Scottish Breast Screening Programme: major review

Introduction

Objectives & Scope of the review

The review of the Breast Screening Programme in NHS Scotland was commissioned to take account of previous reviews, recent incidents affecting the programme, current pressures and future options for delivery. National Services Division (NSD), the (then) Breast Screening Quality Assurance Reference Committee and the six Breast Screening centres advised that a fundamental review of the delivery of Breast Screening programme was required due to a number of factors including:

• Call and Recall
• Programme Slippage and Waiting Times
• Programme Standards
• Adverse Events
• Workforce

The scope of the review did not include a review of whether breast screening should continue to be made available, or the current National Screening Committee advised parameters. This is the remit of the UK NSC which advises the Scottish Government.

In the scope of review:

• Future requirements and population needs
• Expected Standards of Delivery
• Basis of Call/Recall processes (GP Practice Calling)
• Location of screening
• Workforce requirements
• Evidence base for current SBSP policies - in relation to age parameters & self- referral, radiology reading, workforce practice
• Technology – IT and new technology potential
• Addressing health inequalities, tackling known barriers to screening, and improving access to ensure that those in greatest need benefit fully

Out of scope of the review:

• Other Screening programmes
• Future risk stratification of breast screening (evidence is not yet proven)
• Use of Genetic testing for breast screening (evidence unlikely to be available)
• High level governance of breast screening (SG review of Screening)

Review Objectives

• To review the current Breast Screening Programme in Scotland.
• To make recommendations on the future delivery of the Programme.
• To make recommendations on policy direction for the Breast Screening Programme
• To develop costed options for service redesign for consideration by NSD, the screening programme governance structure, NHS Boards and Scottish Government

The Scottish Screening Committee gave support for the major review in November 2018, and subsequently the review was granted Ministerial approval in June 2019.

Approach to the review and Review Governance

The review was informed by standard NSS project management methodologies. The standard approach to reviews as formally conducted by NSD was adapted because of the complexity of the SBSP and the number of independent work streams involved.

An Independent Review Group and Review Team (Review Group secretariat) was established with wide membership from key stakeholders, including the third sector. The review was chaired by an NHS Board Chief Executive.

The Review Team was responsible for the day to day management of the review. The Independent Review Group took responsibility for guiding the review, appraising evidence collected, and producing the review recommendations.

Strategic guidance and assurance were provided by the NSD Senior Management Team. Expertise was obtained from other parts of NSS, in particular Digital and Security, Procurement and Facilities teams in Health Facilities Scotland, and from Public Health Scotland.

The review was originally planned to be undertaken over a twelve-month period commencing in October 2019, however an extension of six months was subsequently approved for the review programme to allow for significant delays in obtaining data, and to help compensate for the impact on the review of the covid-19 response. The review was therefore undertaken over October 2019 to March 2021. The review report, following approval by the Independent Review Group in March 2021, will be taken through internal governance within NSS, and submitted to the Breast Screening Programme Board and the National Screening Oversight Board. The final report will be submitted to the Scottish Screening Committee thereafter.