A review of the network's achievements in 2018 around raising awareness of mental health in Muslim communities and the launch of the network's new campaign around improving cancer screening awareness in the Muslim community. This includes keynote speeches from Simon Stevens (Chief Executive of NHS England), Baroness Dido Harding (Chair of NHS Improvement), Clare Moriarty (Permanent Secretary and Civil Service Faith Lead). Joined by senior colleagues from NHS England, Public Health England and Department of Health and Social Care, the network presented on reasons and barriers to lower screening uptake among Muslim communities. Community Links and Jo's Trust also shared best practice from their engagement with faith communities, whilst on the back of this, the Muslim Council of Britain, the British Islamic Medical Association and Cube Network, shared their commitments to improving awareness of cancer screening in Muslim communities in 2019.

1. Annual General Meeting

2. AGENDAAGENDA
1 Public mental health
2 2018 in review & the task ahead
3 Faith leadership in the Civil Service
4 Cancer screening uptake in the
Muslim community
5 Community engagement
6 The NHS Long term plan

3. Public mental health
Nuzhat Ali
Chair
PHE Muslim Network

4. 350+ members across the Collaboration
Strengthen
the staff
voice
Increase
engagement
Support
health
promotion
& delivery

6. The Muslim Network and it’s
role in delivering the NHS
Long Term Plan
Javid Patel
Chair
NHS Improvement Muslim Network

7. Belief in One God
Creator
• Everyorganism&entity
• Environment&elements
Sustainer
• Everybreath&heartbeat
• Health&provisions
All-Knowledgeable
• Individual&Community
• What’sbestforus

8. Message
Guidance
• Directionandprinciples
• Insights(health,etc.)
• Preventivemeasures
FromAdamtoMuhammad
• Rolemodels

9. Accountability
Rewardandrecompense
• Everypersonwillbejudgedbased
ontheirconductandintention
Responsibility
• ToGod,familyandoneanother
(evenintheworkplaceandwider
community)

10. The NHS Long Term Plan
1. Doingsthingsdifferently
2. Preventingillnessand
tacklinghealthinequalities
3. Backingourworkforce
4. Makingbetteruseofdata
anddigitaltechnology
5. Gettingthemostoutof
taxpayers’investmentinthe
NHS

11. 1. Doing things differently – collaboration
• Providingaccessto
establishedfaithinstitutions
• Newavenueforhealth
promotion
• Acollaborativepartnership
betweenhealth
organisationsandthe
community

12. 2. Prevent illnesses, tackle health inequalities
• Activatingfaithleaders
andinstitutions
• Breakingbarriers
• Iterativefeedback

13. 3. Backing our workforce
• Advisingonculturally
sensitiveservices
• Trainingandawarenessfor
cliniciansandstaff
• Connectionwithfaith
experts

14. How can you get involved?
• Signuptoourmonthly
newsletter
• Getinvolvedwiththecancer
screeningsteeringcommittee
• Sharebestpracticeand
learningswithus

15. Thank you for listening
Nhsi.Muslimnetwork@nhs.net

16. Using policy to tackle health
inequalities
Gina Radford
Deputy Chief Medical Director
Department of Health and Social Care

17. Cancer Screening
and Inequalities
Muslim Network Health Collaboration
Linda Syson-Nibbs

18. Screening inequalities-ANNB ISF Nov 2017
Content
• Introduction to cancer screening
• Health inequalities and screening
• Who experiences screening inequalities?
• Screening and black and minority ethnic groups
• PHE Screening inequalitiesstrategy
PHE – Inequalities in screening and Muslim community uptake

19. UK National Screening Committee
In the UK, the UK National Screening Committee (UK
NSC) advises Ministers and the NHS in all four countries
on all aspects of population screening, and supports
implementation. Screening programmes are only
recommended where the offer to screen provides more
good than harm.
DES Networking day PHE – Inequalities in screening and Muslim community uptake

20. Screening inequalities-ANNB ISF Nov 2017PHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
NHS National Screening Programmes:
The NHS provides 11 national population-based screening:
Antenatal
• Infectious diseases in pregnancy (HIV, Syphilis, Hepatitis B)
• Sickle cell and thalassaemia
• Foetal anomaly screening programme (FASP) – 12 conditions
Newborn
• Newborn and infant physical examination - 4 conditions
• Newborn hearing
• Newborn blood spot – 9 conditions
Adult and Young People
• Diabetic eye – type 1 / type 2 diabetes, age 12+, every 12 months
• Abdominal aortic aneurysm (AAA) – men, age 65, one-off
• Bowel cancer – age 55 (one-off bowel-scope); age 60-74, every 2 years
• Breast – women, age from 50 up to 71st birthday, every 3 years
• Cervical – women, age 25-64, every 3 years

21. Screening inequalities-ANNB ISF Nov 2017PHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
NHS Breast Cancer Screening:
The NHSBreastScreening Programme (BSP)offers
allwomenfromaged 50 – upto their71st birthday an
x-ray (mammograph)everythree years,to help detect
abnormalitiesandreduce liveslost to invasivebreast
cancer

22. Screening inequalities-ANNB ISF Nov 2017PHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
NHS Cervical Screening:
Womenaged 25-49 areinvitedforcervicalscreening
every3 years;and women aged 50-64 every5years.
Currently

23. Onaverage59%ofpeoplein
Englandwho aresentthefreeFOBt
inthepostcompleteit.
Almost42,000peopleare
diagnosedwith bowelcancer
eachyearintheUKandmore
than16,000peoplediefrom
thedisease.
PHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
NHS Bowel Cancer Screening:
Men and women aged 60-74 aresenta home FOBt
(FaecalOccultBloodTesting)kit every2 years. If
positive(hidden bloodfound in stools),patient invitedto
have a colonoscopy.

24. PHE Screening Division’s Inequalities StrategyPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
What are health inequalities?

25. DES Networking dayPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
Who experiences screening inequalities?
Published evidence shows that the groups at greatest risk include:
• Those experiencing economic deprivation
• Members of minority ethnic groups
• People with learning or physical disabilities
• People with serious and enduring mental illnesses
• Other protected groups identified by Equality Act 2010

26. DES Networking dayPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
Screening coverage - end of March 2018
Bowel cancer screening coverage - 59.0% increase from 58.8 in 2017
- had a screening result recorded in the last 2.5 years
Breast screening coverage - 74.9% decline from 75.4% in 2017
- had a screening result recorded in the last 3 years
- Acceptable: ≥ 70%; Achievable: ≥ 80%
Cervical screening coverage – decline from 2017 69.5% & 77.2%
- Under 50 years of age: 69% (had a screening result recorded in the last 3.5 years)
- 50 to 64 years of age: 76.2% (had a screening result recorded in the last 5.5. years)
The coverage is lower for all three cancer screening programmes in the most deprived
compared to the least deprived areas in England

27. DES Networking dayPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
What the research evidence tells us
• Uptake of bowel screening in England is lower in ethnically diverse areas
(38% compared to 52 to 58% in other areas).
• Women from ethnic minority groups are less likely to attend cervical
screening compared to White British women. The disparity is particularly
great for certain ethnic minority groups – for example, for Indian and
Bangladeshi women respectively compared to White British women.
• There is some evidence that women from some ethnic minority
groups are less likely to attend breast screening compared to White
British women, but estimates vary by study and by minority ethnic group

28. NB Linear trend
lines are guides
only and may
not be
statistically
significant.
Source for ethnicity data:
https://www.ons.gov.uk/census/2011
census = proportion of population
from mixed, black, Asian and ‘other’
ethnic groups
Source for coverage data: National
Health Application and Infrastructure
Services (NHAIS) systems accessed
using Open Exeter.
Data for September 2017
Green line indicates national
coverage standard of at least 80%
50
55
60
65
70
75
80
85
0 10 20 30 40 50 60 70 80 90 100
Percentage coverage
Percentage black and minority ethnic groups
Age 25 to 49
Age 50 to 64
Standard
Linear (Age 25 to
49)
Linear (Age 50 to
64)
PHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
Ethnicity rate vs. Cervical coverage at CCG level

29. DES Networking dayPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
Factors influencing bowel screening uptake
• Cultural norms/misperceptions
• Gender (men reported as less likely to engage in screening)
• Language and literacy
• Newness or user ignorance
• Lack of awareness about cancer or screening
• Age
• Personal pride and taboo
• Religion a factor in some cases (fatalistic view)
• Disability
• Fear of cancer

30. DES Networking dayPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
Exploring reasons for low uptake of bowel cancer screening within South
Asian communities in London

31. NHS England Public Health England Local Government
Social Care
Act 2012
Screening service
providers
Equality Act
2010
Public
Services
(Social Value)
Act 2013
Accessible
Information
Standard 2016
Screening inequalities-ANNB ISF Nov 2017PHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
Inequalities: shared roles and responsibilities

32. DES Networking dayPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake

33. DES Networking dayPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
What PHE is doing to tackle inequalities

34. Screening inequalities-ANNB ISF Nov 2017PHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
Proportionate universalism

35. DES Networking dayPHE – Inequalities in screening and Muslim community uptakePHE – Inequalities in screening and Muslim community uptake
Useful links and references
Cancer diagnosis :
http://www.ncin.org.uk/view?rid=3071 Cancer Research UK and PHE 2016
Interventions
See www.bjcancer.com|DOI:10.1038/BJC.2014.363
Breast cancer awareness
https://www.youtube.com/watch?v=_8K1ausRPM8
https://www.youtube.com/watch?v=nff5xVRrK2Q
https://www.youtube.com/watch?v=SOUf6lSrhrk
https://www.youtube.com/watch?v=DfePwyvvCKA
story on website

36. Thank you for listening

37. Increasing awareness and
early diagnosis of cancer
Yasmin Begum
Community Links
Zoraida Colorado
Community Links

38. Contents
• Community Links – Ready for Everything Communities
• Background to our Health Programme
• Our model
• Results and successes
• Key learning

39. • Early action
• Deep value
• Ground up
• Co-delivery
Community Links Approach

40. Background to Health Programme
2010 Newham breast screening
uptake was 51%
PCT Newham commissioned a calling
programme
Breast screening uptake went from
51% to 66% (2007 vs 2010)

41. Since then…
Commissioners:
NHS England, CCG & Public Health Newham, CCG Wandsworth,
Camden and Lambeth, Macmillan and RM Partners

42. Health Facilitators
Work with local organisations to recruit
Recruitment according to the demographics of the
patients in the local area (e.g. women from South Asian
background who speak Bengali)
All callers are DBS checked
Subheading
Name surname or date
Subheading
Name surname or date
Community-based peer callers:
• local knowledge
• the ability to connect with patients

43. Health Facilitators Training
Delivered alongside NHS, Cancer Research UK and
Macmillan staff
Able to provide additional health awareness
information (e.g. how to do self-examination, signs &
symptoms of cancer, etc.)
Information Governance & GDPR
Subheading
Name surname or date
Subheading
Name surname or date
Peer callers:
• Have strong health knowledge
• Understand the Deep Value approach
•High quality of delivery

44. The Conversation
‘Open and Honest’ conversation
Culturally appropriate to break down the barriers of accessing health
services
Discuss concerns or issues
Encourage further discussion with screening centre or GP practice staff
Patient needs orientated – going the extra step for patients
Calling on site of GP practices
Feedback loop to the service provider

45. Results and Successes
Patients’ satisfaction
Girls’ knowledge of breast cancer symptoms increase by 58% and
by 54% among mums.
Coverage* for bowel screening in Newham has gone from 37.7%
to 46.6% in the last three years
Camden coverage* in breast screening went from 49.3% to 59.9%
(2014/15 vr 2015/16)
Tower Hamlets coverage* in breast screening went from 55.9% to
64.1% (2015/15 vr 2016/17)
We have saved lives (case studies)
*Source: https://fingertips.phe.org.uk/profile/general-practice/data#page/4/gid/1938132829/pat/46/par/E39000018/ati/152/are/E38000113/iid/92600/age/280/sex/4

46.  Proved it could be done – poor screening uptake is not inevitable
 Method transferrable to other screening programmes, boroughs and
settings
 Method is routed in Deep Value Approach to breakdown barriers –
effective with the most deprived and diverse populations
 Methodology is a determinant of success
 Public Health campaigns work when they are community based
Key Learning

47. Thank you for listening

48. Barriers to cervical cancer
Adriana MacNaughton
Jo’s Trust

49. © Jo’s Cervical Cancer Trust 2019

50. Cervical screening coverage
© Jo’s Cervical Cancer Trust 2019
• Last year in the UK, 1.3 million women didn’t attend cervical
screening.
• That’s 1 out of every 4 women.
• In some areas, only every 1 in 2 women attended (53.5%)

51. © Jo’s Cervical Cancer Trust 2019
https://www.youtube.com/watch?v=Bc7jmmZsMiE

52. © Jo’s Cervical Cancer Trust 2019
What causes cervical cancer?
A. Having sex
B. Human Papilloma Virus (HPV)
C. It is hereditary
D. Multiple partners
E. A genital infection

53. 25-29 year olds Over 50s Women from BAME
communities
Embarrassment, fear,
risk of cancer, accessibility
Health literacy, knowledge,
relevance,
culture,
stigma
Relevance,
knowledge
unidentified risk
Who are our non-attenders?
© Jo’s Cervical Cancer Trust 2019

54. Women with a learning
disability
People who identify as
LBTQ
Women that have
experienced sexual
violence
Health literacy, knowledge,
culture
Relevance,
health literacy,
unidentified risk
Specialised need
Who are our non-attenders?
© Jo’s Cervical Cancer Trust 2019

55. Knowledge
Health literacy
Relevance
https://www.youtube.com/watch?v=2Vo8C
CURtQk
Ethnicity
© Jo’s Cervical Cancer Trust 2019
1/3rd more BAME women of screening age compared
to white women said they had never attended a
cervical screening appointment
Four times as many BAME women as white women
said “It did not seem relevant to me”

56. I’m too busy, I
don’t have time
I am scared of the
results I don’t know
what it’s for…
I’m
embarrassed.
It’s not
relevant to
me
I can’t get
someone to look
after the children!
I am put off by the
fact it might be
painful
It’s hard to book
an appointment
© Jo’s Cervical Cancer Trust 2019
Barriers to screening - Accessibility/
psychological

57. © Jo’s Cervical Cancer Trust 2019
Barriers to cervical screening amongst
Ethnic Minority women aged 25-64
• A survey
• 3 focus groups

58. “As a Muslim, cleanliness of the private regions
is important and not having sex during
menstruation are ways we can reduce the risk
and save ourselves from developing cervical
cancer”
© Jo’s Cervical Cancer Trust 2019
Barriers to cervical screening amongst
Ethnic Minority women aged 25-64

59. © Jo’s Cervical Cancer Trust 2019
“Maybe it’s the way you wipe yourself lower
down”
Barriers to cervical screening amongst
Ethnic Minority women aged 25-64

60. Barriers identified from
our focus groups
From a young age, I was
told not to show my
private areas to anyone
Are the results confidential?
I’m scared people in my
community will find out.
I am
unmarried
There’s very little
knowledge about
it
I had a male who
did that at a smear
test so I didn’t go
(again)
If I get the test,
everyone will
think I’m
promiscuous
Some women would
rather not know if
they had cancer
Taking your
clothes off in front
of a stranger is
also an issue
© Jo’s Cervical Cancer Trust 2019

61. © Jo’s Cervical Cancer Trust 2019
Barriers to cervical screening amongst
Ethnic Minority women aged 25-64
“There are feelings in the community that
someone may have sinned and they got cancer
as a result”

62. © Jo’s Cervical Cancer Trust 2019
Barriers to cervical screening amongst
Ethnic Minority women aged 25-64
“It’s going to be frowned upon isn’t it? Because
your automatic assumption is that somebody’s
been… naughty. Oh my God she has got
cervical cancer so she must have a numerous
amount of partners somewhere.”

63. © Jo’s Cervical Cancer Trust 2019
Barriers to cervical screening amongst
Ethnic Minority women aged 25-64
“My mum had cancer and I only found out after
eight months of her having it. She had
treatment and I didn’t even know [tearful]. I
couldn’t go to London to visit her because my
kids had GCSE’s so I went down in the
holidays and had the shock of my life. I am a
talker and believe these things are what
families need to know.”

64. © Jo’s Cervical Cancer Trust 2019
Barriers to cervical screening amongst
Ethnic Minority women aged 25-64
“Get out there and reach out, get into the
communities out there. Face to face works.
Leaflets won’t help. They are a waste of
resources. If you have to use letters, then
persistence is required for this.”

65. © Jo’s Cervical Cancer Trust 2019
Barriers to cervical screening amongst
Ethnic Minority women aged 25-64
“I think openness will help break barriers. Not in
bigger groups but in smaller groups, face to
face discussions work.”

66. https://www.jostrust.org.uk/about-
cervical-cancer/cervical-screening/what-is-
cervical-screening
© Jo’s Cervical Cancer Trust 2019
Language barriers
In 2015 we launched a new video resource called "Your
Guide to Cervical Screening (the smear test)" which is
aimed at raising awareness of cervical screening to
women with low literacy from a BAME background.c

67. © Jo’s Cervical Cancer Trust 2019
1. Community Engagement
Public health engagement coordinator

68. © Jo’s Cervical Cancer Trust 2019
1. Community Engagement
2. Volunteer Management
Public health engagement coordinator

69. © Jo’s Cervical Cancer Trust 2019
1. Community Engagement
2. Volunteer Management
3. Training – on methods to
improve screening
uptake
Public health engagement coordinator

70. © Jo’s Cervical Cancer Trust 2019
1. Community Engagement
2. Volunteer Management
3. Training – on methods to
improve screening
uptake
4. GP interventions
More information on the project:
https://www.jostrust.org.uk/about-us/what-we-do/public-health-engagement
Public health engagement coordinator

71. © Jo’s Cervical Cancer Trust 2019
Resources for you
Online information:
www.jostrust.org.uk/smeartest
Printed materials and films:
www.jostrust.org.uk/resourcecentre
Information for health professionals:
https://www.jostrust.org.uk/information-healthcare-
professionals

72. Thank you for listening

73. Break & Prayers
To perform prayers please use room 3.15

74. Faith in the Civil Service
Clare Moriarty
Permanent Secretary, DEFRA
& Civil Service Faith Lead

75. Interactive Session
Josephine Ruwende
Screening and Immunisation Lead at Public Health England

76. Interactive Session
1. Howcanweworktogethertoimprovecancer
screeningawarenessanduptakeinMuslim
communities?
2. Whatspecificactionswillyourorganisationstake
tosupportthiscampaignoverthenext12
months?
3. Whatsupportandresourcesdoyouneedtodo
this?
4. Doyouhaveanybestpracticewhichwecantake
learningsfrom?

77. Community delivery partners
British Islamic Medical Association
Muslim Council of Britain

78. British Islamic Medical Association
FebruaryBookaSpeaker
campaign
• Cancerscreeningcampaign
startedin2018
• Deliveringcancerscreening
talksacrossfaithand
communityinstitutions
• Increasedcoveragein2019

79. • Collaboration with British Islamic
Medical Association (BIMA) and
Cancer Research UK
• Mosques & Community Organisations
can Book a Speaker online
• Breast, Bowel and Cervical Cancer
February
2022
• World’s Biggest Coffee
Morning Campaign!
• Encouraging mosques to take
part in Sep 2019
• Template Friday Sermon for
Imams on Cancer
July September
• Workshop on Community Health
Issues, including cancer screening, for
200+ delegates representing MCB
Affiliates nationwide
• Annual General Meeting in Birmingham

80. • Encourageallpartnerstoraise
awarenessamongnetwork
membersandencouragethem
toparticipateandcollaborateon
healthandwellbeingevents
• Distributecancerscreening
resourcesacrossit’snewsletter
andamongpartners
• Encouragefocusofjointtalks,
newslettersandfundraisers
amongitswidernetworkon
cancerscreeningawareness
CUBE Network

81. The NHS Long term plan
Simon Stevens
Chief Executive
NHS England
Baroness Dido Harding
Chair
NHS Improvement

82. Q&A Session
Simon Stevens
Chief Executive
NHS England
Baroness Dido Harding
Chair
NHS Improvement

83. Closing Remarks