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Cancer Reform Strategy: Age Extension in Breast Screening

A 3-phase modelling study looking at site locations, screening schedules, and staffing in order to assist in plans for extending breast screening services in Greater London.


The Cancer Reform Strategy requires all Breast Screening Services (BSS) to extend the age range of eligible women from 50-70 to 47-73 and that analogue screening machines are upgraded to digital. Eligible women must be invited to screening at least every 36 months.

For the service in Barking, Dagenham, Havering, Redbridge, and Brentwood areas, this would mean a step-increase from 79,000 eligible women to 104,000 in 2010 rising to 117,000 in 2020. This rise is all the more challenging when a service is struggling to maintain its 36-month round-length. On the face of it, the service would need to replace 3 analogue screening machines with 5 new digital ones and significantly increase headcount when other BSS were recruiting scarce resources too.


The project had 3 Phases:

Phase1 of the project was focused on understanding and choosing the most appropriate sites for the mobile and static screening facilities.

(click on image to enlarge)

This required the post codes of 79,000 women across all of the area codes.

The agreed scenario means the King George site will serve Barking & Dagenham Women plus those in the Ilford area; women living in B&D will travel to the Hospital to utilise the increased daily capacity. The other static screening facility will be located at either Victoria or Harold Wood to serve the Romford localities and a single mobile facility will serve Woodford & Brentwood women.

Phase 2 of the project was focused on finding a pragmatic and economic schedule for the next 10 years including age extension (inviting women aged 47 to 73) as of December 2010.

This was particularly challenging due to the service’s past and present need to use its assessment facilities to maintain a 36-month round-length. On the face-of-it, the service would need at least 5 screening machines to replace the existing single mobile & double mobile.

Schedules have been prepared and accepted by the client that require only 3 new facilities; two will be static and operate at 80 invites per day by running extended hours and a single mobile will operate at 58 invites per day by making use of digital technology.

(click on image to enlarge)

These schedules necessitate an interim period (2011) of old + new whilst the service overcomes its legacy problems of stress and agglomeration and moves across to new digital facilities.

This strategy offers a massive cost saving equivalent to 2 digital facilities.

Phase 3 of the project is focused on validating staff availability and includes a simulation model to verify consistent 36 month round-length.

(click on image to enlarge)

The new facilities and extended hours need to be supported by a team of at least 16 WTE (Whole Time Equivalent) radiographers & assistants.


“The project had three natural phases: Site Locations, Screening Schedules, and Staffing. However, the combined challenges of age extension, Round-length  and optimal spend is significantly more difficult when using large area codes rather than individual GP Practices as the basis for inviting eligible women.”

“We had to redesign our Scheduling software.”

– Brent Wherry, Technical Director, Focused_On Ltd.


“Focused_On have demonstrated great understanding, patience, and skill in helping us to find a robust solution to a problem that was becoming quite intractable or very expensive. Now, we have a viable plan for success.”

“Commissioners and BHRT can be confident in making the investment choices and resource allocation decisions.”

– Victor Ferreira, Lead Commissioner.

Further Information

More information can be found at:


NHS Barking & Dagenham, NHS Havering, NHS Redbridge, and NHS Brentwood plus the Barking, Havering and Redbridge Hospitals NHS Trust (BHRT)


Focused_On Limited

Key Dates


Contact Person

Steven J Burnell

Contact Email

sjburnell [at]


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