Evidence review · Her Way Forward
Four in Ten
Four in every ten eligible women in Wandsworth are not up to date with breast screening, and the borough has some of the lowest cervical screening uptake in England, lowest of all in South Asian communities. There is also, right now, a policy window that will not stay open.
The finding
The new self-sampling kits arrive by post, and post is the failure mode
NHS England began sending HPV self-sampling kits to under-screened women from early 2026, never-attenders first. It removes the barriers the research keeps naming, which are embarrassment, modesty, fear of the procedure and the gender of the person doing it.
But it is delivered the same way the invitations that already failed were delivered. London's low uptake is attributed in part to population mobility putting invitations through the wrong doors. A kit posted to a woman who has moved, or who cannot read the leaflet confidently, or who does not know what the envelope is, fails exactly as the letter did. A trusted women-only room where somebody opens it with her is the missing step, and it is only worth funding while the rollout is happening.
What the evidence says
Wandsworth is behind on all three programmes
Medium confidencePercentage of the eligible population covered
Source: Wandsworth Health & Care Plan 2025–27. Bars are absolute percentages, not scaled to each other. Note that national comparators use different age bands and reporting periods, so a precise borough-versus-England gap should not be quoted from this page.
For context rather than direct comparison, English breast screening coverage in the three years to March 2024 was 69.9% among women aged 53 to 70, and cervical coverage 66.1% among women aged 20 to 49. London is the only English region below the national average across all three programmes, roughly ten points behind the rest of the country.
The barriers are documented and specific
High confidenceA mixed-methods systematic review of thirteen UK studies identified barriers to breast and cervical screening among women from ethnic minority communities. For breast screening, embarrassment, fear, anxiety, fatalism and lack of family support. For cervical, embarrassment, fear and shame, fear of the procedure itself, the belief that sexual inactivity removes the need, work and family responsibilities, and fear of racism. Religious and cultural expectations of modesty, the gender of the person taking the sample, and experience of discrimination ran through both.
Locally, Wandsworth Care Alliance working with IVAR found the same pattern among South Asian women, plus something more particular. Medical vocabulary frightens people, and some of it has no equivalent in the languages women think in. There is no word for hysterectomy in Urdu. Women also reported simply not knowing what would happen in the room.
What women asked for describes Her Way Forward
High confidenceThe same local research asked women what would help. They said ladies-only sessions, comfortable and safe environments, follow-up in the community, information with diagrams and pictures rather than dense text, and outreach in the places they already go, naming stay-and-play and playgroups. They mentioned WhatsApp.
That list was not written with any organisation in mind. It describes a women-only community session with a WhatsApp group, which is what Her Way Forward already operates.
Accompaniment moves the numbers
Medium confidenceWandsworth Community Health and Wellbeing Worker programme, Arthur Court practice data
Observational, single site, small numbers, and the engaged group at Arthur Court included only four Asian residents. Good evidence that accompaniment works as a mechanism, weak evidence about these communities specifically. Marked medium for that reason.
The time-limited part
Kits are going out now, never-attenders first
The rollout is prioritised by risk, so the women being posted a kit first are precisely those who have never attended at all. In Wandsworth that group is disproportionately the one Her Way Forward sits with every week. The value of a trusted person explaining an unfamiliar envelope is highest during a rollout and falls away afterwards.
The page written for women rather than funders is You Can Do It Yourself Now.
What we could not verify
- The comparisons are not like-for-like. Wandsworth’s cervical figures are reported for ages 25–49 and 50–64. The English figure available to us covers ages 20–49 over three and a half years. Breast is 53–70 nationally. Any bid quoting a borough-versus-England gap should source both sides from the same dataset rather than from this page.
- “Lowest in South Asian communities” comes from the local research summary rather than a published dataset we could inspect. It is credible, locally produced, and consistent with the national review, and it is not a figure we can show you.
- There is no uptake data for self-sampling yet. The policy is months old. Nobody can currently say whether the kits reach the women who most need them, which is precisely the question this proposal exists to answer.
Why this matters for funding
- The intervention is a conversation, not a service. Explaining what an envelope is, and sitting with somebody while they read the instructions, requires no clinician and no premises beyond the room already booked.
- The ask is time-bound, which funders prefer to open-ended core costs. This is a rollout window with a beginning and an end.
- The evidence pointing here was produced locally. Wandsworth Care Alliance and IVAR asked women in this borough what would help, and the answer was a description of a women-only community session.
- It is measurable without a clinician. How many women arrived not knowing what the kit was, and how many completed and posted one. That second number is a real outcome rather than an output, because posting the sample is the behaviour the programme exists to produce.
Sources
Where figures come from different age bands or reporting periods, that is stated above rather than smoothed over.
Full source list
- Wandsworth screening coverage figures Wandsworth Health & Care Plan 2025–27, NHS South West London Integrated Care Board. Breast 58.5%, cervical 61.9% and 68.7%, bowel 62.1%, bowel deprivation gap 35% against 61%.
- HPV self-sampling UK National Screening Committee recommendation, June 2025, and NHS England rollout from early 2026 to those at least six months overdue, prioritised by risk.
- England coverage for context Breast 69.9% for ages 53–70 in the three years to 31 March 2024. Cervical 66.1% for ages 20–49 as at March 2024.
- London the only region below the national average Regional screening analysis reported June 2026, citing population mobility, psychological barriers, deprivation and lower uptake among ethnic minority communities.
- Barriers among women from ethnic minority communities Mixed-methods systematic review of thirteen UK studies published 2010–2022, BMC Health Services Research, 2023.
- Local barriers and what women asked for Wandsworth Care Alliance with IVAR, cervical screening research presented at the Women's Health Conference, September 2024.
- Screening uptake with a community health worker Evaluation of Community Health and Wellbeing Workers in Wandsworth, 18 months, Wandsworth GP Federation, October 2025.