22. Universal screening
Public Health Forum to propose
(R) That this meeting of RCN Congress asks RCN Council to lobby for government to regulate the marketing and sales of health screening products and services to individuals
Result
The resolution was passed.
For: 94.53% (380)
Against: 5.47% (22)
Abstain: (23)
Debate report
Jason Warriner, chair of the Public Health Forum proposed this debate which focused on the availability of unregulated home screening kits to members of the public.
Jason described how increasingly, sales and marketing literature is finding its way into people’s homes through magazines, mailshots and online advertising. While not against properly regulated screening, he drew attention to the lack of support and counselling when people who can afford to conduct independent screening. “The question to ask is, are these services really needed or are they targeting the worried well?” he said.
One of the main concerns was that some tests available over the internet are not regulated or licensed, and by using .co.uk web addresses people are fooled into believing they are buying a reliable product.
Kathy Moore from East Dorset Branch seconded the proposal, again highlighting the risks involved with having no support around receiving test results.
Lyn Graham Ray, Children and Young People’s Professional Issues Forum member, shared her experience of supporting a 15 year old, who after being trafficked to this country, was told by her traffickers that she was pregnant and HIV positive after a home screening test. The young women consequently had an abortion, but after seeking help from Lyn discovered that she was not HIV positive and had been put through a terrible ordeal unnecessarily.
The debate continued to emphasise concerns about lack of support, lack of regulation and lack of information. Bringing the debate to a close, Jason said; “The key point is that this is not about stopping self-screening, it’s about ensuring screening is safe and effective.”
Congress voted overwhelming in favour of the debate.
Background
Screening for disease markers and risk factors is an important aspect of public health which assists in identifying at risk people, helping to target preventative actions for those who would benefit from early intervention. Many long-term conditions are preventable if risk factors are identified and healthier lifestyles are adopted at an earlier age.
The NHS should have sufficient resources available to promote preventative screening services. Concerns have been raised over the increased marketing of private health screening services such as simple blood tests or body scans to diagnose potential conditions (all arranged privately for a fee).
The consequences of unregulated health screening products and services include the potential detrimental psychosocial effects on individuals through the misdiagnosis and misinterpretation of results, and the potential impact on public health data collection if numerous providers screen and diagnose without central monitoring. In addition, the growth of private providers may lead to a widening in health inequalities, with the healthiest and wealthiest having greatest access.
In its second report, the UK National Screening Committee (UK NSC) states it is important to be clear and explicit about the risks and limitations of screening and to ensure people accept screening on the basis of informed choice; Croyle (1995) has highlighted the adverse psychological consequences arising when screening results are misinterpreted and conditions misdiagnosed.
On its website, the UK NSC states: “Taking up offers of private health screening, outside of the NHS, is becoming increasingly popular as people seek assurance that they are not suffering from a serious health problem and as more companies advertise the private screening services that they provide.” It goes on to state that the NHS has thought very carefully about balancing the benefit with the risk of screening, and has taken advice on this from the UK NSC.
The NHS has safeguards in place to ensure that the public can be confident that any tests, offered as part of high quality screening programme, are supported by sound research evidence. This ensures anyone having a test is aware of the benefits, risks and limitations and can make an informed choice.
Despite the HIV Testing Kits and Services Regulations (1992) which state, ‘a person who sells or supplies an HIV testing kit, or any component part of such a kit, to a member of the public shall be guilty of an offence’, HIV testing kits can be bought over the internet from illegal suppliers; individuals buying these are unaware the kits are both illegal and unregulated. The provision of a regulated home testing option for people who may have been at risk of HIV would increase access to accurate and appropriate screening for early diagnosis and follow up treatment as currently 24 per cent of people living with HIV are undiagnosed.
While the UK NSC – which is funded by all UK health departments - makes UK-wide policies, it is up to each area of the UK to determine when and how to put those policies into practice. As a result the screening services available will vary in England, Northern Ireland, Scotland and Wales.
References and further reading
British Psychological Society; British HIV Association; Medical Foundation for AIDS and Sexual Health (2011) Standards for psychological support for adults living with HIV London: BPS/BHIVA/MedFASH Available to download (Accessed 02/03/12) (Web)
Croyle, R. (1995) Psychological effects of screening for disease prevention Oxford: OUP
UK National Screening Committee (2012) UK Screening Portal: the gateway to information on screening in the UK. London: UK National Screening Committee Available at: http://www.screening.nhs.uk/ (Accessed 02/03/12) (Web)
