[An open forum discussion with Health Partners about cancer screening, with a particular focus on breast, bowel and cervical. The general theme will be – “What can we do to make things better”].
Minutes:
The Principal Public Health Specialist introduced the item on cancer screening. She remarked that there was a priority in Public Health to halt the decline of cancer screening rates across the City. She was hoping that all health partners would agree to taking steps to halt the decline and hopefully take measures to see an improvement in the uptake. There were three main cancer screening programmes, breast cancer, bowel cancer and cervical cancer. For each of the programmes there was a specific cohort of those that were eligible. As an example she cited that breast cancer screening was for women that were eligible between the ages of 50 and 70. They were invited to a screening appointment every three years.
The Principal Public Health Specialist remarked that the screening rates for breast cancer in Wolverhampton were lower than the West Midlands and England average. The current rate for breast cancer screening in Wolverhampton was at 56.8% compared to 71.5% for the England average. For bowel cancer screening, the uptake nationally was starting to increase, it was at approximately 71%. In Wolverhampton the rate was at 69% and was not increasing, unlike in England and the West Midlands generally. For cervical cancer screening the rates in Wolverhampton were lower than the England average, but there was a smaller performance gap than in breast cancer and bowel cancer screening. She was aiming to try and fully understand why Wolverhampton was so consistently lower in cancer screening performance compared to the regional and country average.
The Wolverhampton Healthwatch Manager remarked that Healthwatch were producing a report on cancer screening, but it was not yet ready to be circulated. She was however willing to articulate the main headlines from the report. They had engaged with 177 females over a period of time. One of the key findings was that there was a fear of women not wanting to know whether they had cancer. Another area that had arisen was regarding the flexibility of appointments, for instance not always having to attend Monday – Friday. Some females had barriers due to their cultural needs and so they did not want to attend an appointment with a male physician. She also noted that the letters were not currently tailored to a person’s ethnicity.
The Wolverhampton Healthwatch Manager commented that some women had said that they would welcome some peer support to encourage them to attend. Another headline from the report was that not all women knew the purpose of cervical screening. The invitation letter did not explain everything in plain or simple language. There were also some women who believed incorrectly that if they had received the HPV vaccine, then they did not require a cervical screening appointment. She was happy to share the full report when completed with health partners.
The Chief Executive of the Royal Wolverhampton NHS Trust remarked that he found it difficult to understand why the bowel cancer screening rate was falling behind the national and regional rates. He felt that part of the problem was not enough advertising. A story needed to be told of the consequences of presenting late with cancer symptoms. It was much better to be diagnosed earlier than later. He made reference to the strong campaigns that had been undertaken in relation to smoking and argued that this could be the way forward. He felt advertising needed to be pushed harder and for it to be more hard hitting, similar to the approach that had been taken for lung cancer.
The Principal Public Health Specialist was in agreement with the Chief Executive of the Royal Wolverhampton NHS Trust’s points. The bowel screening process had changed, where only one sample was now required, rather than three. The new simpler testing process was something which had not been actively promoted in the Wolverhampton area.
A Panel Member commented that promotion and accessibility were key to improving the uptake of cancer screening. They were of the view that nurses and GPs should be talking to women about cervical cancer screening more. This was echoed by another Panel Member who commented that GPs should be given resources to promote cancer screening. If the promotion of cancer screening was linked to performance related pay, he believed there would be an improvement in uptake rates. He made a comparison to how the uptake in the flu vaccine had increased since their was a financial incentive for GPs.
A Member of the Panel echoed the point on promotion being key. They had worn a football top promoting bowel cancer screening and had been struck by the number of people that had said their test was still in a draw unused.
The Principal Public Health Specialist confirmed that a reminder letter was sent out, if the test had not been returned. By that point though, the test may have been lost by the person and therefore the reminder would not be acted upon. The Chief Executive of the Royal Wolverhampton NHS Trust commented that in his opinion the reminder letter should be sent to the persons GP. The Principal Public Health Specialist commented that they wanted to have discussions with NHS England to try and bring about some changes.
The non-executive Board Member of the Royal Wolverhampton NHS Trust commented that the testing for prostate cancer increased after celebrities, Stephen Fry and Rod Stewart went public with their diagnosis. He suggested that a more hard-hitting message would help to increase cancer screening rates. The Principal Public Health Specialist made reference to the Jade Goody effect on cervical cancer screening. Celebrity endorsements and making best use of the media platform to promote cancer screening services was important to utilise.
The Director for Adult Services made reference to the flu fighters work, he believed the communication campaign was the reason for engaging so many more people. Social media campaigns, looking at the places which the target population were frequenting and using notice boards in those areas would help. Through the Council’s, Safeguarding Board, they had a
Faith Group Engagement worker, who could potentially help engage different communities. He spoke in support of pop up shops to help improve screening rates. Last year Social Services had supported 4,500 people, with approximately 3,500 of them in the target age group. People were regularly going out to these individuals delivering care packages, if there was a simple way to ask certain questions which could then be fed back, he would be happy to assist. He thought care providers would also include this as part of their work.
The Chair thanked Health Partners for their contribution to the item.
Resolved: That Health Partners, including GPs, make all efforts to ensure that the uptake of cancer screening in Wolverhampton does not decline and use all their best endeavours, working in partnership, to try and improve the situation.