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Access to cervical screening is unequal, declining and risking lives

Mon, 11/06/2018 - 09:25

New report calls for urgent review of how programme is delivered

Jo’s Cervical Cancer Trust is warning that failings in the delivery and development of the cervical screening programmes have led to declining and unequal opportunities for women to access the potentially life-saving test. It says urgent action is needed, cautioning if changes are not made, then lives will be at risk.

In its new report ‘Computer says no[1], launched during Cervical Screening Awareness Week 11-17 June, the charity is calling for an urgent audit to identify where inequalities exist and for greater oversight and investment to ensure the programmes are fit for purpose and future-proofed.

Cervical screening, which prevents 75% of cervical cancers, is largely delivered in GP practices with five million women invited every year in the UK. However, new research[2] by Jo’s Cervical Cancer Trust has found a worrying one in eight women find it difficult or even impossible to book an appointment. 7.4% of women were told no appointments at their GP practice were available the last time they tried to book.

Opportunities to access screening through sexual health services have been rapidly declining and are unequal across the UK. Since 2013 there has been a 52% reduction in samples taken through sexual health services in England and a 42% reduction in Wales.[3] This is further concerning as there is a greater risk of cervical cancer among those accessing the service. In England 5.2% of samples taken at a GP come back as abnormal compared to 8.1% in NHS Community Clinics (mainly sexual health services) and 12.3% in GUM clinics[4].

The charity is highlighting a number of factors which it believes are contributing to declining attendance, including a lack of long-term planning and oversight, a complex commissioning environment, lack of incentive and resource for screening to be delivered in sexual health services and IT systems preventing innovation. The report raises further concerns over the disjointed governance structure in England which it believes has resulted in responsibility not being taken for aspects of the programme including an IT system, comprising of hundreds of databases, which was worryingly deemed “no longer fit for purpose” in 2011.

It identifies certain groups of women who are further disadvantaged as a result of the current delivery including transient populations, those with a physical disability and women who have experienced sexual violence.

The charity is calling for greater accountability and responsibility to be taken to address the problems that exist:

  • An audit to be carried out in each country with Government, NHS, commissioners, providers and public health specialists working together to identify the problems that exist
  • The Department of Health and Social Care, along with NHS England and Public Health England, to conduct an immediate review of the IT landscape in England and commit to investing in a system which is fit for purpose, fit for the future and safe
  • Women having to wait a maximum of four weeks for an appointment in primary care with more early morning, evening and weekend appointments made available in GP practices
  • An integrated approach to commissioning and delivering screening taken across primary care and sexual health with adequate resourcing and funding, including a national budget line for cervical screening in sexual health services in England
  • Funding for large-scale pilots on self-sampling, which 80% of women would prefer to use
  • Innovation in the delivery of the programmes including more digital methods of communicating with women

Robert Music, Chief Executive, Jo’s Cervical Cancer Trust, said: “We have fantastic and highly effective cervical screening programmes saving thousands of lives every year. We know they can save many more, however this is only if it is made easier for women to access the programme. We must act now to ensure the programmes are fit for the needs of the current, and future population with the right infrastructure, resource and funds to provide safe, accessible programmes. We know that we can make cervical cancer a disease of the past but we won’t get there if cervical screening attendance continues to fall.”

Paula Sherriff MP and Chair of the All Party Parliamentary Group on Women's Health said: “Cervical screening is the best protection against cervical cancer and I support Jo’s Cervical Cancer Trust in their calls to make it easier for women to access the test. There are many reasons which can make attending cervical screening difficult, including fear and embarrassment, so it should not be the case that women are also struggling to get appointments. There is a clear need for action and I will be working with Jo’s to ensure it happens.”

Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: “Every day in the UK, eight women are diagnosed with cervical cancer and three lose their lives to the disease, yet cervical cancer is largely preventable due to the cervical screening programme and the human papillomavirus (HPV) vaccination. Early detection is key to increasing survival rates so we are very concerned to hear that one in eight women find it difficult to make an appointment. We are working with the Royal College of General Practitioners and Faculty of Sexual and Reproductive Healthcare to ensure women have access to cervical screening appointments and GP surgeries are adequately funded to meet this need.”

Dr Anne Connolly, Vice President of the FSRH, said: “The new report by Jo’s Cervical Cancer Trust sheds light on an increasingly neglected part of women’s healthcare: cervical screening. Screening rates are now at their lowest in two decades and the minimum 80% national target is far from being achieved. It comes as no surprise that access to cervical screening in community sexual and reproductive health services has been declining. Cervical screening is a not a mandated requirement for local authority commissioning and, therefore, local authorities do not have an obligation to include this essential aspect of women’s health care in their service specifications. Cuts to SRH services by local authorities under severe budgetary pressure further compounds the problem, and primary care is not able to effectively meet the increased demand, missing the chance to offer opportunistic screening, an effective way of increasing uptake.

These factors act as barriers on top of the existing ones, effectively preventing women from pro-actively or opportunistically attending screening. FSRH supports Jo’s Cervical Cancer Trust call for an integrated approach to commissioning and delivering screening across primary care and sexual and reproductive healthcare with adequate resourcing and funding. It is also important that service specifications for SRH services include cervical screening and that reduced access does not inadvertently increase inequality of provision.”

One in four women don’t attend cervical screening when invited and during Cervical Screening Awareness Week Jo’s Cervical Cancer Trust will be addressing the different barriers to attendance and talking about how the test can be made easier for more women and people with a cervix to attend.  Find out more at www.jostrust.org.uk/csaw and join the campaign using #SmearTestsSaveLives


For further comment, interviews or case studies please contact [email protected] or call 07772 290064

Notes to editors

[1] www.jostrust.org.uk/access

2 Survey of 2,031 women aged 25-64, fieldwork was undertaken from 21.05.2018 - 23.05.2018 by Censuswide

3117,028 samples taken through GUM and community clinics in England in 2013/14 dropping to 56,347 in 2016/17. 10,254 taken from Integrated Sexual Health Clinics in Wales in 2013/14 to 6,002 in 2016/17. www.jostrust.org.uk/access

4 https://digital.nhs.uk/data-and-information/publications/statistical/cervical-screening-programme/cervical-screening-programme-england-2016-17


Supportive case study quotes

Helen, said: ““I had great difficulty booking my last smear as there were no appointments for over six weeks so I had to wait for new appointments to be released. By the time I got through on the phone, the appointments would be booked up for another week as the nurse only does tests one afternoon per week. I eventually had my test 5 months late and am now on yearly smears to an abnormal result. This year when my reminder letter came I called my surgery but again they were booked up for weeks with appointments only available on Thursday afternoons which I could not make due to work as I’m a nurse and unable to swap shifts once the rota is out. My local hospital only does smear testing on Thursday afternoons too. I was offered a walk in service in their GUM Clinic with the condition I had a full STI check at the same time, I’m a married woman so this was a mortifying experience for me. All this to have a test we are told is vitally important not to avoid! Smear testing should be easily accessible for all women.”

Cate Shelmerdine, said: “For the last 20 years I have had my test at my local sexual health and contraception centre. It meant I could go around work and school runs as well as helping with nervousness and embarrassment as the test can be done at the same time as things such as fitting my coil. I’m so much more at ease with the clinicians there too. My last test was due in November but I was told by the centre that they can no longer do smears due to funding being stopped. It has taken almost six months to get an appointment with a GP due to lack of appointments, them rearranging appointments and irregular periods. It’s made me really anxious. I feel strongly that by reducing where women get their smears done, the already low uptake will get even lower and as a result more women will go undiagnosed until it is too late.”

New research by the charity has found:

  • Almost one in ten (9.2%) were only offered times they couldn’t make the last time they tried to book and 7.4% were told there were no appointment available
  • A quarter (24%) only offered appointments during 9-5
  • Over one in ten (11%) don’t want to delay attending but feel they have no choice as they can’t get a suitable appointment
  • Almost two fifths (18%) struggle to get an appointment around work and 7% had to take annual leave to attend
  • A quarter (28%) want greater flexibility of appointments at GP surgeries rising to a third (33%) among those that have delayed
  • 15% of women would be more encouraged to go if they could access a drop-in service at their GP surgery, a walk in appointment at a sexual health service (13%), attend at a community clinic (12%), or a mobile screening clinic (12%)
  • 11% would be encouraged to attend if they didn’t have to take holiday
  • Only half (49%) of women said they found it easy to book an appointment, falling to 42% among those that have delayed