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Breast Test Wales review finds women report an excellent experience, but further action needed

We have published our review of how the breast screening process in Breast Test Wales is managed for women who have an abnormal screening mammogram.

Breast Test Wales is the division of Public Health Wales that manages the national breast cancer screening programme for women between the ages of 50 and 70 for NHS Wales. Women who attend Breast Test Wales and have an abnormality identified during their mammogram are then invited to attend an assessment clinic for further tests.

It is important to highlight that this review and fieldwork were undertaken prior to the COVID-19 pandemic and publication of this report delayed due to measures we took to reduce the burden of our work on services during the height of the pandemic. As such, the review has not examined in any way how Public Health Wales has undertaken its role during the pandemic.

Our review found the service is well-organised and has committed staff, who largely felt well supported in their roles with robust arrangements to ensure that a high-quality service is provided. However, staff shortages meant that in some parts of Wales, women experience significant differences in the timeliness of follow-up care.

We found that action was being taken to address the timeliness issues, and that women had an excellent experience when recalled to attend an assessment clinic. Survey responses also praised the professionalism of staff and the care provided by them.

Although breast cancer is only identified in a very small proportion of the women invited to attend an assessment clinic, the experience of being recalled for further tests can cause considerable anxiety and distress. The review findings highlighted that staff strongly believed in the importance of helping to minimise women’s anxiety throughout the process.

The review found women in west Wales had the longest waits for a follow-up appointment, whilst those in north Wales had the shortest waits. Some women in the west waited six weeks or longer for an assessment clinic appointment, which is double the national target of three weeks. This is primarily due to unfilled vacancies for medical staff who run assessment clinics. Recruitment issues also affect the south east Wales region.

Breast Test Wales has responded to these issues by taking a collaborative approach to sharing staff between the south east and west Wales regions. Additionally, the north Wales region completes a large proportion of the mammogram image reporting for the west Wales region. These actions have led to a significant improvement in the timeliness of care. However, there remains a need for a sustainable, long-term workforce plan to ensure these issues are addressed.

Alun Jones, the Interim Chief Executive of Healthcare Inspectorate Wales, said:

The identification of an abnormality following a mammogram can be a worrying experience leading to anxiety or distress. It was pleasing therefore to note the positive feedback from women who had attended an assessment clinic. Our review found Breast Test Wales was a well organised service with committed staff and robust arrangements to ensure a high quality service.

Inconsistency in the timeliness of follow-up care is, however, a concern. Whilst new processes have been introduced to help improve the service, we recommend that Public Health Wales develops and implements a long term workforce plan in order to deliver a sustainable and equitable service across Wales.


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