Implementing recommendations within the Liverpool, Sefton, and Knowsley Mobile Breast Screening Programme has brought about substantial enhancements. Augmented engagement, clarified governance, and the establishment of a robust service level agreement process have boosted efficiency and effectiveness.

Background

In the summer of 2023, the NHS Midlands and Lancashire’s (NHS ML) Improvement Unit, commissioned by NHSE North West (NHSE NW), conducted a comprehensive review of the mobile breast screening sites utilised by the Liverpool, Sefton, and Knowsley Breast Screening Programme (LSK BSP). This initiative aimed to enhance the efficiency and effectiveness of the program. Subsequently, a series of recommendations were proposed for improvement. In December 2023, phase 2 began with our Improvement Unit revisiting to aid the LSK BSP Team in implementing the initial recommendations from the mobile breast screening site review.

Action

An initial face-to-face workshop was conducted with the team to review the recommendations outlined in the report. Our consultants devised an action plan to monitor and track the progress of implementing the proposed improvements. Each action was assigned a lead, and delivery timelines were agreed upon.

Actions and deliverables included:

• Establishing a foundation for effective system working, including refreshing the program’s stakeholder meetings.

• Testing the new process developed in phase 1 for relocating a mobile breast screening site.

• Assisting the program team in developing a service level agreement (SLA) process within the trust.

• Ensuring internal governance arrangements encompass oversight of the mobile screening site management process.

• Collaborating with stakeholders across the system to develop a dataset to monitor screening uptake across all mobile screening sites.

Impact

The initiatives undertaken resulted in several positive impacts:

• Increased engagement from senior leaders in the trust, bolstering support for the team and raising the profile of the programme.

• Established and documented governance arrangements around mobile screening sites, including clear escalation routes for risks and issues.

• Development and agreement of the SLA process by senior leaders in the trust, facilitating the negotiation and implementation of SLA’s for all mobile screening sites.

• Negotiations led by our consultants resulted in a 60% reduction in costs for two mobile sites in the locality, with an SLA drafted with the landowner.

• Enhanced confidence among team members in executing the mobile site relocation process following a testing workshop led by our consultants.

• Creation of a suite of documents to support the team in further advancing and embedding the work into their operational practices, including refreshed stakeholder group terms of reference, stakeholder group agenda, options appraisal guide, and mobile site uptake data report template.

The implementation of the recommendations outlined in the review of the Liverpool, Sefton, and Knowsley Mobile Breast Screening Programme has led to positive impacts. Through enhanced engagement from senior leaders, the establishment of clear governance arrangements, and the development of a robust service level agreement process, the program has seen increased efficiency and effectiveness. Notably, negotiations resulting in cost reductions for mobile sites and improved confidence among team members in executing relocation processes highlight tangible benefits. The creation of supportive documentation further ensures the sustainability and continuous improvement of the program’s operations. These improvements signify a strengthened commitment to providing accessible and high-quality breast screening services to the community.

Feedback

The work undertaken by NHS ML’s Improvement Unit (IU) has supported the Liverpool, Sefton and Knowsley Breast Screening Programme team to meet a key recommendation of a health equity audit. The IU’s contribution was invaluable – they engaged with the programme team throughout the project, offering support and advice, sharing knowledge and their expertise to foster new ways of working in the management of mobile screening sites. This project also provided the blueprint for a wider review of mobile screening sites across the North West which will ensure that all sites continue to meet the needs of our population to maximise uptake of breast screening. 

Helen Dickinson| Public Health Senior Manager | NHS England – North West.

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