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Published: 02 March 2023

Improving Equity in Screening - Development of a Strategic Framework for the National Screening Service

What is equity?

Health equity is when everyone has the opportunity to be as healthy as possible. Health inequities are differences in health status or in the distribution of health resources, between population groups, which are avoidable and unfair.

Why are we developing a Strategic Framework to improve equity in screening?

We know there are some population groups who are less likely to come for screening when invited compared to the general population. We want everyone to understand what screening is and to be able to participate in screening if they want to. The Framework will set out how we can understand and improve equity in our four screening programmes: BowelScreen, BreastCheck, CervicalCheck and Diabetic RetinaScreen. We are working with screening participants and our partners to co-produce the Framework.

Health is influenced by a range of factors including social considerations like education, employment, income level, gender and ethnicity. The lower an individual’s socio-economic position, the higher their risk of poor health. Those with the highest risk of poor health, who would benefit most from screening, are often the least likely to participate for several reasons. There are many unfair barriers that can prevent people from engaging with our screening services. An example of an unfair barrier may be that somebody has difficulties with reading or writing, and for these reasons they cannot access or understand our screening information. If we provide easy-read leaflets or information videos, we may be able to reduce this barrier, and make it easier for them to attend screening, if they want to. 

We know from research that barriers exist that can dissuade participation in screening programmes within specific population groups. Some of these include:

  • people living in deprived areas
  • ethnic minority communities
  • people with a learning disability and people with autism
  • people with severe mental illness
  • other groups that share protected characteristics as defined by the Equality Act such as people from the LGBTQ+ community and people with a physical disability
  • groups experiencing social exclusion such as people experiencing homelessness, drug and alcohol dependence, migrants, Traveller and Roma communities. 

Our Framework will build on existing work of the National Screening Service (NSS) and will help create a roadmap for how we will understand and improve equity in screening over the next five years. The Framework will also help build trust and partnerships with our stakeholders, as we work towards providing equitable screening programmes for everyone living in Ireland.

How are we developing the Framework?

The image below demonstrates the steps we are taking to co-produce the Framework. Steps 1 and 2 are complete. Step 3 has been completed with the Equity Project Advisory Group i.e., a group of 15 members made up of internal and external stakeholders and members of the Patient and Public Partnership. Further consultation will take place with a wider stakeholder group of internal (NSS) and external partners. 

Process to develop a strategic framework to improve equity in screening
Figure 1. Process to develop a strategic framework to improve equity in screening

What do we know so far?

Through a series of workshops, we have identified these 5 priority areas:

  • Research and data
  • Education, learning and development
  • Accessibility and inclusivity
  • Partnership, and 
  • Communication 

Our work has also identified some high-level actions that we will commit to doing over the next 5 years. We know these priority areas and high-level actions may change through the next stage of consultation, i.e. with a wider stakeholder group.

What is the context to this work?

We know that improving health equity is our duty as a public sector organisation. Many strategies such as SláintecareHealthy Ireland and the HSE National Service Plan 2022, and our upcoming NSS Corporate Strategy have identified equity as a priority. In the NSS, we have already carried out a lot of work to improve equity across our screening programmes. You can read more about the work here.

Next Steps

We want to give all our stakeholders a chance to have their voice heard. In February, we will invite our stakeholders from across the community, voluntary and statutory sectors to attend a consultation workshop. This will give them an opportunity to have their say, and to provide feedback on the suggested priorities and actions that we have developed.

We will then make more changes and improvements to our Framework, based on their recommendations. Our final Framework will be published in summer 2023.

If you are on our Stakeholder mailing list, you will receive an email from the Equity Team in February. If you are not already on our Stakeholder mailing list and would like to be involved in this work, please email