On direct flights from Wuhan into the United Kingdom, 1,466 passengers and 95 staff arrived between 10 and 24 January. Of these, 162 of the passengers have already left the UK, 53 of the crew have already left the UK and all of the remaining passengers (1,304) are now outside of the incubation period.

As of 5 February, a total of 468 UK tests have concluded, of which 466 were confirmed negative and two positive. Information is published daily online on the Coronavirus: latest information and advice page on the Government website.

Posters and leaflets with health advice has been made available in all UK international airports, Eurostar terminals and Dover. As of 5 February, the two patients who tested positive are receiving specialist National Health Service care and we are using tried and tested infection control procedures to prevent further spread of the virus.

The NHS is extremely well-prepared and used to managing infections and we are already working rapidly to identify any contacts the patients had, to prevent further spread. We are continuing to work closely with the World Health Organization and the international community as the outbreak in China develops to ensure we are ready for all eventualities.

Enhanced monitoring measures are in place for all direct flights from Wuhan to the United Kingdom in response to the outbreak of Wuhan novel coronavirus (WN-CoV). We are rolling the enhanced monitoring for all direct flights from China. The focus of the measures is to identify those who may be at risk of having contracted WN-CoV, ensuring that they have information and support if they are concerned and can contact Public Health England staff at the airport.

These measures do not include the introduction of ‘medical screening’ such as temperature screening. Expert advice suggests ‘medical screening’ such as temperature screening would be of very limited effectiveness and detect only a small minority of cases. This is because symptoms do not usually appear until five to seven days, and sometimes up to 14 days.

As announced by the Secretary of State for Health and Social Care on 23 January, enhanced monitoring measures were put in place for all direct flights from Wuhan to the United Kingdom in response to the outbreak of Wuhan novel coronavirus (WN-CoV).

We are now rolling out enhanced monitoring of all direct flights from China. These measures do not include the introduction of temperature screening. Expert advice suggests temperature screening would be of very limited effectiveness and detect only a small minority of cases. This is because symptoms do not usually appear until five to seven days, and sometimes up to 14 days.

This means that only a very small proportion of people would likely be symptomatic during a flight or immediate arrival to the UK and would therefore be picked up by temperature screening.

The focus of the proposed measures is to identify those who may be at risk of having contracted WN-CoV, ensuring that they have information and support if they are concerned and can contact Public Health England staff at the airport.

The Human Fertilisation and Embryology Authority has granted a licence to one clinic, Newcastle Fertility Centre at Life, to undertake screening and treatment for mitochondrial disorders.

Five patients at risk of producing a child with mitochondrial pathologies have undergone treatment using in vitro fertilisation and nuclear or spindle transfer.

No births have been achieved following those treatments to date.

The Department does not have any plans to establish mandatory annual health screenings. Screening in the United Kingdom is undertaken through informed consent.

There are 11 national screening programmes that are recommended by the UK National Screening Committee, which cover 37 conditions across adults and babies (antenatal and neonatal). Approximately 11 million people are invited to participate in screening programmes each year.

There is also the NHS Health Check service which is a health check-up for adults in England aged 40-74 every five years. It is designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia. The Government’s recent Green Paper Advancing our health: prevention in the 2020s announced the intention to undertake a review of the NHS Health Checks programme to maximise the benefits it delivers in the next decade.

Professor Richards’ review of National Adult Screening programmes was published on 16 October and as part of this review it explored the future of screening. The Department, NHS England and Public Health England will consider the recommendations of Professor Richards’ report and publish an implementation plan in due course.

In the United Kingdom, screening is an end to end service from test to treatment. This is not necessarily the case in other countries such as the United States of America. Therefore, comparisons with other health systems can be misleading.

In April 2014, the UK National Screening Committee (UK NSC) recommended extending the newborn bloodspot screening programme to include four additional conditions: maple syrup urine disease; homocystinuria; glutaric acidaemia type 1; and isovaleric acidaemia. The newborn blood spot screening is currently offered to all babies to identify nine conditions, as recommended by the UK NSC.

The UK NSC welcomes any new topic proposals through its annual call for topics. Using research evidence, pilot programmes and economic evaluation, the UK NSC assesses the evidence for programmes against a set of internationally recognised criteria. To ensure that screening is offered where the balance of benefit outweighs the harms.

In August 2019, the UK NSC published Generation genome and the opportunities for screening programmes. The report reflects the specific opportunities identified by each of the 11 population screening programmes, including the antenatal and newborn screening programmes. The report concluded that the advances in genomic technologies present exciting and potentially effective developments for screening programmes. Current and developing research and technology will be used to determine how, in future, genetics can best be used in screening. A copy of the report is attached.

NHS England recognises the importance of delivering public health services, including screening, which people find easy to access. This is why the NHS Long Term Plan and detailed improvement actions are about ensuring services are easy and convenient for people to use in order to deliver the Long Term Plan ambition on cancer to see 55,000 more people surviving cancer for five years in England each year from 2028.

The actions plans include real-world case studies which have demonstrated improvements in local areas. These case studies sit alongside widely published evidence which has been proven to deliver improvements in uptake. We expect these actions to have a positive impact on the uptake of screening.

Sir Mike Richards’ Review of Screening report is due to be published shortly which will identify additional opportunities to improve the uptake of breast, bowel, and cervical screening. In addition, NHSX is looking at possible improvements to screening IT systems, which should support the delivery of cancer screening programmes.

NHS England is committed to improving the uptake of national cancer screening programmes, for breast, bowel, and cervical cancer.

In January, NHS England published its Long Term Plan, which outlined its ambition to deliver improvements in the uptake of national cancer screening programmes. To support this process, NHS England has developed improving uptake action plans, which can be used by providers and the wider health system, to improve the performance of screening programmes.

The uptake action plans include proposals for reviewing and extending appointment hours (for example for breast cancer screening) and using data to inform strategies for improving uptake in those populations of greatest need. These plans are already available to commissioning teams and will be updated and reissued throughout the year.

National Health Service regions are currently developing implementation plans to deliver on these commitments. To provide robust oversight and assurance of delivery, NHS England has established national programme boards for each cancer screening programme area.

In addition, we expect the Sir Mike Richards’ Review of Screening report, due to be published soon, to identify additional opportunities to improve the uptake of breast, bowel, and cervical screening.

Further, Public Health England has been running ‘Be Clear on Cancer’ campaigns since 2011. These are designed to raise the public’s awareness of specific cancer symptoms; encourage people with those symptoms to go to the doctor; and diagnose cancer at an earlier stage, and therefore make it more treatable, and thereby improve cancer survival rates.

The UK National Screening Committee (UK NSC) advises ministers and the National Health Service in all four countries about all aspects of screening policy and supports implementation. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria.

The UK NSC has not reviewed the evidence to screen for malnutrition, however the Committee welcomes new topic proposals via its annual call for topics which opens each year from September to December.

The UK NSC has published its evidence review process online on GOV.UK, which includes how to submit a new topic proposal.

Funding for cancer genomic testing is included under the National Tariff Payment System, excluding whole genome sequencing which NHS England is funding nationally, and is included within the healthcare resource group tariff payment for an individual patient. For example, epidermal growth factor receptor (EGFR) testing for lung cancer, along with oestrogen (positive/negative progesterone) receptor status and human epidermal growth factor receptor 2 (HER2) testing for breast cancer have been established tests within the National Health Service for a number of years.

Cancer genomic testing will continue to be funded by the National Tariff Payment System and the National Genomic Test Directory outlines the cancer genomic tests which will be delivered by the NHS in England.

Building on the 100,000 Genomes Project and existing genetic services, NHS England announced in October 2018 that over the next 18 months work to mobilise the NHS Genomic Medicine Service (GMS) would get underway. The aims of the GMS are to:

- Provide consistent and equitable care for the country’s 55 million population;

- Operate to common national standards, specifications and protocols;

- Deliver to a single national genomic testing directory – covering use of all technologies from single gene to whole genome sequencing initially for rare disease and cancer;

- Give all patients the opportunity to participate in research, for individual benefit and to inform future care; and

- Build a national genomic knowledge base to provide real world data to inform.

Through the GMS, NHS England will be exploring how to ensure that the funding flows for cancer support equity of access to testing across the country.

The Annual Report of the Chief Medical Officer 2016: Generation Genome, made clear that in order to achieve equitable access to genomic testing the National Health Service will need to implement a first-class genomic medicine service that is scalable, future proof and delivers value for money. The report also noted the work undertaken as part of the 100,000 Genomes Project. A copy of the report is attached.

Therefore, NHS England announced in October 2018 that over the next 18 months work to mobilise the NHS Genomic Medicine Service (GMS) would get underway. The aims of the GMS are to:

- Provide consistent and equitable care for the country’s 55 million population;

- Operate to common national standards, specifications and protocols;

- Deliver to a single national genomic testing directory – covering use of all technologies from single gene to whole genome sequencing initially for rare disease and cancer;

- Give all patients the opportunity to participate in research (for individual benefit and to inform future care); and

- Build a national genomic knowledge base to provide real world data to inform.

A key element of the GMS is the National Genomic Test Directory which outlines the entire repertoire of genomic tests for cancer and rare and inherited disease – from Whole Genomic Sequencing to panel tests, to tests for single genes and molecular markers – that are available as part of the NHS clinical service in England.

The NHS GMS will be supported by an informatics system, that is being developed in partnership with Genomics England. When fully operational the National Genomics Informatics Service will enable NHS England to monitor the number of genomic tests being carried out across the country and benchmark activity.

The current National Institute for Health and Care Excellence guidance recommends genetic cascade testing for familial hypercholesterolaemia as highly cost effective. This guidance is currently under review, due to be issued in May 2017, and will take into account the latest changes to the costs of drugs and genetic tests in its revised economic modelling.

NHS England and Public Health England are working to raise the profile of familial hypercholesterolaemia (FH) and break down the barriers to genetic testing. Specifically, FH is emphasised in the NHS England Prevention aide memoire to support Sustainability and Transformation Planning, which is available at:

www.england.nhs.uk/wp-content/uploads/2016/05/stp-aide-memoire-prevention.pdf

NHS England’s National Clinical Director for heart disease chairs an FH steering group which comprises representatives from relevant stakeholder organisations, including Public Health England. This group, with funding from the British Heart Foundation, has established FH specialist nurses in many areas of England, aimed at increasing FH cascade testing across the country so that more affected families can be identified. The steering group aims to develop a systems approach to the detection and management of FH.

One third of England is now covered by these FH nurses as well as cascade testing, and over the last three years more than 1,000 new people with FH have been identified.

Software to support cascade testing and provide a database for FH is available and will be increasingly used in England as FH services are established.

NHS England has also identified FH as a possible condition that it could focus on as part of the work looking into personalised medicine and how the NHS might make better use of increased genetic testing.

Finally, a cholesterol test is included as part of the NHS Health Check that is mandated by the Health and Social Care Act for delivery across all local authorities in England. Revised NHS Best Practice Guidance published in February now includes strengthened guidance for detection of FH as part of the NHS Health Check. Every patient with a cholesterol test result above 7.5mmol/l (as per National Institute for Health and Care Excellence guidance) will be alerted to their general practitioner for consideration of FH in combination with other diagnostic criteria.

There are no current plans to introduce specific screening for brain injury within the secure estate for adults. If as part of the general health screen, an adult presents with what is suspected to be a brain injury, a specialist neurological referral would be made.

All children and young people (under 18) within the Secure Estate for Children and Young People are screened for brain injury through part 5 of the Comprehensive Health Assessment Tool.

Healthcare in Immigration Removal Centres (IRCs) is commissioned by NHS England. Testing for infectious diseases among new entrants to IRCs, including Yarl’s Wood, is guided by advice from Public Health England and, where applicable, National Institute for Health and Care Excellence guidance.

New entrants to all IRCs have a symptom-based questionnaire at first reception screening where healthcare staff ascertain whether patients have either signs or symptoms of tuberculosis (TB) or past history of infection or recent contact with someone with TB.

Since 2014, IRCs are advised to offer testing for HIV, hepatitis B and hepatitis C to new entrants as part of an ‘opt-out programme’ for blood-borne virus testing promoted by Public Health England, NHS England and the Home Office through the National Partnership Agreement.

Testing for malaria is usually done following presentation of symptoms consistent with malaria in someone with a history of travel from endemic countries and is not done routinely on asymptomatic patients.

NHS England and Public Health England (PHE) are working to raise the profile of familial hypercholesterolaemia (FH) and break down the barriers to genetic testing.

NHS England’s National Clinical Director for Heart Disease chairs a FH steering group which comprises representatives from relevant stakeholder organisations including representation from PHE’s Healthcare Public Health Team. This group, with funding from the British Heart Foundation, has established FH specialist nurses in many areas of England, aimed at increasing FH cascade testing so that more affected families can be identified. The steering group aims to develop a systems approach to the detection and management of FH. Software to support cascade testing and provide a database for FH is available and will be increasingly used in England as FH services are established.

NHS England has also identified FH as a possible condition that it could focus on as part of the work looking into personalised medicine and how the National Health Service might make better use of increased genetic testing.

Finally, a cholesterol test is included as part of an NHS Health Check. Guidance alerts practitioners conducting the check to consider the possibility of FH in line with National Institute for Health and Care Excellence Guidance. Emerging evidence shows that, compared to routine primary care practice, the NHS Health Check programme is detecting more cases of FH.

The United Kingdom National Screening Committee, the independent body, who advises Ministers and the National Health Service in all four countries on screening matters, is currently reviewing the evidence for human papillomavirus self-sampling as an additional test within the NHS Cervical screening programme.

There is a range of work being undertaken by Public Health England (PHE) to understand the reasons for the decline in cervical screening uptake and to try and address them. They include: providing access to data, benchmarking for providers, and timely and useful information for commissioners; developing behavioural insight through communication with commissioners, providers, patients and public; commissioning contracts in public health and primary care; developing relationships with commissioners and providers; and sharing best practice including what works well, evaluation and how to embed quality improvement.

PHE is working with colleagues in NHS England and NHS Digital to implement the Accessible Information Standard which is intended to improve access to services for vulnerable and disadvantaged groups. Through the re-development of cervical Information Technology systems opportunities will arise to review how to help improve uptake.

PHE supports providers to help meet the Accessible Information Standard through the provision of high quality information for people with learning disabilities or sensory loss. A national group of experts and service users has been set up to oversee this work and will be updating the existing easy read leaflets and developing new materials over the next 18 months.

NHS England closely monitors the coverage rates for cervical screening in all age groups and is committed to improving coverage and reducing variation between all age groups. Local NHS England commissioners analyse coverage rates within their area and work with general practices to improve coverage by sharing best practice.

The United Kingdom National Screening Committee, the independent body, who advises Ministers and the National Health Service in all four countries on screening matters, is currently reviewing the evidence for human papillomavirus self-sampling as an additional test within the NHS Cervical screening programme.

There is a range of work being undertaken by Public Health England (PHE) to understand the reasons for the decline in cervical screening uptake and to try and address them. They include: providing access to data, benchmarking for providers, and timely and useful information for commissioners; developing behavioural insight through communication with commissioners, providers, patients and public; commissioning contracts in public health and primary care; developing relationships with commissioners and providers; and sharing best practice including what works well, evaluation and how to embed quality improvement.

PHE is working with colleagues in NHS England and NHS Digital to implement the Accessible Information Standard which is intended to improve access to services for vulnerable and disadvantaged groups. Through the re-development of cervical Information Technology systems opportunities will arise to review how to help improve uptake.

PHE supports providers to help meet the Accessible Information Standard through the provision of high quality information for people with learning disabilities or sensory loss. A national group of experts and service users has been set up to oversee this work and will be updating the existing easy read leaflets and developing new materials over the next 18 months.

NHS England closely monitors the coverage rates for cervical screening in all age groups and is committed to improving coverage and reducing variation between all age groups. Local NHS England commissioners analyse coverage rates within their area and work with general practices to improve coverage by sharing best practice.

The United Kingdom National Screening Committee, the independent body, who advises Ministers and the National Health Service in all four countries on screening matters, is currently reviewing the evidence for human papillomavirus self-sampling as an additional test within the NHS Cervical screening programme.

There is a range of work being undertaken by Public Health England (PHE) to understand the reasons for the decline in cervical screening uptake and to try and address them. They include: providing access to data, benchmarking for providers, and timely and useful information for commissioners; developing behavioural insight through communication with commissioners, providers, patients and public; commissioning contracts in public health and primary care; developing relationships with commissioners and providers; and sharing best practice including what works well, evaluation and how to embed quality improvement.

PHE is working with colleagues in NHS England and NHS Digital to implement the Accessible Information Standard which is intended to improve access to services for vulnerable and disadvantaged groups. Through the re-development of cervical Information Technology systems opportunities will arise to review how to help improve uptake.

PHE supports providers to help meet the Accessible Information Standard through the provision of high quality information for people with learning disabilities or sensory loss. A national group of experts and service users has been set up to oversee this work and will be updating the existing easy read leaflets and developing new materials over the next 18 months.

NHS England closely monitors the coverage rates for cervical screening in all age groups and is committed to improving coverage and reducing variation between all age groups. Local NHS England commissioners analyse coverage rates within their area and work with general practices to improve coverage by sharing best practice.