Breast screening modernisation programme: final report

Development and Philosophy of the Programme

Development of the Modernisation Board

The Modernisation Board was established in June 2022 and was set up to be a broad based and inclusive Board. Members were recruited from across the Breast Screening community covering a wide range of experience, skills and interests. Those asked to join the Board had to be able to provide insight into all aspects of the service and be willing to challenge the status quo to ensure the programme explored all options to modernise the service. We recognised that we needed to have input from the whole Breast Screening community and to incorporate the diversity of views and geography within the service and its stakeholders. The inaugural board took place on 20^th June 2022.

A Terms of Reference (see Appendix A.1) was drafted to set out the purpose, role and governance around the Modernisation Board. By approving the scope of individual projects, aligning the programme to wider strategic priorities, and continually reviewing the programme’s priorities across the three years, the Modernisation Board was in a good place to ensure the programme delivered the agreed outcomes and benefits.

The Board was created not as a representative body but as a flexible group which sought new members/skills as the discussions required. At each meeting, Board members were encouraged to suggest new members to inform the work. Membership, which grew as the programme developed, initially included Clinical Directors, breast surgeons, service management, NSS National Services Division (NSD), Screening Oversight & Assurance Scotland (SOAS) – known then as NSO – and Public Health Scotland (PHS). The Board would continue to have a core membership, with additional members being added during periods where their expertise was required. A list of members past and present can be found in Appendix A.2.

The Modernisation Board was also able to engage with the Third Sector across the lifetime of the programme (predominantly Breast Cancer Now and Cancer Research UK), which was helpful and informative. Efforts were made to identify participant networks and engage with these groups; however, the programme was unsuccessful in this endeavour. The programme team are grateful for the support and guidance offered by the third sector during this time.

Members were made aware of what was expected of them during the programme. They were asked to provide their time, take on responsibility to lead and/or contribute to projects and where possible engage with all aspects of the programme. In return, the programme team were aware of the need to maximise the use of the time members gave us and actively to listen to their needs to allow service evolution.

We consulted widely across all stakeholder groups and were very encouraged by the degree of engagement we found. The Terms of Reference clearly outlined the distinction between BAU activity and the Modernisation Programme. The Breast Screening Programme Board retained oversight of BAU activity, with regular communication between the Senior Programme Manager for Breast Screening and the Modernisation Programme team ensuring clear boundaries in activity. In reality, and as we would have hoped, the aspirations, projects, and developments for Breast Screening Modernisation were closely aligned with BAU, and as projects got underway, there was significant overlap with BAU initiatives. Strong and effective communication links were established from the outset, and this enabled projects to be discussed at the programme Board but then to cross into BAU as required. A summary of the consultation and engagement approach is provided below.

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Consultation Approach

Groups central to the programme comprised:

• Modernisation Team
• Modernisation Board
• Breast Screening Modernisation SLWGs (reporting to the Modernisation Team and Modernisation Board)

These consulted with and reported to SOAS, which turn reported to:

• NSS EMT
• SG
• UKNSC

The central groups engaged with:

• NSD
• Partnership
• Breast Screening Programme Board
• Medical Physics
• SABI
• CDs
• CPH Leads and Primary Care
• DaS
• NUG
• Third sector
• SBSP (all service staff)
• HIS
• Suppliers
• SNBTS
• National Screening Service, Republic of Ireland

As a result of these strong communication links, the Board found that it performed a supporting role over the period of the programme in some developments within business as usual. We are proud to have become an enabling forum within screening to encourage wider discussion and innovation beyond the scope of the programme.

The SBSP has been performing to a high standard since its inception, so, while acknowledging the need and drivers for change, the ethos of the Modernisation Board was one of evolution, not revolution. The Board wanted to maximise the benefits of evolving the service using what currently exists, rather than radical change in the operational delivery of the service. This ethos continued across the lifetime of the programme, as the workplans evolved, culminating in the development of the management structure target operating model, which is seen as the key change to underpin the Scottish Breast Screening Programme of the future.

The Modernisation Board was not a formal decision-making board but was based on developing a consensus about priorities, workstreams, and solutions. Challenges were encouraged, and this worked well with issues discussed and resolved at the face-to-face meetings. It was striking throughout the three years of the programme how strong the consensus remained about what was required and how it could be achieved.

A summary of activity at each of the eight board meetings is given below:

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Modernisation Board Meetings

Meeting 1

• Introduction and expectations
• Modernisation Board ethos
• Fears, successes and what screening could look like from scratch

Meeting 2

• Terms of reference and membership sign off
• Current issues presentation
• Programme visioning activities

Meeting 3

• Validation of initial project dossier and programme vision
• Project prioritisation exercise

Meeting 4

• Project updates
• SABI updates
• Programme management documentation review

Meeting 5

• Project updates
• EQFIA & Programme definition sign off
• Challenging ideas and horizon scanning activities

Meeting 6

• General project and BAU updates
• Breast Cancer Now: Cost of Breast Screening Report

Meeting 7

• Project updates
• Workforce plan presentation
• End of programme planning

Meeting 8

• Final progress updates
• Final report review
• Lessons learned