Information for Local Health Boards
Networking across Wales
Breast Test Wales has operated as a all-Wales organisation from its inception. It is organised on a Divisional basis (South East, West and North), each aiming to invite all eligible women who live in the area every three years. Breast Test Wales was set up in 1989, before NHS Trusts and Local Health Boards were introduced.
In order to ensure that the service was appropriate to the needs of women in Wales, the Welsh Breast Screening Advisory Group was established by the (then) Welsh Office to advise on the development of the service. Breast Test Wales still delivers the service according to that advice.
Breast Test Wales is a single, directly managed all-Wales service, commissioned by Health Commission Wales. Screening is organised from centres in Cardiff, Swansea and Llandudno (with its satellite in Wrexham). They are supported by ten mobile screening units, in order to ensure accessibility to the service, given the sparse population of large areas of Wales. About 90% of women are screened on the mobile units.
If an appearance that may be cancer is seen on the mammograms, further tests are carried out in the screening centres by Breast Test Wales’ skilled multi-disciplinary assessment teams. Within each team is a specialist breast surgeon, contracted from a hospital in the local Division. Women who need treatment are then directly transferred to the symptomatic services as ready diagnosed breast cancer cases. They may stay with their assessment team or choose to be treated by another surgeon. If they stay with their assessing surgeon, arrangements are made for them to be admitted directly and they do not normally need to go to the hospital breast clinic.
Breast Test Wales now has 14 multi-disciplinary teams providing assessment clinics and linking directly to treatment services in ten hospitals across Wales. Over one in every three breast cancer cases are now diagnosed through screening.
The screening schedule
The order in which practices across Wales are screened was set during the years 1989 to 1996. It was determined by various factors, such as:
- the availability of the multi-disciplinary teams. These took some time to establish;
- the establishment of the static centres and the procurement of the mobile units;
- geographical considerations - if possible, avoiding the more distant areas in the winter and holiday towns in the summer;
- the implementation of the programme in England, especially along the Wales/England border.
The first round of breast screening in Wales started in February 1989 with women being invited to the Cathedral Road centre in Cardiff. In October 1989 the first mobile unit was brought into operation, visiting localities in Taff Ely and Rhondda. In October 1991 the Llandudno centre opened and began screening the local area. In January 1992 the Swansea centre opened and began screening there. Mobile screening started in North (at Llanrwst) and West Wales (at Crosshands) in 1992.
There have been minor alterations to the order in which practices are screened so that a more even workload per multi-disciplinary team can be achieved. However, this can only be done in exceptional circumstances as it inevitably results in some women undergoing an increased interval between screens as the programme is adjusted. In general, the pattern set down in the early years has to be maintained.
The above results in an uneven workflow within each Local Health Board area and each Trust catchment area over the three year screening round, as the mobile units move around Wales. There are times when two or more mobiles are working quite close to each other and others when no screening is taking place in an area.
Breast Test Wales always tries to allocate women who need more tests to a multi-disciplinary assessment team which links to a convenient local hospital. However, women will be assessed by a different team if the most appropriate clinic is already full (usually because of the uneven workflow) or if one or more members of the multi-disciplinary team is on leave. Women then tend to choose to stay with the surgeon they have seen at the assessment clinic.
From time to time, Local Health Boards may receive unexpected invoices from Trusts with which they do not have block contracts for breast work.
Networking in this way is vital to the effective and sustainable delivery of the programme. However, please let us know if we can help with any specific issues.