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Diabetic retinopathy is a leading cause of blindness in people of working age. Screening programmes for its early detection are therefore crucial. Following the introduction of screening programmes for diabetic eye disease, research carried out at the University of Aberdeen enabled the resulting images to be analysed by computer rather than manually, a technique that has now been adopted by Scotland's national screening programme. This has achieved a significant impact on patient health, as well as economic impacts for the taxpayer, through cost savings, and for the company that developed the screening software commercially.
Therefore this research has had impact in health and welfare by influencing decisions and care practices by a health service.
Around 2.5 million people in the UK have Type 2 diabetes, with many more in a pre-diabetic state, Both conditions are hard to detect and frequently remain undiagnosed and untreated for years. The cost burden to the NHS of eventual treatment is estimated at £10 billion; 80% of which is spent on complications that are, with good care, avoidable. Targeted diabetes prevention programmes could aid in prevalence reduction and associated costs. Leicester's Diabetes Research Centre has developed two risk scores, both suitable for use with an ethnically diverse UK population, to detect these conditions: a self-assessment questionnaire and a general practice database tool. Recommended by NICE, they have been used successfully in varied settings. Since July 2011, around 260,000 people have completed the self-assessment score online and more than 40,000 through other means.
Abdominal aortic aneurysms (AAAs) affect more than 4% of British men aged 65-74 and are responsible for over 6,800 deaths annually. The MASS trial showed that screening could reduce AAA-related mortality by 42%, and the Health Economics Research Group (HERG) demonstrated, through the MASS trial, that AAA screening was cost-effective. HERG thus helped inform the policy announced by UK ministers in 2008 to introduce a national screening programme for all men reaching 65. By Spring 2013 it was fully introduced in England — offering screening to 300,000 men annually; the latest Annual Report (2011-12) claimed an uptake rate of 75%. In 2008 the DH estimated the health gain from a screening programme would be at least 130,000 QALYS over 20 years. Internationally, MASS is the most significant trial of AAA screening, and provides the most robust evidence-based model of its cost-effectiveness. It extensively influenced AAA screening guidelines, policies and services, including in the USA and Europe.
Research by Professor Judith Stephenson and colleagues at the UCL Institute of Women's Health into the effectiveness of chlamydia screening has led to guidance to health policy makers in the EU about national strategies for chlamydia control, and has influenced NICE guidelines on the subject. In particular, our work has informed debate on the value for money of the National Chlamydia Screening Programme (NCSP). Stephenson advised the National Audit Office on this topic, and a resulting report led to the NCSP focusing on chlamydia testing in sexual health services and primary care rather than screening in low risk groups. These changes are expected to make considerable cost savings to the NHS.
Healthcare Associated Infections (HAI) can be an unintended consequence of healthcare delivery. They are caused by a range of organisms but are often preventable. GCU-led research has reduced avoidable infections in healthcare in the UK and Europe by stimulating policy debate and investment in new healthcare practice and influencing policy decisions, evidence guidelines, and educational practices. Important changes have been made to national and international approaches to meticillin-resistant Staphylococcus aureus (MRSA) screening with cost savings of £7.5 million to the NHS. 28 European countries now use the HAI point prevalence survey validation method determined by our research.
Antenatal screening aims to identify genetic carriers of sickle cell/thalassaemia in order to provide prospective parents with "informed choice". Throughout the period January 2008-July 2013, the NHS in England has used a Family Origins Questionnaire in connection with sickle cell/thalassaemia screening derived from our research programme. The original policy issue concerned whether or not it is possible/desirable to target antenatal screening for sickle cell/thalassaemia by means of an ethnicity question. The policy problem was that socially constructed "ethnicity" categories correspond imperfectly and to an unknown degree with actual prevalence of genetic carriers. The screening question based on our research now guides the offer of initial screening and/or further laboratory tests for all pregnant mothers in England.
The results of two major randomised trials and a cohort study based at the University of Manchester (UoM) have had a major impact on cervical screening in the UK and influenced thinking internationally. These trials evaluated two technologies which had the potential to improve cervical screening. As a result HPV primary screening has moved to a large national pilot study. HPV as a test of cure following treatment of cervical precancerous lesions has now been adopted as standard across the National Screening Programme. Automation assisted technology, which was shown to be inferior to manually read cytology, will not be adopted.
School dental screening was a statutory function of the NHS. University of Manchester (UoM) research demonstrated that the national screening programme was ineffective and likely to increase inequalities in health and service utilisation. As a direct result of UoM research, the National Screening Committee recommended that the national programme should stop. This changed Departments of Health policy resulting in new guidance to the NHS, which stopped the screening programme and redirected resources to treatment services for vulnerable groups and prevention programmes. In 2010 in England the costs of a national screening programme were estimated to be £17m per year; money released for reallocation to other dental services.
Research led by Pardhan has enhanced the healthcare offered to diabetic patients of South Asian origin in the UK and overseas (Pakistan, East Africa). Prevalence of diabetes within this ethnic group is six times higher than in Caucasians. Our research into this group, which demonstrated an increased risk of sight-threatening eye disease and poor engagement with screening/treatment regimes, has impacted upon both patients and healthcare practitioners. Ophthalmologists, general practitioners and other clinicians have used our findings to target various physiological and cultural factors that influence diabetic control and eye health in the South Asian population.
Our research also provided the underpinning data that informed reports commissioned by the Royal National Institute of Blind People (RNIB). These reports demonstrate the increased prevalence of eye problems in patients of South Asian origin, and highlight the barriers that affect patients' access to primary and secondary eye-care across the UK. The reports evaluate the effectiveness of current management, and suggest strategies to improve the eye health of this group of patients.
These reports have led directly to the creation of dedicated community-based eye-care programmes. Funded by the Royal National Institute of Blind People (£400,000) and Innovation, Excellence and Strategic Development Fund (Department of Health), the programmes are designed to reduce diabetic-related complications through improved self care by patients in Bradford and Glasgow, regions that have significant Asian diabetic populations.
The UK Faecal Occult Blood Test Screening Programme, based on Dundee-led research (Steele), offers bowel cancer screening through mailed test kits followed up with colonoscopy when faecal blood is detected. It is estimated to prevent about 2,000 UK deaths annually. Steele's Screening Research Unit also trialled immunological faecal occult blood testing, which was subsequently incorporated into the Scottish screening algorithm. In addition to demonstrating a 27% reduction in bowel cancer deaths through participation in Faecal Occult Blood screening, the Unit has researched the incidence of interval cancers and the impact of repeated invitations, development of new tests, and strategies for increasing participation. All of these drive the National Screening Programme, and will further reduce mortality.