Public health commissioning

NHS England works closely with UK Health Security Agency and the Department of Health and Social Care to provide and commission a range of public health services.

Adult and seasonal vaccination programmes

NHS Breast Screening Programme (NHS BSP)

In England, breast screening is currently offered to women aged 50 up to their 71st birthday, every 3 years. Women invited for a breast screening have an X-rays (mammograms) at a clinic or mobile breast screening unit.

The major aim of the NHS breast screening programme is to reduce mortality from breast cancer by diagnosing cancer at an early stage when treatment is more successful.

The key objectives of the NHSBSP include:

  • identifying the eligible population and ensure efficient delivery with optimal coverage
  • delivering and supporting the programme with suitably trained, competent, and qualified, clinical and non-clinical staff who, where relevant, participate in recognised ongoing Continuing Medical Education, Continuous Professional Development, professional revalidation and External Quality Assurance schemes in fit for purpose facilities
  • having audit and service evaluation embedded in the service to maximise safety and accessibility of the service for all groups in the eligible population
  • maximising screening sensitivity and specificity by detecting early stage cancers with the least possible radiation dose and minimising the biopsy and referral of women who do not have breast disease to minimise the adverse impact (physical/ psychological/clinical) of unnecessary investigations
  • having a seamless pathway at the interface between screening and diagnosis and the treatment pathway to ensure women are referred promptly and safely to treatment services

Links to useful documents

NHS England Diabetic Eye Screening Programme (DESP)

Diabetic eye screening is a test to check for eye problems caused by diabetes.  The test can identify problems before sight is affected.

If you have diabetes and you’re aged 12 or over, you’ll get a letter every 1 or 2 years asking you to have diabetic eye screening.

The aim of DESP is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight threatening diabetic retinopathy, at the appropriate stage during the disease process.

This will be achieved by delivering evidence-based, population-based screening programmes that:

  • identify the eligible population and ensure effective delivery with maximum coverage
  • are safe, effective, of a high quality, externally and independently monitored, and quality assured
  • lead to earlier detection, appropriate referral, effective treatment and improved outcomes
  • are delivered and supported by suitably trained, competent, and qualified, clinical and non-clinical staff who, where relevant, participate in recognised ongoing continuing medical education (CME), Continuous Professional Development (CPD), and Quality Assurance (QA) schemes
  • have audit embedded in the service

Links to useful documents

NHS England Abdominal aortic aneurysm (AAA) screening programme

AAA screening is a way of checking if there’s a bulge or swelling in the aorta, the main blood vessel that rums from the heart to the stomach.  The swelling in an AAA. In England, screening for AAA is offered to men from aged 65.

Key objectives include:

  • Inviting eligible men to the AAA screening programme using standard information provided by PHE
  • Providing clear, high quality information that is accessible to all
  • Carrying out high quality abdominal ultrasound on those men attending for initial or follow-up screening according to national protocol

Links to useful documents

NHS Cervical Screening Programme

Cervical screening is a test to help prevent cervical cancer. All women and people with a cervix aged 25 to 64 should be invited by letter. During the screening appointment, a small sample of cells will be taken from your cervix. The sample is checked for certain types of human papillomavirus (HPV) that can cause changes to the cells of your cervix. These are called “high risk” types of HPV. If these types of HPV are not found, you do not need any further tests. If these types of HPV are found, the sample is then checked for any changes in the cells of your cervix. These can then be treated before they get a chance to turn into cervical cancer. You’ll get your results by letter, usually in about 2 weeks. It will explain what happens next.

The aim of the NHS Cervical Screening Programme is to reduce the number of people who develop invasive cervical cancer and the number of people who die from it. This includes working across local systems and partnerships to find ways that screening can be made more accessible, including people with a learning disability.

Watch the video below for a good example of how this is happening.

Links to useful documents

NHS Bowel Screening Programme

NHS bowel cancer screening checks if you could have bowel cancer. It’s available to everyone aged 54 to 74 years. The programme is gradually expanding to also make it available to people aged 50 to 53 years. Regular NHS bowel cancer screening reduces the risk of dying from bowel cancer.

Bowel cancer is the third most common type of cancer. Screening can help find it at an early stage, when it’s easier to treat. To test for bowel cancer you use a home test kit, called a faecal immunochemical test (FIT), to collect a small sample of poo and send it to a lab. This is checked for tiny amounts of blood. Blood can be a sign of polyps or bowel cancer. Polyps are growths in the bowel. They are not cancer but may turn into cancer over time. If the test finds anything unusual, you might be asked to have further tests to confirm or rule out cancer.

Link to useful information

NHS Antenatal Newborn Screening (ANNB)

You’ll be offered some screening tests during pregnancy to try to find any health conditions that could affect you or your baby. The tests can help you make choices about further tests and care or treatment during your pregnancy or after your baby’s born. All screening tests offered by the NHS are free.

The screening tests offered during pregnancy in England are either ultrasound scans or blood tests, or a combination of both. Ultrasound scans may detect conditions such as spina bifida. Blood tests can show whether you have a higher chance of inherited conditions such as sickle cell anaemia and thalassaemia, and whether you have infections like HIV, hepatitis B or syphilis.

Blood tests combined with scans can help find out how likely it is that the baby has Down’s syndrome, Edwards’ syndrome or Patau’s syndrome.

Public Health England have published revised newborn blood spot (NBS) screening standards, with an implementation date of 1 April 2020.  Details of the revision can be found on the PHE website at the following link: NBS New Standard

Link to useful information

NHS Newborn Hearing Screening Programme (NHSP)

One to 2 babies in every 1,000 are born with a permanent hearing loss in one or both ears. Most of these babies are born into families with no history of hearing loss. The programme offers all parents in England the opportunity to have their baby’s hearing screened tested shortly after birth.

Early identification gives babies a better ‘life chance’ of developing language, speech and communication and language skills and of making the most of social and emotional interaction from an early age.

The NHSP aims to:

  • identify all children born with moderate to profound permanent bilateral deafness within four-five weeks of birth and to ensure the provision of safe, high quality age-appropriate assessments and support for deaf children and their families
  • offer screening to all babies up to 3 months (12 weeks) of age or if born ≤40 weeks gestation, up to 3 months (12 weeks) corrected age although ideally babies will be screened within days of their birth
  • ensure babies with a no clear response from the screen are referred for audiological assessment and are initially seen within 4 weeks of screen completion
  • promote and develop family friendly integrated services
  • empower parents to make personal informed choices
  • ensure equity of access for all children and families
  • work to deliver an integrated approach to screening and follow-on services
  • influence the development and delivery of high- quality screening services, using the latest research, technology, best practice guidance and benchmarking.

Links to useful documents

Newborn and Infant Physical Examination (NIPE) Screening Programme

NIPE is one of 11 English population screening programmes.

The NHS newborn and infant physical examination (NIPE) programme’s main aims are to:

  • identify and refer all children born with congenital abnormalities of the eyes, heart, hips and (in males) testes, where these are detectable, within 72 hours of birth
  • to further identify those abnormalities that may become detectable by 6 to 8 weeks of age, at the infant physical examination
  • reduce morbidity and mortality

These recommended ages are based on best practice and current evidence and should facilitate a prompt referral for early clinical assessment.

Babies are screened (ideally) within 72 hours of birth (NIPE newborn screening examination) and again at 6 to 8 weeks of age (NIPE infant examination) for conditions relating to the:

  • eyes
  • heart
  • hips
  • testes (if applicable)

Links to useful documents

For further information please see the gov.uk website: Newborn and infant physical examination: programme handbook

Infectious diseases in pregnancy screening programme (IDPS)

The NHS IDPS screening programme recommends screening for HIV, hepatitis B and syphilis to all women in England in every pregnancy, regardless of any past results or treatment. Women already known to be living with HIV or hepatitis B need early referral into specialist services to plan their care in pregnancy.

Screening is a personal informed choice, however the early detection and treatment offered by screening can significantly reduce the chances of a mother passing on an infection to her baby in the period immediately before and after birth (vertical transmission).  Women with HIV, hepatitis B, and syphilis can be identified early in pregnancy to facilitate appropriate timely assessment and management of their health and appropriate and timely neonatal referral, management and follow up of their babies.

It is important to remember that a negative result is negative at the time of testing, and repeat tests should offered and recommended if a woman changes her sexual partner, she or her partner are sexually active with other people, her partner is diagnosed with or suspected to have a sexually transmitted infection (STI), she injects recreational drugs, is a sex worker, or for any woman who requests a test.

Fetal anomaly screening programme

The NHS FASP offers screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome and a number of physical conditions to all eligible pregnant women in England.

This screening can help you make personal informed choices about further tests, care or treatment during your pregnancy or after your baby is born. These tests may lead to a discussion about continuing or terminating your pregnancy. Screening is your choice. Some people want to find out if their baby has one of the conditions and some do not.

There are 2 NHS FASP screening pathways. These are:

Down’s syndrome, Edwards’ syndrome and Patau’s syndrome screening pathway

This screening pathway may involve several different tests to find out how likely it is that your baby has Down’s syndrome, Edwards’ syndrome, or Patau’s syndrome.

The first screening test is called the combined test and involves a blood test and ultrasound scan around 11 to 14 weeks of pregnancy.

If you are more than 14 weeks pregnant the combined test is not possible. You will instead be offered a blood test, called the quadruple test, between 14 and 20 weeks of pregnancy. This test screens for Down’s syndrome only. You will be offered a 20-week screening scan to screen for Edwards’ syndrome and Patau’s syndrome.

If you receive a higher chance result from either the combined or quadruple test, you will be offered a screening test called NIPT (non-invasive prenatal testing). This is a blood test.

Following these screening tests, you may be offered a diagnostic test to confirm whether or not the baby has one of the conditions.

20-week screening scan pathway

The 20-week screening scan looks for 11 physical conditions in your baby and cannot find everything that might be wrong. The scan will look in detail at your baby’s bones, heart, brain, spinal cord, face, kidneys and abdomen.

In most cases the scan will show that your baby appears to be developing as expected but sometimes a condition is found or suspected. Some of the conditions that can be seen on the scan will mean the baby may need treatment or surgery before or after birth. In some very serious rare cases, where no treatment is possible, the baby may die soon after birth or during pregnancy.

Scans cannot find all conditions. There is always a chance that your baby may be born with a health issue that scans could not have identified.

You may be offered a diagnostic test to find out for certain if your baby has one of the conditions. If necessary, you will be referred to a specialist, possibly in another hospital.