National Screening Advisory Committee: Recommendations

The NSAC use international evidence to consider whether to recommend the establishment of new national screening programmes or modifications to existing programmes.

The NSAC Criteria for appraising the viability, effectiveness and appropriateness of a screening programme for reviewing evidence relating to introduction or modification of screening programmes is available on this website.

The NSAC has made the following recommendations which have been approved by the Minister for Health:

1. The addition of Adenosine Deaminase Deficiency - Severe Combined Immunodeficiency (ADA-SCID) in the list of conditions to be screened for as part of the National Newborn Bloodspot Screening Programme (NNBSP):

• at its meeting on 17 July 2020, the NSAC approved the application of the Governance Group of the National Newborn Bloodspot Screening Programme to add ADA-SCID to the list of the 8 conditions currently screened in the existing programme
• Severe Combined Immunodeficiency (SCID) is a group of inherited disorders of the human immune system and, unless treated, is fatal in infancy
• with the introduction of screening for ADA-SCID, affected babies will be identified earlier, commenced on treatment earlier and outcomes will be improved
• this recommendation is currently being progressed by the HSE and is included as part of the HSE National Service Plan 2021

Read further information (decision/recommendation).

2. Modification of the National Diabetic Retinal Screening Programme, to extend the interval between screens from one to two years for people with diabetes who are at low risk of retinopathy:

• at its meeting on 15 October 2020, the NSAC approved the modification of the National Diabetic Retinal Screening Programme. This will now change from once a year to a every two- year appointment for people who are deemed eligible.
• the new pathway will reduce the number of screening appointments and reduce unnecessary clinic visits and examinations for those at lower risk for diabetic retinopathy
• the modification to the Diabetic RetinaScreen was announced by the HSE on 16 February 2021
• the decision on modification of the Diabetic RetinaScreen Programme was informed by the following document produced by HIQA to support the work of the NSAC: HIQA Scoping Report Protocol - Extended Interval Screening by the Diabetic RetinaScreen Programme in Ireland

Read further information (decision/recommendation).

3. Modification of the National BowelScreen Programme, to adopt the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines to ensure that BowelScreen is aligned with current clinical practice across the symptomatic service in the HSE.

• This proposal concerning the BowelScreen programme was received by the Committee from the National Screening Service BowelScreen programme, in response to the first Annual Call for proposals, which ran during November and December 2021. The proposal came to the National Screening Advisory Committee (NSAC) as the Bowelscreen Programme incorporates surveillance as part of the full pathway.
• At its meeting on 17 February 2022, the NSAC considered and approved the proposed modification of the BowelScreen Programme.
• This change will update the current surveillance pathways for people who, after their initial screening test, go on to have a colonoscopy and removal of pre-cancerous polyps, and will have the operational effect of changing the frequency of post-polypectomy surveillance for some patients.
• The recommendation was approved by the Minister in March 2022 and will now be implemented by the HSE.

Read further information (decision/recommendation).

4. The National Screening Advisory Committee recommended the addition of the group of Severe Combined Immunodeficiency (SCID) conditions to the National Newborn Bloodspot Screening (NBS) Programme.

• At its meeting on 08 December 2022 the Committee decided to recommend to the Minister for Health that screening for Severe Combined Immunodeficiency (SCID) should be added to the National Newborn Bloodspot Screening Programme on the basis of the evidence provided in the Health Technology Assessment (HTA) carried out by HIQA.
• On 03 January 2023 the Minister for Health, Stephen Donnelly approved the recommendation made by NSAC in relation to Severe Combined Immunodeficiency (SCID)
• SCID is a group of rare but serious inherited conditions which are almost uniformly fatal in first year of life without appropriate treatment.
• The introduction of screening for Severe Combined Immunodeficiency (SCID) will result in the condition being identified earlier which will enable early treatment and improved outcomes for babies affected.
• Work will now begin by the HSE to prepare to plan for implementation of the addition of the group of SCID conditions to the NBS Programme.

5.The National Screening Advisory Committee (NSAC) recommended the addition of Spinal Muscular Atrophy (SMA) to the National Newborn Bloodspot Screening (NBS) Programme.

• At a meeting of the NSAC on 20 October 2023, the Committee decided to recommend to the Minister for Health that SMA be added to the National NBS Programme based on the evidence outlined in the comprehensive Health Technology Assessment (HTA)completed by HIQA.
• The Minister for Health, Stephen Donnelly formally approved the Committee’s recommendation in relation to SMA on 26 November 2023.
• SMA is a rare but serious genetic neuromuscular disorder, which can have very significant effects on children, including infant mortality and serious permanent disabilities such as walking and breathing difficulties.
• The introduction of screening for SMA will enable earlier identification and diagnosis, thereby facilitating earlier disease management and treatment.
• Minister Donnelly has asked the HSE to commence implementation planning to prepare for the addition of SMA to the National Newborn Bloodspot Screening Programme.

6. The National Screening Advisory Committee (NSAC) does not recommend the development of a universal ultrasound screening programme for developmental dysplasia of the hip (DDH) in infants.

• A proposal was received through the 2022/2023 Call for Submissions, supporting the introduction of a universal screening programme for DDH. This would have involved all babies being routinely referred for ultrasound examination, to be performed by 6 weeks of age.
• At its February 2023 meeting, NSAC agreed to submit a request to the Health Information and Quality Authority (HIQA) to look at the evidence in other jurisdictions in relation to ultrasound screening of all newborn babies for Developmental Dysplasia of the Hip.
• HIQA presented the results of its evidence review report at the December 2023 NSAC meeting. The report noted that recommendations for a selective ultrasound screening programme for DDH in Ireland were published in 2017. These recommendations are included as part of the diagnostic pathway for DDH, referred to as a targeted clinical diagnostics programme. As part of this programme, infants who are at greater risk of DDH may be selected for ultrasound examination.
• Considering universal screening, the report found that there was limited evidence to suggest that universal ultrasound screening for DDH, compared to selective ultrasound screening, would lead to improved functional outcomes, decreased need for surgical interventions, and reduced harms. As a result, there was significant uncertainty regarding the relative benefit of introducing a universal ultrasound screening programme in Ireland.
• After careful consideration of the details presented in the comprehensive HIQA report, NSAC decided that there is currently not a sufficient level of evidence available to support an expansion of screening for DDH. A recommendation was made to the Minister for Health on this basis, advising against establishing a universal ultrasound screening programme for DDH.
• The full HIQA report was published on the HIQA websitein May 2024.