Local Lens: Greater Manchester

DID YOU KNOW?

Greater Manchester’s work on cancer inequalities sits within substantial NHS investment in earlier diagnosis and system improvement.

Through NHS England’s Cancer Alliance programme, Greater Manchester received around £13.6 million in 2023/24 and a further £13.6 million in 2024/25 — alongside separately funded national programmes including targeted lung screening.

That investment has supported a wider programme spanning screening, earlier diagnosis, pathway redesign, primary care, community engagement, data and innovation.

And there are signs of movement.

Greater Manchester reported that cancers diagnosed at stage 1 or 2 increased from 53.2% in August 2021 to 58.3% by July 2024, later reaching 60.2% across February 2024 to January 2025.

But the most interesting story may sit underneath the system-wide numbers.

In Brinnington, one of Stockport’s most deprived communities, breast screening uptake increased from 58% in 2019 to 70% in 2025.

The intervention brought together breast screening services, GP practices, Public Health and community organisations, using public-health intelligence, culturally sensitive support, multilingual conversations, drop-ins and local champions.

Ten breast cancers were diagnosed during that screening round.

That raises an important question:

What happens when the screening pathway adapts to the person — rather than expecting the person to adapt to the pathway?

The inequalities are real

Greater Manchester’s own data shows why adaptation matters.

For bowel cancer screening, national figures cited by NHS Greater Manchester show that in 2022/23, 50% of people with a learning disability completed colorectal cancer screening, compared with 66% of the general population.

For cervical screening, the gap is even wider.

A Greater Manchester project reported screening uptake of 30% among people with a learning disability, compared with 70% among people without one.

Local population-health intelligence has also shown substantial variation by ethnicity, with lower breast screening coverage among some minority ethnic groups in parts of Greater Manchester.

These are not small differences.

And they are unlikely to be explained by one barrier.

Sometimes the pathway itself needs to change

Greater Manchester’s response to bowel screening among people with learning disabilities is instructive.

Rather than simply sending another reminder, the system introduced a learning-disability flagging programme.

People who had not previously returned a FIT kit were identified.

Pre-notification lists were shared with cancer screening improvement leads.

Community learning-disability teams became involved.

Tailored education and practical support were offered.

The purpose was straightforward: identify people who had not previously participated and support them to complete screening successfully.

That is a very different model from passive invitation.

It is:

Identify → understand need → support → follow up → complete.

And the logic extends beyond the first screening test.

Greater Manchester has also identified difficulties further along the bowel pathway, particularly when someone receives an abnormal result and needs a colonoscopy.

In response, local teams developed accessible journey films showing what happens next and the reasonable adjustments that can be made.

The important point is that the gap can occur anywhere.

Not just before attendance.

But between:

screening → abnormal result → investigation → completion.

Accessible information can be an intervention

The cervical screening work makes the same point in another way.

Autistic women and women with learning disabilities helped co-produce accessible films explaining cervical screening, HPV vaccination, preparation, what happens during the test and what happens afterwards.

The intervention was not designed only around what professionals thought people needed.

It was designed with people who had lived experience of the barriers themselves.

That matters.

Because sometimes the problem is not unwillingness.

It is anxiety.

Uncertainty.

Communication.

Previous experience.

Or a pathway that assumes everyone receives and processes information in the same way.

Targeted screening can also change when cancer is found

Greater Manchester’s lung cancer programme shows what targeted approaches can achieve at scale.

More than 333,000 people have been invited for a lung health check.

Around 202,000 checks have been completed.

More than 1,750 lung cancers have been detected through the programme.

And 81% were diagnosed at an early stage.

Across Greater Manchester more broadly, the proportion of cancers diagnosed at an early stage has also improved in recent years.

No single intervention explains that improvement.

But the direction is important.

Targeting.

Community engagement.

Primary-care education.

Accessible information.

Pathway redesign.

Screening closer to people.

These things can change outcomes.

The lesson may be simpler than it looks

Greater Manchester is not telling us that one intervention will solve screening inequality.

It is telling us something more useful.

Different barriers require different responses.

A woman in Brinnington may need trusted community engagement.

A person with a learning disability may need accessible information and practical support.

A high-risk smoker may benefit from targeted outreach and a lung health check.

Someone with an abnormal bowel screening result may need reassurance and reasonable adjustments before colonoscopy.

The common thread is not the disease.

It is the pathway adapting to the person.

From targeted projects to routine practice

Greater Manchester is showing that screening inequalities can shift when the system does more than invite.

The strongest examples have several things in common:

someone is identified,

a barrier is recognised,

support is adapted,

follow-up happens,

and the outcome is measured.

That is more than outreach.

It is a different way of thinking about the screening journey.

Instead of asking only:

Did this person attend?

we begin to ask:

What got in the way?

What support was offered?

What happened next?

And did the person ultimately complete the pathway?

That is where the implementation challenge becomes much more interesting.

Because if personalised support works, the next question is not simply whether individual projects should continue.

It is:

How do we make barrier-aware, person-centred support part of the pathway itself?

For BloomShield, that is the question we are increasingly focused on.

Our work is moving beyond identifying where screening gaps exist towards understanding how people move through those gaps over time — and what kinds of intervention help them move forward.

Greater Manchester gives us a practical glimpse of what that can look like.

Identify → understand → adapt → support → follow up → complete.

The opportunity now is to make that logic easier to apply, easier to evaluate and easier to scale.

That is where implementation science has to move next.

Local data. Local voices. Local action.