Breast Screening Modernisation Programme Final Report

30 Nov 2025 03:43 PM

This report presents findings and recommendations from Scotland’s Breast Screening Modernisation Board. It outlines challenges in the breast screening programme and proposes steps for a more efficient, sustainable, equitable, and participant-focused service. Request appendices at screening@gov.scot.

Chair’s Foreword

The need to update the Scottish Breast Screening Programme (SBSP) was well researched and articulated in the 2021 Major Review of the Scottish Breast Screening Programme. This Review was supported and then endorsed by Scottish Government, which accepted the 17 recommendations.

This all occurred against the background of the pandemic. Covid had a profound and far-reaching impact on all health services but screening programmes, which were temporarily paused during the first lockdown, were particularly affected.

Breast Screening was hit hard by a 5-month total shutdown, and the recovery from the incurred slippage has been a long, hard journey for the whole service.

As with all adverse events, some good as well as bad came out of this. New ways of working were necessary and became part of normal practice. Meetings could be held online, saving hours of travelling. Hybrid working in some roles became possible. Culture changed around selfcare, and the uptake for screening went up significantly as the population took a greater interest in their own health outcomes.

As a result, a rethink was required around the review recommendations and SG agreed with the Scottish Director of Screening, Gareth Brown, that a Modernisation Programme was required to revisit the Review and look afresh at the Service post pandemic. It has been my privilege to Chair this Modernisation Programme.

Much had changed and already been modernised through the work of the Service tackling the recovery processes. This meant that from the outset there was significant overlap between the work of the Modernisation Board and business as usual (BAU).

However, despite the Service’s best efforts, the truth is that the Scottish Breast Screening Programme post pandemic was, and is, in a challenging position: key roles at senior level have been difficult to recruit to; chronic staff shortages generally mean that those within the service are under real pressure; and ageing infrastructure and equipment failures are leading to unacceptable amounts of downtime, cancellation of appointments and potential reputational damage.

The result of these issues is that, although we continue to meet KC62 standards as is adopted practice, time frames are slipping, with slippage edging towards a four year-round in some circumstances, despite Herculean efforts to pull this back. There is no firm evidence that demonstrates a significantly reduced mortality from breast cancer at this interval.

More generally, although there has been targeted investment in specific technical advances such as digital mammography, the baseline funding which supports the nationally commissioned Breast Screening centres has not been reviewed since the establishment of the programme more than 25 years ago and has only received the modest annual inflation-related uplift. As such, the current allocations are an artefact of history rather than a reflection of the current realities of delivering the programme.

For all these reasons, the six individual host boards and six assessment centres have been firefighting problems locally, leading to significant divergence in the way they provide Breast Screening. It is a fair assessment to say that a truly “National” Breast Screening Service currently exists only in name.

So, the importance of this Modernisation Programme cannot be overstated.

This report has been prepared to summarise the work of the Modernisation Programme over the last three years. The 2021 Review, and other areas of modernisation within the service have been explored as far as capacity allowed, and the result is that the programme is able to present to Scottish Government a clear set of deliverables to update and truly modernise the Breast Screening service. It represents a comprehensive review of the key processes within the programme post Covid, makes well informed and evidence-based recommendations, and outlines projects for delivery, which will allow Breast Screening in Scotland to adapt and grow.

The detail of these deliverables can be found in the following sections of the report and its appendices. Each of the workstreams can be viewed and undertaken as standalone projects which will help some of the key stress points within the system. However, the key to all of these is the overarching new management model: this is the fundamental change needed to modernise Breast Screening in Scotland and will underpin and enable all aspirations to ensure deliverables can be achieved in good order.

The message from the Modernisation Board is unanimous and clear. Investment and change in this service is required to ensure a safe, sustainable and robust service continues to exist in the years to come and so is able effectively to deliver reduced mortality from breast cancer within the eligible population.

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