Screening inequality report 2024 and 2025

Executive summary

Background

Our vision across the national screening programmes in Wales is that everyone eligible for screening has equitable access and opportunity to take up their screening offer, using reliable information to make a personal informed choice.

This is our third Screening Inequity Report, providing an update on actions described in our Screening Equity Strategy 2022-2025 and bringing together data from across the young people and adult screening programmes with a specific focus on inequity. The update on actions included in the report is up to date as of December 2025 and is structured around the five key areas defined in the Screening Equity Strategy 2022-2025.

This report presents data on those invited for screening from April 2022 to March 2024, presented as 2022/23 and 2023/24 data. Allowing participants six months to take up their offer of screening, this reflects uptake and coverage as of October 2024. The data presented focuses on the determinants and demographic factors that are collected within our routine data collection.

Actions from the Equity Strategy

Our aim is to enable all eligible participants to make informed choices about screening. Our approach identifies a series of commitments to progress action across five key areas:

1. Communication
2. Community and Engagement
3. Collaboration
4. Service Delivery
5. Data and Monitoring

Communication

Key activities have included:

• Standard to provide public information resources in Plain English, Welsh, Easy Read, British Sign Language (BSL), and Audio formats across all screening programmes
• Produced programme-specific BSL videos for: Breast Test Wales (2023); Bowel Screening Wales (2024) and Wales Abdominal Aortic Aneurysm Screening Programme (2025)
• Moved to a Digital-First information delivery in Antenatal and Newborn screening programmes, with printed materials available on request
• Created tailored resources, developed through extensive engagement, for groups facing barriers to screening access including for: Carers and those they support (launched 2024), Transgender and non-binary communities (launched 2025) and the Working Together Guide for people working with ethnic minority communities (July 2024)
• Reviewed participant communications with Behavioural Science lens, ensuring letters and information use clear and concise language with strong calls to action

Community and engagement

Key activities include:

• The Screening Engagement Team has developed a wide network of stakeholders and community partnerships across Wales to support screening awareness and participation. Teams regularly participate in community events across Wales to raise awareness of screening and gather insights to improve access

• Delivering a community training and education model with free screening awareness training to equip community workers as screening advocates within their communities. During 2024/25, ten training sessions were delivered, with more than 150 participants attending

• Establishing a Screening Engagement Network to provide ongoing support for community screening champions including producing a regular ‘Screening Matters’ bulletin to partners, providing updates and information on screening programmes

Collaboration

Key activities include:

• The Screening and Inequalities Group continues to strengthen links between Health Board Public Health Teams and the Screening Division providing a forum for sharing learning and best practice including new developments across screening programmes.

• Development of Screening Information for Professionals webpages to provide a shared learning platform with access to screening-specific resources, information and guidance.

• Develop dedicated SharePoint pages for Primary Care with screening data and insights, evidence-based interventions and best practice toolkits and resources

• Regular engagement with Primary Care through cluster networks

• Collaborative work with Primary Care including GP endorsement of bowel screening invitation letters

Service delivery

Key activities include:

• Establishing Learning Disability Champions within all screening programmes to advocate for the needs of people with learning disabilities, promote inclusion and equitable access and ensure appropriate care, support and screening opportunities are available.
• Provide reasonable adjustments to support participation, including: early morning, evening or late appointments, longer appointment times and pre-visit appointments where available.
• Diabetic Eye Screening Wales (DESW) now offers extended hours clinics on evening and Saturdays to improve accessibility for working-age adults and those who support them to attend appointments.
• Developed a ‘What to Expect’ Breast Test Wales video (2025) to explain the screening pathway from invitation to results.
• Established Prison and Long-Term Care Settings Group to ensure eligible people in these settings receive appropriate invitations for screening. Screening programmes have developed links with all prisons in Wales to support access to screening services for eligible individuals.

Data on inequity

• There is geographical variation in uptake of screening at Health Board and Local Authority level.
• There is a social gradient in uptake of screening, people living in the most deprived communities in Wales are less likely to take up their offer of screening compared to those living in the least deprived communities.
• For programmes that invite people across age groups there is an inequity in uptake of screening offer with people in younger age groups less likely to take up their offer of screening than people in older age groups.
• For the diabetic eye screening programme which invites people across the lifecourse, coverage varies by age however, coverage is higher in the youngest age groups with lowest coverage in working age adults.
• For programmes that invite all genders to participate in screening, in bowel screening there is an inequity of uptake with men less likely to take up their offer than women, though the inequity gap is small. For eye screening, there is an inequity gap with women less likely than men to take up their screening offer, though the inequity gap is small.
• For programmes where people are invited more than once, people who have attended are more likely to respond to subsequent invitations.
• The inequity gap in uptake/coverage for people in the most disadvantaged communities compared to the least disadvantaged communities is persistent in time across all adult and young people screening programmes.

Table 1: Difference in uptake between most and least deprived quintile

Programme	2023/24	2022/23	2021/22	2020/21	2018/19
Programme Bowel	2023/24 16.9%	2022/23 16.2%	2021/22 15.9%	2020/21 14.5%	2018/19 16.5%
Programme Breast	2023/24 17.3%	2022/23 19.6%	2021/22 15.3%	2020/21 18.9%	2018/19 15.9%
Programme Cervical	2023/24 14.6%	2022/23 14.3%	2021/22 13.2%	2020/21 12.1%	2018/19 11.5%
Programme AAA	2023/24 18.3%	2022/23 17.2%	2021/22 12.4%	2020/21 8.4%	2018/19 12.8%
Programme DESW	2023/24 8.9%	2022/23 6.8%	2021/22	2020/21	2018/19

Recommendations and conclusions

Achieving our vision for equitable access and opportunity for everyone eligible for screening is a long-term goal and ambition. This will require coordinated and committed action across the screening system led by Public Health Wales. The introduction of a Screening Equity Strategy has provided the strategic direction needed to highlight this as key priority for the Screening Division.
However, translating this into real shifts in screening inequities remains challenging as demonstrated by the persistent inequity gap in uptake/coverage for people in the most disadvantaged communities compared to the least disadvantaged communities seen across all
young people and adult screening programmes. The data from the Screening Inequity Report will inform the focus of targeted interventions required within the new Screening Equity Strategy and its supporting Screening Equity Action Plan.

Links to relevant Public Health Wales work

• Screening equity strategy 2022-2025
• Screening division inequities in uptake Report 2020-21

Cite this publication

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Acknowledgement to Public Health Wales NHS Trust to be stated.