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).

If July 2022, Clinical Commissioning Groups (CCGs) ceased to exist and were replaced by the Integrated Care System. Data will still be available at CCG level for some time after July 2022 so this page continues to refer to CCGs and Hull CCG, and continues to present data at the CCG geographical level. Six local CCGs were also combined to form the Humber, Coast and Vale geographical area, which has also ceased to exist. It has been replaced by the Humber and North Yorkshire ICS. However, data will still be available at Humber, Coast and Vale geographical level, and will be presented within our JSNA.

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.
• In 2019, 71.1% of women aged 53-70 years were screened for breast cancer in Hull (74.5% in England).
• Screening for cervical cancer in 2019 was higher in Hull compared to England among women aged 20-49 years (71.5% versus 69.8%), although uptake was slightly lower among women aged 50-64 years (75.0% versus 76.2%).
• In 2019, uptake for screening for bowel cancer among persons aged 60-74 years was lower in Hull (55.5%) compared to England (60.1%).
• In 2018/19, uptake for screening for abdominal aortic aneurysm among men aged 65 years was similar in Hull (81.2%) compared to England (81.3%).
• 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 2021, the uptake rate of breast screening among women aged 53-70 years was 67.0% which was higher than England (64.1%). 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 uptake rate was unchanged between 2019 and 2020 for Hull remaining at 71.1%. Any disruption to services would have likely commenced at the end of March 2020 when the first COVID-19 lockdown occurred, so around three-quarters of women due to be screened over the last nine months of 2020 would have been affected by the pandemic. However, there has been a greater impact between 2020 and 2021 in Hull mirrored regionally and nationally, with the screening uptake rates falling. However, the rates fell by a greater amount for both the Yorkshire and Humber region and for England, and as a result the uptake rate for Hull in 2021 was higher than England and the region for the first time since 2010.

For the year 2021, around one-third of women would have been already been invited or attended screening as the rates are given as the number of women attending screening over the last three years, and thus the pandemic would not have had an influence on the all women screened for breast cancer during the three year period 2019-21. Furthermore, women who were due to be screening during the last nine months of 2020 and most of 2021 might not all have been affected depending on the levels of disruption to the service throughout the pandemic.

The take-up rate at CCG level is slightly higher at 67.5% for 2020/21, and it is not known if this is because it is based on financial year or whether the difference in the populations has influenced the take-up rate.

For 2020/21, the screening uptake rate among patients registered with Hull GPs is higher than England which may imply that screening services were less disrupted throughout the pandemic in Hull.

Slightly fewer women in Hull attended their breast screening appointment within six months of invitation for 2020/21 compared to England and other CCGs across Humber, Coast and Vale.

The uptake rate among patients registered with Hull GPs was quite static at around 67% between 2009/10 and 2013/14, before increasing from 2013/14 to 2017/18. The decrease between 2018/19 and 2019/20 is unlikely to have been substantially affected by the COVID-19 pandemic as the first lockdown started a week before the end of March 2020, although it is possible services were affected slightly before this. Throughout the COVID-19 pandemic (beginning 2020/21) breast cancer screening rates have decreased both in Hull and across England, although the decrease across England was much greater than that in Hull.

The percentage of female patients 50-70 years who take up breast cancer screening in the last three years 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 in 2019/20 and 2020/21. 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, although the percentage of Hull women attending their appointment within six months for 2020/21 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).

The majority of the practices that have the lowest screening uptake percentages serve the most deprived populations in Hull (in terms of the average Index of Multiple Deprivation 2019 score of their practice patients). The figures in brackets give the average IMD score of their patients and the rank of those deprivation scores of Hull’s 32 practices as at October 2021 with the higher the IMD score and rank the higher the deprivation (and average age of the patients for some practices too). Dr Nayar’s practice has a high percentage of students so the age profile may be influential in the screening uptake rate. The average IMD score of patients ranges from 20.3 to 52.9, and the average age of the patients ranges from 29.1 to 48.1 years for the 32 Hull practices (as at October 2021).

For 2020/21, the percentages are lowest for the following practices with these practices having fewer than 60% of women undertaking breast cancer screening:

• B81018 – Orchard 2000 Group – 21.0% (IMD 51.6, rank 30)
• B81032 – Wilberforce Surgery – 53.5% (IMD 49.7, rank 29)
• B81017 – Kingston Medical Group – 56.0% (IMD 51.8, rank 31)
• B81052 – Princes Medical Centre – 56.0% (IMD 37.6, rank 12 / age 38.0, rank 12)
• B8104 – Dr Nayar – 59.0% (IMD 25.4, rank 3 / age 29.1, rank 1)

Cervical Cancer

During 2021, 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 among women aged 50-64 years is the lowest across the Yorkshire and Humber local authorities for 2021. 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. The uptake rate for cervical screening among women aged 25-49 years has been statistically significantly higher than England between 2012 and 2020. The take-up rate increased slightly in Hull between 2018 and 2020 (as it did nationally and across the region), although rates decreased between 2020 and 2021 due to the COVID-19 pandemic. The rate in Hull fell by a greater amount than the fall for England.

As the percentages are given for the number of eligible women attending within the last three years this means that the disruption in services due to the COVID-19 pandemic will have had less of an impact on attendance if screening had been required every year. For 2021, over one-third of women should have already been invited and attended screening prior to March 2020 when the disruption to screening services would have occurred.

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. The rate decreased between 2020 and 2021 in Hull due to the COVID-19 pandemic and the magnitude of the decrease was similar to that across the region and England.

As the older women are only eligible for cervical screening once every five years, the impact of the COVID-19 lockdowns would have been even less of an influential factor for 2021 as around three-fifths of women should have already been invited and attended screening during 2017-2019.

A similar pattern occurs when examining the percentage uptake of cervical screening among patients registered with Hull GPs with the percentage in Hull being higher than England for women aged 25-49 years and lower for women aged 50-64 years.

The percentage at CCG level tend to be higher than the rate at local authority level as the local authority figures are based on residents and the CCG figures are based on patients registered with Hull GPs.

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 has levelled off, although the percentage has decreased in Hull by more than decrease for England between 2019/20 and 2020/21 with the impact of the COVID-19 pandemic. The rate has been consistently higher in Hull compared to England although the difference for 2020/21 is the smaller it has been since 2009/10.

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 over the last couple of years, so the rate in Hull is now lower than the rate for England. The uptake rate for cervical cancer screening among women aged 50-64 years in Hull is the lowest it has been in 2020/21 (since 2009/10).

Fingertips presents information on the percentage uptake of cervical screening at practice level for women aged 25-49 years (opens an external website).

Among women aged 25-49 years, the practices with the lowest rates for 2020/21 were as follows all having the percentage uptake is 65% or lower (with average Index of Multiple Deprivation 2019 score and age of their practice patients ranked out of 32):

• B81104 – Dr Nayar – 42.1% (IMD 25.4, rank 3 / age 29.1, rank 1)
• B81058 – Sydenham Group Practice – 60.3% (IMD 49.5, rank 27)
• B81032 – Wilberforce Surgery – 60.5% (IMD 49.7, rank 29)
• B81017 – Kingston Medical Group – 60.7% (IMD 51.8, rank 31)
• B81675 – Haxby Group Calvert – 61.6% (IMD 41.1, rank 17 / age 35.9, rank 3)
• B81052 – Princes Medical Centre – 62.9% (IMD 37.6, rank 12 / age 38.0, rank 12)
• B81027 – St Andrew’s Practice – 64.4% (IMD 50.0, rank 28)

Fingertips presents information on the percentage uptake of cervical screening at practice level for women aged 50-64 years (opens an external website).

Among women aged 50-64 years, the practices with the lowest uptake rates for cervical screening for 2020/21 were as follows all having rates is 70% or lower:

• B81058 – Sydenham Group Practice – 63.4% (IMD 49.5, rank 27)
• B81027 – St Andrew’s Practice – 65.5% (IMD 50.0, rank 28)
• B81018 – Orchard 2000 Group – 65.6% (IMD 51.6, rank 30)
• B81032 – Wilberforce Surgery – 66.4% (IMD 49.7, rank 29)

Bowel Cancer

During 2021, 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. Around six in ten 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 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 being lower than England and lower than across the Humber, Coast and Vale. The percentage at CCG level tend to be higher than the rate at local authority level as the local authority figures are based on residents and the CCG figures are based on patients registered with Hull GPs.

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. The trends over time in Hull have been similar to those for England and across the Humber, Coast and Vale, 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) which increased take-up.

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 64% in 2019/20. Similar increased occurred for England and across the Humber, Coast and Vale.

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).

The practices with the lowest percentage of take-up of bowel cancer screening occurred in the following practices for 2020/21 being 55% or lower (with average Index of Multiple Deprivation 2019 score and age of their practice patients ranked out of 32):

• B81032 – Wilberforce Surgery – 47.0% (IMD 49.7, rank 29)
• B81017 – Kingston Medical Group – 52.2% (IMD 51.8, rank 31)
• B81027 – St Andrew’s Practice – 53.9% (IMD 50.0, rank 28)

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 2020/21, just over a half of men attended screening for AAA in Hull which was slightly lower than the rate in England.

However, there has been a sharp fall in the uptake rate due to the COVID-19 pandemic. Screening uptake rates for cancer screening were less impacted by the COVID-19 pandemic as the men and women were only eligible for screening every 2.5 to 5.5 years (depending on the cancer) so a proportion would have already attended screening prior to the pandemic. The uptake rate for AAA has been much more influenced by the pandemic as it is a different cohort of men who are eligible for screening each year (and the data is not based on three or five years worth of screening).

Between 2013/14 and 2019/20, there had been some variability in the percentage uptake for AAA screening for Hull. The rate was highest in 2015/16 at 82.4%, but has generally been between 78% and 81% although for 2019/20 the rate was lower at 74.9% which had been the lowest rate since 2013/14.

The uptake rate halved between 2019/20 and 2020/21 from 74.9% to 52.4% in Hull.

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 period 2016/17 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/

Updates

This page was last updated on 14 July 2022.

This page is due to be updated / checked in February 2023.