prior to April 2023 (there are now 29 practices with B81002 and B81095 merging with B81074 in April 2023, and Y02344 merging with B81112 in May 2023).

Practices with the lowest rates tend to be those with younger patient populations and practices serving patients from slightly more deprived areas for cervical screening. The practices with the third, fifth and sixth youngest average age of patients and practices serving patients with the third, fourth, fifth and sixth highest deprivation scores have rates below 70% for cervical cancer screening among women aged 50-64 years.

Uptake for cervical cancer screening among women aged 50-64 years ranges from 62.0% (Sydenham House Group Practice) to 85.1% (CHCP – East Park).

Among women aged 50-64 years, the practices with the lowest uptake rates for cervical screening for 2021/22 were as follows all having rates is 70% or lower (with average Index of Multiple Deprivation 2019 score and age of their practice patients ranked out of 29)::

• B81058 – Sydenham House Group Practice – 62.0% (IMD score 49.6, IMD rank 5, average age 40.6 years, age rank 19)
• B81018 – Orchard 2000 – 63.7% (IMD score 51.0, IMD rank 3, average age 37.0 years, age rank 6)
• B81052 – Princes Medical Centre – 68.9% (IMD score 38.2, IMD rank 17, average age 37.6 years, age rank 8)
• B81027 – St Andrew’s Group Practice – 69.3% (IMD score 50.2, IMD rank 4, average age 40.1 years, age rank 17)
• B81675 – Haxby – Calvert & Newington – 69.5% (IMD score 42.0, IMD rank 13, average age 35.4 years, age rank 3)
• B81032 – Wilberforce Surgery – 69.6% (IMD score 48.8, IMD rank 6, average age 36.0 years, age rank 5)

Bowel Cancer

During 2022, the percentage of men and women aged 60-74 years screened for bowel cancer was the lowest across the Yorkshire and Humber local authorities and statistically significantly lower than the percentage for England.

Two-thirds of eligible men and women were screened for bowel cancer.

The percentage relates to the percentage of the eligible population with an adequate faecal occult blood test (FOBt) screening result in the previous 30 months (based on data ending with 31 March). Those eligible for the bowel cancer screening are those who live in the area at a given point in time excluding those whose recall has been ceased for clinical reasons (e.g. no functioning colon) or if they opt out of the programme.

The percentage uptake of bowel cancer screening in Hull has been consistently around 55% and this was the case between 2015 and 2019. Between 2019 and 2020, the percentage increased to 59.7%, and increased slightly again between 2020 and 2021 to 60.3%.

Despite the recent increases, the percentage has been statistically significantly lower than England between 2015 and 2020, although has followed a reasonably similar pattern to England and the region. Generally, access to health services reduced at the end of March 2020 due to the COVID-19 pandemic and lockdowns, but it is possible that the uptake for bowel cancer screening increased as slightly more people were at home particularly those in their early 60s of working age, had more free time, or it is possible that people focused more on their health or were more aware of health-related issues during the pandemic.

The rate has continued to increase in 2022 and the uptake rate is the highest it has been in Hull at 66% albeit statistically significantly lower than England (70%).

There has also been increased media and social media interest in bowel cancer in the last couple of years which could have increased uptake.

The percentages of patients aged 60-74 registered with Hull GPs who have taken up bowel cancer screening within the last 2.5 years is also available, and show a similar discrepancy with the rate in Hull (03F) being lower than England and lower than across the Humber and North Yorkshire Integrated Care Board. The percentage at sub-ICB level tend to be higher than the rate at local authority level as the local authority figures are based on residents and the sub-ICB figures are based on patients registered with Hull GPs, although the difference is relatively small.

Note the second indicator presented relates to screening within six months out of those screened in the last year, but it does not specifically state this within Fingertips (and the label cannot be changed). Two-thirds of patients registered with Hull GPs were screened within six months of their invitation out of those invited for bowel cancer screening in the last year which is lower than England (70%).

When the bowel cancer screening programme started in 2009/10 the percentage uptake in Hull was 49.8%, and whilst this increased over the next couple of years the rate remained relatively static at around 57% for the period 2011/12 to 2018/19. The rate increased in Hull between 2018/19 and 2019/20, and further increased between 2020/21 and 2021/22. The trends over time in Hull have been similar to those for England and across the Humber and North Yorkshire Integrated Care Board, so it is possible that the way the programme has been administered or advertised has changed to prompt the increase in take-up, or it could be more people were at home and/or focused on their health (due to the pandemic) or were more aware of bowel cancer which increased take-up.

Note that this indicator presented relates to screening within six months out of those screened in the last year but it does not specifically state this within Fingertips (and the label cannot be changed).

Between 2009/10 and 2017/18, around 55% of people were screened for bowel cancer within six months of their invite, but this increased to 57% in 2018/19 and to 69% in 2020/21, although there has been a decrease to 66% for 2021/22. A similar pattern of change in the last few years occurred for England and across the Humber and North Yorkshire Integrated Care Board.

The percentage of patients aged 60-74 years screened for bowel cancer in the last 2.5 years is also available at practice level on Fingertips (opens an external website), although as at August, the information is based on the 32 GP practices in Hull prior to April 2023 (there are now 29 practices with B81002 and B81095 merging with B81074 in April 2023, and Y02344 merging with B81112 in May 2023).

Practices with the lowest rates tend to be those with younger patient populations and practices serving patients from slightly more deprived areas for cervical screening. The practices with the fourth and fifth youngest average age of patients and practices serving patients with the second, fourth and sixth highest deprivation scores have rates below 60% for bowel cancer screening.

Uptake for bowel cancer screening ranges from 52.7% (Wilberforce Surgery) to 81.4% (Laurbel Surgery).

The practices with the lowest percentage of take-up of bowel cancer screening occurred in the following practices for 2020/21 being 60% or lower (with average Index of Multiple Deprivation 2019 score and age of their practice patients ranked out of 29):

• B81032 – Wilberforce Surgery – 52.7% (IMD score 48.8, IMD rank 6, average age 36.0 years, age rank 5)
• B81017 – CHCP – City Centre – 55.7% (IMD score 51.2, IMD rank 2, average age 35.6 years, age rank 4)
• B81027 – St Andrew’s Group Practice – 56.2% (IMD score 50.2, IMD rank 4, average age 40.1 years, age rank 17)
• B81047 – Wolseley Medical Centre – 59.8% (IMD score 45.8, IMD rank 9, average age 40.0 years, age rank 16)

Abdominal Aortic Aneurysm

The percentage of men in their 65th year who screened for an abdominal aortic aneurysm (AAA). The number eligible for screening is the total number of men aged 65 years who live in the area but it excludes men who die or move out of the area responsible for the local screening service before the screening can be offered.

For 2021/22, just over a half of men attended screening for AAA in Hull which was considerably lower than the rate in England where seven in ten men attended screening.

The uptake rate for screening of AAA among Hull men was consistently around 80% and similar to England between 2013/14 and 2018/19. There was a slight fall in 2019/20 due the COVID-19 pandemic as there is a three month period after the end of the financial year where men are counted as having been screened to account for cancellations and changes in appointments for men invited during the last few months of the financial year. This ‘grace’ period would have been from April to June 2020 at the same time as the COVID-19 lockdowns, so it appears that this had an impact on the reported uptake rates as initial screening appointments for mid-March to June 2020 were cancelled, and fewer men also attended.

A very similar reduction in the uptake rates occurred in England and the region as it did in Hull for 2020/21, but the rate remained relatively unchanged for Hull men for 2021/22 compared to an increase for both England and the region.

Screening rates for cancer screening are reported out of those eligible for screening over a 2-5 year period, so it would be anticipated that the screening for AAA would be less affected as the eligible cohort is based on a single year. However, it is possible that uptake rates in 2021/22 were affected by a backlog generated in 2020/21.

The uptake rates for England, the region, and in particular Hull, have a considerably way to go to return to levels observed prior to the pandemic.

NHS Health Check

There are three measures relating to take-up of the NHS Health Checks and they are given as cumulative figures over a period of time.

Everyone between the ages of 40 and 74 years, who has not already been diagnosed with heart disease, stroke, diabetes and/or kidney disease is eligible for an NHS Health Check and invited for a check every five years.

Local authorities have a legal duty to make arrangements to provide the NHS Health Check programme to 100% of the eligible population over a five year period and to achieve continuous improvement in uptake. The data demonstrates the cumulative progress made by local authorities over time.

In Hull for the five year period 2017/18 to 2021/22, 33.9% of the population eligible for an NHS Health Check were offered an NHS Health Check, of whom 45.7% took up the offer of an NHS Heath Check. Thus overall, 15.5% of the eligible population had an NHS Health Check (45.7% of 33.9%). For Hull, the percentage offered an NHS Health Check was just over half that of England (33.9% versus 63.3%) and whilst the uptake rate among those invited was slightly higher in Hull compared to England (45.7% versus 44.8%), this resulted in a much lower overall percentage of Hull’s eligible population receiving an NHS Health Check with the figure just over half of that of England (15.5% versus 28.4%).

The percentage of people aged 40-74 years who were offered an NHS Health Check has steadily decreased in Hull from 88% for 2013/14-2017/18 to 34% for 2017/18-2021/22. There have also been decreases over time for England and across the region, but the decrease in Hull has been greater.

Whilst it is possible to influence the number of people who are invited for an NHS Health Check, it is more difficult to influence the uptake rates among those who have received an invite. Uptake rates tend to be lower in more deprived areas, and as a consequence, the uptake rates of those who have been invited has tended to be lower in Hull than England and across the region. For the four years, 2013/14-2017/18 to 2016/17-2020/21, the percentage of Hull’s eligible population who were offered an NHS Health Check who received the health check was statistically significantly lower than England, but for the most recent year (2017/18-2021/22), the percentage increased in Hull and is slightly higher than England.

As a consequence of the relatively low number of invitations sent out, and a low uptake, the percentage of eligible residents in Hull who have received an NHS Health Check is low. For 2013/14-2017/18, around one-third of the eligible population received an NHS Health Check, but this has halved to 15.5% for 2017/18-2021/22.

Strategic Need and Service Provision

In general, the uptake of screening in Hull is low compared to other areas. Furthermore, there are relatively large variations in screening uptake rates within primary care practices, perhaps associated with the patients within those practices (for example, people living in less deprived areas including patients living in East Riding of Yorkshire).

In Hull, 13 of the GP practices are contracted to undertake NHS Health Checks so this could potentially explain some of the relatively low uptake in Hull, but the same reasons will apply to screening with uptake generally lower in more deprived areas like Hull compared to more affluent areas in other parts of the country. There is a Community Outreach Service that offers NHS Health Checks to patients registered with GP practices who do not want to deliver the NHS Health Checks, but not on a ‘call and recall’ basis coordinated through the practice.

Due to COVID-19, a large number of screening appointments were postponed which could potentially have an impact on the rates of late diagnosis among cancers and AAA that are picked up at screening appointments as well as postponing diagnosis and treatment of medical conditions through the NHS Health Check. However, for the case of bowel cancer screening which does not need an appointment or medical examination, uptake rates have increased slightly for 2020 and 2021. It is possible that changes in people’s working arrangements could have also made it easier to attend screening appointments. Furthermore, the impact on cancer screening uptake where eligible patients attend screening once in every three or five years will be lower compared to other services where patients attend more frequently. For instance, for breast screening where patients attend once in every three years, a disruption to the service of a few months will only impact on a relatively small percentage of patients over the entire three year period. For 2020/21, two-thirds of eligible women will have already been screened during 2018/19 and 2019/20, and probably some of those eligible for screening during 2020/21 might have had the opportunity to be screened during 2020/21 depending on when services resumed.

Resources

The Office for Health Improvement & Disparities (formerly Public Health England). Health Matters infographics

Cancer Research UK: Breast Cancer infographic

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

NHS Breast Screening Programme, England 2020/21. COVID-19 impact during 2020-21. https://digital.nhs.uk/data-and-information/publications/statistical/breast-screening-programme/england—2020-21/covid-impact—programme-summary-2020-21

Castanon A, Reboli M, Pesola F, Pearmain P, and Stubbs R. COVID-19 disruption to cervical screening in England. Journal of Medical Screening, 2022; 29(3): 203-208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9381684/

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Updates

This page was last updated / checked on 26 September 2023.

This page is due to be updated / checked in February 2024.