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British government revamps screening policy

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6925.357a (Published 05 February 1994) Cite this as: BMJ 1994;308:357
  1. R Smith
  1. BMJ.

    The British government has announced its policy for introducing new screening programmes and the steps it will take to improve existing ones. The announcements last week follow several highly publicised failures in the cervical screening programme and were made by Ken Calman, the chief medical officer, at a conference organised by the BMJ and the Journal of Medical Screening.

    “We have seen in the past,” said Dr Calman, “screening tests creeping into the health service in a piecemeal and uncoordinated fashion and without quality assurance. Cervical screening has been part of the NHS services since the 1960s but was implemented in an ad hoc fashion without the basis of solid research evidence, leading to variations in local practice.” Dr Calman said that screening for hearing loss in young children was another programme that needed review.

    Screening currently costs the NHS pounds sterling 300m-400m ($450m-600m) a year, and a new programme should be introduced only, said Dr Calman, if research has shown it to be effective and affordable. The government has rejected the idea of a health screening research unit, but the population screening Headlines

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    The advisory committee will consider quality, cost effectiveness, and the economic implications of the proposed programme in relation to other services. Proposals will be designated either category A (should be taken forward as a national programme) or category B (insufficient evidence to warrant a programme). Each programme that goes ahead will have a national advisory committee and a national coordinator to oversee implementation. They will be responsible for training staff, educating the public and professions, and evaluating the programme.

    Dr Calman said that a national coordinator for the cervical screening programme should be in post by April. Guidance on the correct way to take cervical smears was being issued to all general practitioners, and training programmes were being set up.

    “Reviewing and improving existing screening programmes is much more difficult than developing a system for introducing new ones,” said Dr Muir Gray, director of health policy and public health in Oxford region and the first national coordinator of the breast screening programme, at the conference. “We had only about 200 centres offering mammography, but there are tens of thousands offering cervical screening. If introducing mammography was like knitting a cardigan and getting people to wear it then improving cervical screening is like unravelling and reknitting a cardigan while we continue to wear it.”

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