As our petition to guarantee women’s access to breast screening reaches over 50,000 signatures, we break down the government’s initial response and explore the issues it still needs to address.
As our petition to guarantee women’s access to breast screening reaches over 50,000 signatures, we break down the government’s initial response and explore the issues it still needs to address.
Last month, we teamed up with Julia Bradbury and Dame Joan Bakewell to launch a petition for government to invest in breast screening. On International Women’s Day, we held a parliamentary reception to launch our blueprint for transforming the breast screening programme over the next 5 years.
All parliamentary petitions that get 10,000 signatures receive a public response from the government. Unfortunately, their reply to our petition does little to reassure that they’re serious about fixing the screening programme’s underlying issues.
Breast screening numbers have not recovered
As the government notes, the breast screening programme was heavily disrupted by COVID-19. The number of women who had routine breast screening in 2020/21 fell by almost 720,000 from the year before. While the increase in breast screening that followed last year was welcome, it’s not enough to make up for the shortfall that built up during COVID-19.
Also, the increased number of women screened last year was a result of the delayed invites being sent out, rather than more women attending. In reality, the proportion of women responding to their screening invite in England remained at a record low of 62% in 2021/22 - the lowest level of uptake across all UK nations.
Providing convenient, flexible, and equitable access to screening is a core principle of our screening transformation blueprint. The measures we’re suggesting will help drive uptake and mitigate the damage caused by COVID-19 over the next 5 years.
Some of the key issues that the government needs to address are:
Inequalities in screening are not monitored
We know that women living in areas of higher deprivation are less likely to attend screening - a trend the government acknowledges in their response. However, the breast screening programme itself doesn’t publish any data on how breast screening varies depending on deprivation, or any other wider characteristics linked to poor uptake. Without good data on how these factors affect someone’s access to screening, local services will always be limited in how they understand and try to address existing barriers.
This is why our screening transformation blueprint calls on NHS England (NHSE) to give local teams access to real-time breast screening data, including insights into inequalities, so that action can be taken.
Mobile vans aren’t a catch-all solution
The government focuses on the rollout of additional mobile screening units, noting it as the “best way to increase capacity in breast screening while also improving access and addressing health inequalities”. Mobile units can make breast screening easier to access, but accessibility is more than just a question of location. More often, it’s a combination of practical, financial, geographical, informational and social barriers that make screening increasingly inaccessible. Women from certain ethnic backgrounds, women with disabilities and members of the LQBTQIA+ community are less likely to attend screening. Lack of information or misconceptions about the screening process can lead to fewer people taking up their invite. Fears about facing stigma, beliefs about modesty, and related worries about maintaining dignity also play a part.
What’s more, these mobile vans still need enough staff to run properly, and there are real workforce shortages that make this difficult.
Our screening transformation blueprint argues for breast screening uptake to be a core focus of plans to tackle inequalities and highlights the need for a long-term, fully funded workforce plan.
Incremental changes and short-term thinking are not good enough
The government response also notes that last year, as a part of the July 2022 Women’s Health Strategy, £10 million was awarded to the NHS breast screening programme. We welcomed this investment, but the truth is that limited one-off budgets and minor improvements will never be enough to fix the fundamental problems in the system.
The £10 million funding, spread across all of England’s 78 screening units, includes spending to refurbish an existing mobile unit and replace old equipment, and some upgrades to better connect screening units to the rest of the system. We have no doubt these improvements are sorely needed, but they’re unlikely to have a meaningful impact on national uptake or remove the need for a complete overhaul of the IT system, which is outdated and prone to failure.
In our screening blueprint, we’ve highlighted the steps that must be taken to ensure the breast screening programme has the resources it needs to succeed.
The lack of ambition is genuinely concerning
The actions highlighted by the government to help improve uptake are mostly focused on catching up with sending out screening invites which were delayed due to the pandemic. However, breast screening uptake was steadily declining for over a decade pre-pandemic, for reasons that are not addressed in their response.
Regional screening teams have been asked to create “uptake improvement plans” for their area, but the biggest systemic problems impacting uptake, like poor data systems, can only be addressed by national level transformation and leadership.
The recommendations in the screening transformation blueprint are designed to support local screening teams in their work, while keeping a national focus on modernising the programme.
What’s next?
It’s clear that more work needs to be done to get the government to commit to meaningful breast screening transformation. That is why we’re asking people to keep signing our petition, so we can secure a parliamentary debate on this issue, as well as build support for the changes put forward in our screening transformation blueprint.