Item 14 - NSS Screening
North Lanarkshire Council · 14 February 2023
Back to IJB Performance, Finance and Audit Committee — 14 February 2023 and its agenda
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1 REPORT Item No: 14 SUBJECT: NSS Screening Data Intelligence Pilot TO: Performance, Finance and Audit Sub-Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer North HSCP DATE: 14th February 2023 1. PURPOSE OF REPORT This paper is coming to the Sub-Committee: For approval For endorsement To note 2. ROUTE TO THE IJB Sub-Committee This paper has been: Prepared Reviewed Endorsed 2.1 The paper was prepared by the Chief Officer and agreed by members of the Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The Sub-Committee is asked to: Note the contents of the report; Request future updates from the Programme Board on the delivery phase of the project. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background Yes No N/A
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2 5.1.1 Through the nation Health and Social Care Scotland Chief Officers’ Group, an engagement forum has been developed with National Services Scotland to explore potential areas for collaboration. The group is supported by the Chief Officers for North Lanarkshire and West Lothian, with a range of inputs from National Services Scotland and Public Health Scotland. 5.1.2 The first area of potential collaboration was put forward by the North Lanarkshire partnership building on the work undertaken as part of the Joint Strategic Needs Assessment undertaken to support the development of the current Strategic Commissioning Plan. The needs assessment highlighted significant inequality in screening uptake across North Lanarkshire’s communities, with further work required to fully understand the impact. 5.1.3 In November 2018, the Scottish Screening Committee set out a range of objectives with the aim of making screening more accessible; breaking down barriers to participation; creating person centred approaches; and making better use of data and performance information to improve planning, operational performance and outcomes. 5.1.4 Data from this work highlighted that around 35% of the population do not attend screening appointments, with a high correlation between deprivation and non- attendance. 5.1.5 The reasons for non-attendance are multifaceted and complex, but by understanding the barriers to attendance better, it should be possible to focus resources and personalise services to facilitate participation. 5.1.6 A project team was established with lead officers from National Services Scotland, Public Health Scotland, North Lanarkshire Health and Social Care Partnership and West Lothian Health and Social Care Partnership, working on a five step approach to deliver the proof of concept: 1. Identify analysis objectives with the Health and Social Care Partnerships 2. Define areas of focus and use cases 3. Data analysis and modelling 4. Test insight with users and identify potential interventions 5. Define ongoing monitoring to track benefits and improve 5.1.7 The proof of concept was established with the broad aim to “reduce the barriers to participation through better use of screening data, advanced analytics and working with Health and Social Care Partnerships to identify opportunities to focus local resources and third sector partners more effectively to encourage and facilitate participation in screening.” 5.1.8 Four key outcomes were sought from the work, covering the geographical presentation of data; contextual outcome information to understand the impact of screening; investigation of factors underlying screening participation; and identified use cases to leverage data and existing resources to improve uptake of screening.
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3 5.1.9 Two pilots have since been identified, with the North Lanarkshire HSCP leading work with local communities on how best to understand the impact of screening and encourage uptake, while West Lothian HSCP is exploring the impact of personalised screening reminders. 5.2 Developing our approach Geographical Presentation of Data 5.2.1 The first focus of the programme was to get a better understanding of the data, moving away from the normal data presentation at Health Board level to smaller geographical areas. Uptake was able to be viewed at Health Board, Council, Locality and Electoral Ward geographical areas, with the potential to build this data flexibly to population areas that make most sense locally. 5.2.2 An example of the ward level uptake across North Lanarkshire for bowel screening uptake is as follows: 5.2.3 While overall North Lanarkshire is only slightly below the Scottish average for uptake, there is considerable difference in uptake between most affluent and most deprived areas, with only 50% uptake in our most deprived communities:
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4 Contextual Information to Understand Impact 5.2.4 Using nationally available data from England, the impact of early identification of cancers can be fully understood. Using bowel cancer as an example, early identification at stage 1 has a 5-year survival rate of over 90%, but later detection at stage 4 compares at 10%. 5.2.5 Using local data for the two Health and Social Care Partnership areas involved in this programme highlights the impact of poor screening uptake quite clearly, with North Lanarkshire showing around 10% lower levels of early detections than West Lothian. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 I II III IV % net survival Stage of detection 5-year bowel cancer net survival (England)
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5 5.2.6 Through this area of the project, an intelligence platform has been created, connecting a range of different data sources and developing advanced analytics to build predictive models. Investigation Underlying Factors for Screening Participation 5.2.7 Through development of the intelligence platform, a number of areas have been explored to gain a better understanding of screening participation, looking at a range of underlying factors including ethnicity; homelessness; mental health; and linkages to those with frequent unscheduled care attendances. 5.2.8 An example of this output is the impact of ethnicity in uptake of bowel screening, with lower uptake in some ethnic groups strongly evident: 5.2.9 Linkages have also been made with the research undertaken around uptake of the Covid vaccination programme, and the learning from some of the initiatives developed to increase uptake, such as the use of different coloured envelopes and individualised support to attend appointments. Identified Use Cases to Improve Uptake 0% 10% 20% 30% 40% 50% 60% 70% North Lanarkshire West Lothian % detected at stage I-II HSCP Proportion of bowel cancers detected at stage I-II All cancers Screening-detected cancers
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6 5.2.10 A framework was developed to look at how to best frame the improvement cycles from the proof of concept. This includes gaining a better understanding of what drives non-participation; the system-based changes that could improve the screening pathway; local changes that could support more individualised approaches; and how we can make best use of community touchpoints and assets to support attendance. 5.2.11 Using this framework, the project team have been able to identify two key pilots as the next stage of the project. Pilot 1 (West Lothian) is looking at the impact of personalised screening reminders, which include localised content such as public transport routes. Pilot 2 (North Lanarkshire) aims to engage with local communities on how best to understand the impact of screening and encourage uptake. 5.3 Developing the North Lanarkshire Pilot 5.3.1 The development of the North Lanarkshire pilot has heavily focused on a broad engagement programme, through a series of structured interviews, focus groups and workshops, covering the following groups: Male ethnic minorities in deprived communities People without English as a first language in deprived communities Volunteers with sensory impairment via Deaf Blind Scotland Clinicians in deep end clinics Health improvement practitioners working on inequalities Pharmacists Key leads from across the North Lanarkshire HSCP/NHSL system 5.3.2 The Service Design Process was undertaken as follows:
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7 5.3.3 Through the engagement journey and broader supporting research we have been able to identify the top barriers to participation in bowel screening: Fear and denial around the test outcome A misconception that the test is not applicable if you don’t have any apparent symptoms of bowel cancer Concerns around the practicalities and cleanliness of the test Individual perceived risk being low or consideration of future consequences of bowel cancer The fact that it takes place away from the usual health care settings Low health literacy and numeracy Gender – on the whole males were less likely to participate in screening Lower socioeconomic group 5.3.4 The research undertaken in North Lanarkshire with those with lived experience led to a reframing of the screening journey: 5.3.5 The workshops have identified for ideas for piloting in North Lanarkshire: Texts to introduce the bowel screening process and track the stage in the process Communication and guidance to activate community touchpoints Local pharmacy encouragement and kit pick up for non-attenders Focused community workshops with specific low uptake groups
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8 5.3.6 The concept cards developed behind each of these four ideas are included in appendix one. 5.3.7 The aim is now to move into the delivery phase, using the Community Boards as the primary delivery vehicle. The aim from the outset of the North Lanarkshire projects is to develop community activity to support screening uptake and the Community Boards offer a unique opportunity to move this into the delivery phase. 5.3.8 A Project Board will commence in late January 2023 to coordinate this next phase of the project. Terms of Reference for the group are included in Appendix 2. 5.3.9 In November 2022, Cancer Research UK published its report Deprivation and Cancer Inequalities in Scotland, which highlights the extensive cancer inequalities currently faced. Those in the most deprived areas are 30% more likely to develop cancer and all cancer mortality a staggering 74% higher than those in the least deprived areas. 5.3.10 A key theme from the report is the need to have access to high-quality data, which was the starting point for this programme of work and collaboration between National Services Scotland, Public Health Scotland and the NL Health and Social Care Partnership. 5.3.11 The report also identifies the impact of lower screening uptake in more deprived communities, noting a 20% lower uptake for bowl and breast screening and 11% lower uptake for cervical screening in the most deprived communities, which is similar to the findings of our local research. 5.3.12 It is vital that this screening project is seen as part of a wider strategic focus on cancer inequalities, bringing together all partners across the Community Planning Partnerships to tackle the key thematic areas outlined: reducing preventable causes of cancer; taking bold action to diagnose cancers earlier; ensuring equitable access to optimal treatments; and improving the quality and availability of data. 5.3.13 NHS Lanarkshire’s Population Health Committee is coordinating some review activity around the main themes outlined in the report, to support a whole system approach to tackling this issue. 6. CONCLUSIONS 6.1 Progress around the bowel screening pilot programme continues, following an extensive programme of engagement and research. 6.2 A Programme Board will commence in late January 2023 to coordinate the next delivery phase of the programme, which will be focused through our local Community Boards. 6.3 It is vital that this is seen as one part of a wider strategic focus on cancer inequalities, forming a key strategic objective for our community planning partnerships in North and South Lanarkshire.
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9 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES 7.1.1 The programme impacts on all nine national health and wellbeing outcomes. 7.2 ASSOCIATED MEASURE(S) No further measures. 7.3 FINANCIAL 7.3.1 There are no direct financial implications identified to date, though small budgets may be required to support action across the Community Boards as the programme develops. 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1 There are no associated risks on the risk register at present. 7.5 PEOPLE 7.5.1 An extensive engagement programme was undertaken to form the basis of the next phase of project delivery. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 7.6.1 An EQIA is being developed to support the next phase of the programme, building on the information gleaned from our wider engagement and research. EQIA Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS 9. APPENDICES Appendix 1: Opportunity Cards Appendix 2: Programme Board terms of Reference ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 858 119.
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10 Appendix 1 – Opportunity Cards
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14 Appendix 2: NSS Screening Data Intelligence Pilot: North Lanarkshire HSCP Project Board ToR NHS Lanarkshire Screening Inequalities Project: Outline brief Background The provision of screening uptake data will enable Community Boards to plan and deliver local interventions to increase uptake, supporting the early intervention and prevention of bowel cancer within the population. Objectives and deliverables • Conduct a discovery of what data is available and how this is currently used. • To agree what data is needed and the frequency of data updates on a recurring, automatic basis to be of use to the Community Boards planning interventions. Duration TBC In-scope Bowel screening uptake data Out of scope Other screening services data Outline plan • To conduct a discovery of what data is available and how this is currently used. • To agree what data is needed and the frequency of data updates on a recurring, automatic basis to be of use to the Community Boards in planning interventions. Expected benefits Community Boards will be able to determine which regions to target with interventions Methodology Project team will create a plan for approval by the Project Board Stakeholders Community Boards, LIST Analysts, PHS Analysts, NHS Board Screening Co-ordinators, Screening Programme, National Screening Oversight, NHS Lanarkshire Health Improvement team. Constraints Availability of uptake data, information governance restrictions, availability of subject matter experts. Resource requirements Project Lead: TBC, PM Support: Sarah Adams, Data Analyst input: TBC Governance This project is governed by North Lanarkshire HSCP with Ross McGuffie, Chief Officer acting as Senior Responsible Officer
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15 Project Board Membership Name Organisation Project board role Responsibilities Ross McGuffie North Lanarkshire Health & Social Care Partnership Chair & HSCP Representative Chair project meetings Represent the interest of NL HSCP Lead the project, providing clear leadership and direction throughout its lifespan Ensure the project remains aligned to the strategic direction of the NSO with respect to tackling inequalities in access to screening. Accountable for the delivery of project objectives Julie Anderson/Garrick Wagner NHS National Services Scotland National Services Division (NSD) Representative To represent the interest of the Bowel Screening Programme and ensure the project is aligned to the strategic objectives of the Screening Programme. Celia Biffa-Watt NHS Lanarkshire Health Board Health Board Representative To represent the interest of the regional Health Board and ensure the project is aligned to the strategic objectives of the Health Board. Gavin Clark/Angus Morton Public Health Scotland Public Health Scotland Representative To represent the interest of Public Health Scotland. Provide advice and guidance about population needs with regards access to population screening services. Graeme Cowan North Lanarkshire HSCP Represent North Lanarkshire HSCP Provide advice and guidance around how data can be used to support activities led by the Community Boards. Leanne Pollock North Lanarkshire Council Community Board representative To represent the interests of the North Lanarkshire Community Boards. David Readhead North Lanarkshire Local Intelligence Support Team) LIST Represent LIST Analysts Provide advice and guidance around available data and information governance requirements for access. Helen Reed NHS National Services Scotland National Screening Oversight representative To represent the interest of the National Screening Oversight. To provide advice and guidance based on information gathered from other inequalities initiatives undertaken/planned by other Health Boards/organisations.
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16 Name Organisation Project board role Responsibilities Vicki Trim NHS Lanarkshire Health Improvement Lead Provide advice and guidance around selection and implementation of interventions to be led by the Community Boards.
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17 Project Governance Reporting Group Name Interests Lead contact Digital Modernisation Programme Board Progress updates David Proud Screening Programme Board Progress Updates Garrick Wagner National Screening Oversight Progress Updates David Proud Chief Officers Reference Group (CORG) Progress Updates Katherine Ross NHS Lanarkshire population health committee Progress Updates Ross McGuffie Adult social work and care committee Progress Updates Ross McGuffie IJB performance, finance and audit committee Progress Updates Ross McGuffie
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18 Meetings Chair: Ross McGuffie Deputy Chair TBC Frequency of meetings as and when required for the purpose of project decision making, but starting monthly Agenda The agenda and any supporting papers will be circulated one week in advance of each meeting by the project board secretariat. Requests for agenda items should be sent to the secretariat no later than 2 weeks before the next meeting. Decision Making The quorum for decision making and carrying out the business of the Board will be 50% of members, and decision making will be by majority. In circumstances where the group are unable to come to a consensus the Chair has the authority to make the final decision. Logging of decisions made All decisions will be recorded in the action log by the board secretariat. Minute of meetings An action log will be updated at each meeting. Lifespan The group will close when the project is completed. Review The terms of reference will be reviewed and updated on an annual basis. The next review date is January 2024.