Deloitte sheds light on the barriers faced by vulnerable populations, disparities in cancer screening, and strategies for equitable access.

Britain has the worst five-year survival rates for three of the most common cancers, and more cancer deaths than any other G7 country. According to Cancer Research UK, this is in part due treatment delays and late diagnosis of cancers. Unfortunately, the UK expects cancer cases to rise by a further 20 per cent by 2040, which would imply 20,000 people dying from cancer each year.

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Cancer screening is one of the most effective tools to identify cancer early and save lives - yet participation rates across the country vary significantly. People living in deprivation have much lower participation rates for screening and poorer health outcomes. This is why Deloitte conducted a study into participation and access with a focus on cancer screening.

We focused on cancer screening in the first instance, with a deep dive into bowel and cervical screening. Uptake ranges from as low as 10 per cent up to nearly 100 per cent across different areas. By plotting enriched census data against GP-practice participation rates, we developed several hypotheses that will be detailed in our upcoming report.

To gain a better understanding of Core20Plus5 and minority ethnic groups, we conducted ethnographic research, interviewed subject matter experts, and ran online focus groups. Our analysis showed that areas with high levels of rental accommodation only had 44.5 per cent uptake for breast screening, versus a 76.6 per cent uptake in areas with low levels of rental accommodation. In other words: High housing mobility appears correlated with a 32.1 per cent drop in participation levels.

How renting impacts screening

Renters are more likely to suffer economic deprivation and move addresses, which makes them vulnerable to missing communications given the reliance on postal mail by the NHS. If addresses are not up to date, vital tests for bowel cancer and screening invitations do not reach people. To make matters worse, there is no reliable way of tracking where post and test kits are received or returned by recipients. There appears to be no central process in place to amend addresses or notify agencies when mail is returned.

“There are different ways to find people – email, text as well as post. It costs very little but it’s not being done. Are we convinced we are doing that across the country? The answer is almost certainly no.” Cancer Screening Governance Expert”

Another likely contributing factor could be over-reliance on GPs: In population areas that have a high degree of housing mobility and flux, people are less likely to enter into lasting relationships with a GP, and possibly not enroll at all with their local GP practice.

Simple, life-saving screening invitations and/or test kits are not reaching people and renters appear more adversely impacted. Cancers are being diagnosed at later stages, with lower chances of survival. The low screening rate puts financial strain on NHS resources, because late-stage cancers are more costly to treat. Beyond the health economic impact, there are tragic human costs to finding and treating cancer late – with potentially fatal consequences.

What needs to change?

Research conducted in the London Borough of Hackney revealed that 37 per cent of the population do not use digital technologies regularly. Registering with a GP, updating addresses and receiving health information often involve digital forms and devices, which become barriers. We cannot simply rely on digital channels or the NHS App as a panacea, since many people do not have access to a computer or mobile phone with a comprehensive data plan.

Our research also found lower levels of trust with health services among these populations. Competing priorities such as being able to get time off work when employment is insecure or people’s ability to afford transport, impacts the likelihood of registering with a GP and proactively managing their health.

Tackling the challenges associated with notifying people about screening will require engagement to be personalised to individual and community preferences. This requires an omni-channel strategy and joined-up communications across SMS, email, social media as well as community outreach in collaboration with trusted local organisations. More inclusive approaches for the design and implementation of prevention services have yielded significant benefits in other health jurisdictions and include “assisted channels” as well as Telco sponsored “whitelists” for online resources.

To access the full research findings and find out more, please contact Thorsten Engel to receive a copy of the report and an invitation to our upcoming webinar. We will also use the webinar to discuss findings and lessons learnt from other jurisdictions.