Interview with Anne Mackie
1. Why do you feel so strongly about the benefits of screening?
The UK NSC screens for conditions and disease where early diagnosis can transform people's lives. For example, an early cancer diagnosis has a dramatic effect on survival rates, and by detecting hearing problems in newborn children we can ensure that they are given the best possible start in life. Ultimately, the screening programmes we oversee save the lives of thousands of people every year, and transform the quality of life for thousands more.
2. Do you think that screening is a difficult concept to get across to the public?
In most cases, there are clear benefits of screening and these are easily understood: for example, the Cancer Screening Programmes ensure early detection and treatment and better outcomes, all of which provides a very clear message to the public. Screening programmes also play a key role in raising awareness of serious conditions to at-risk groups, such as sickle cell disease and abdominal aortic aneurysms.
The more difficult concept to convey to the public is the reasons why the UK NSC does not introduce certain programmes, for example screening for Group B Streptococcus.
3. The UK NSC's tag line is ‘screening doing more good than harm'. Why is this, and what harm could screening do?
Although there are clear benefits for conducting screening programmes for certain conditions, this is not always the case. In some cases, a screening programme may cause unnecessary anxiety, and invasive investigations and treatments, which outweigh the programme's potential benefits. There is also a risk that screening may lead to otherwise healthy individuals are being needlessly turned into patients. The UK NSC has to ensure that the programmes it recommends have, on balance, a positive psychological and physical impact on those it screens, rather than a negative one.
4. More often than not, the UK NSC does not recommend screening for a particular condition. Does it just like to say no?
The UK NSC has a strict set of criteria that need to be met before recommending a particular screening programme. These are based on how serious the condition is, how easy it is to test for, how effective early treatment is, and how likely it is people will participate. There are many stringent conditions the Committee has to take into consideration, and we will only recommend a programme if they are all met. The UK NSC's decisions are regularly reviewed as new evidence comes to light using a robust and transparent policy review process.
5. Why does setting up a new national screening programme take so long?
Much research and evaluation has to be undertaken before a particular programme can be recommended. Once a programme has been established, it takes time to ensure that healthcare professionals are able to carry out the tests in a consistent and professional manner, and patients and the public need to be made aware of the availability and implications of the screening. Whilst it is important to make sure programmes are put in place as quickly as possible, for the benefit of patients and the public, it is also important to ensure that we get the programme right.
6. The UK NSC is a great advocate of choice. If screening is so important why not make it mandatory?
Screening is an important tool in enabling patient choice. From Down's Syndrome screening to Abdominal Aortic Aneurysm, the screening programmes help empower people to take control of their health - or that of their children - and make the most appropriate choices for their individual circumstances. Because screening is all about providing choice, people equally have the right to choose not to participate in a screening programme, and we cannot penalise them for doing so.
8. What are your priorities for the UK NSC over the next few years?
My vision for screening in the UK is that it should be based on clear evidence. That evidence should be open to public and academic scrutiny.
Where we have programmes underway they should be delivered in the most efficient and equitable manner with particular emphasis on the quality and safety of the programmes.
This vision means I need to:
- Systemise the policy review, update and production process
- Open the UK NSC's work to public scrutiny and improve user/stakeholder engagement
- Address concerns about inequality of access and uptake of screening programmes
- Develop and implement comprehensive quality assurance for existing programmes
- Engage with the SHAs
- Communicate the work of the UK NSC
- Educate NHS staff and public about screening and in my first year
- Set up a functioning office and team
[The text for question 8 is taken from the UK NSC's Annual Report 2007/08]
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