Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, with reference to the age-related eligibility criteria for NHS screening and vaccination programmes, if he will make an assessment of (a) the evidential basis and decision-making process by which the upper and lower age limits for each programme are determined; and (b) the impact of those age thresholds on patient outcomes, including early diagnosis, morbidity, mortality, and health inequalities.

For screening programmes, the Government is guided by the independent scientific advice of the UK National Screening Committee (UK NSC). It is only where the offer to screen provides more good than harm that a screening programme is recommended.

The UK NSC considers all of the latest scientific evidence when reviewing the case for screening for different conditions. As the policy is based on the benefits and harms to whole populations, the screening decisions are based on the effect on the whole population, rather than individual circumstances. Where there is a lack of evidence, the committee cannot be confident that screening would benefit the population as a whole. In these circumstances, the proportionate approach is to screen within the range that has evidence to support the policy.

The National Health Service bowel screening programme in England was recently extended from 60 – 74 years old to 50 – 74 years old. This aligns with the evidence of where the screening programme can do the most good with the least harm caused. Harm can include increased anxiety, misdiagnosis, over diagnosis (where unnecessary and invasive follow up tests are offered), or unnecessary treatment.

The UK NSC is awaiting the results of the AgeX trial which is looking at extending the upper and lower age thresholds for breast screening. The Committee is also working with researchers in Australia who are considering whether vaccination would have an impact on the lower age of cervical screening.

The UK NSC keeps these age brackets under review. The Committee recognises that screening programmes are not static and that, over time, they may need to change to be more effective.

The Government’s policy on groups eligible for vaccination programmes is based on the recommendation of the independent expert advisory committee, the Joint Committee on Vaccination and Immunisation (JCVI). When advising on programme eligibility, including any upper and lower age limit for vaccination programmes, the JCVI evaluates clinical data from a wide range of sources including disease epidemiology, age specific estimates of disease burden including deaths and hospitalisations, as well as age-specific vaccine efficacy and cost-effectiveness analyses.

Patient outcomes, including early diagnosis, morbidity, mortality, and health inequalities are influenced by multiple health factors. It would therefore not be possible to make an accurate assessment of how age threshold for screening and immunisation alone impacted those outcomes.