Health screening: equity in screening strategy 2023 to 2026

Introduction

Stark inequalities exist within Scotland's national screening programmes. These inequalities are unfair and avoidable and – despite effort in recent years – have not improved meaningfully.

We face a number of challenges. In particular, our knowledge of where inequalities exist, and for whom, remains unacceptably limited. Some groups of people can experience barriers to participation, and our understanding of such barriers and how to address them is incomplete. We also lack evidence of our impact to mitigate against inequalities in screening.

This doesn't mean that there has been no progress in recent years. In terms of national interventions, the greatest impact on inequalities has been the introduction of the faecal immunochemical test (FIT) in the Scottish bowel screening programme in November 2017. The FIT provides a more acceptable screening test for participants, and this has led to an increased uptake in bowel screening by men, and a slight reduction in the gap in uptake between those living in more deprived areas and more affluent areas. However, despite this, bowel screening continues to have the lowest uptake of all screening programmes. There is no one single thing that will address persistent inequalities.

At a local level, the impact of interventions by NHS Boards is likely to have resulted in positive changes to screening inequalities. However, the quality of evidence associated with local intervention makes it difficult to document impact, and to make the case to scale up interventions more widely across the country.

There is much to do, but we benefit from an engaged and committed community of professionals across the screening landscape. This first Equity in Screening Strategy, which has been produced in collaboration with all of those with an interest, sets out our vision to achieve equity for those eligible for screening. We document five areas where we think action is needed and we describe the outcomes we want to achieve.

This is a complex issue and success will only be achieved through incremental improvements and a sustained focus over the longer term. Progress will require leadership, collaboration and ambition, and this work must be a priority for Scotland's national screening programmes, and for everyone who supports them. Everyone involved, across the full screening pathway, must acknowledge the issue, understand the challenge, and take evidence-based approaches to better support those people who will benefit the most.

Gareth Brown, Scottish Director of Screening