Tackling inequalities in cancer pathways

RM Partners Cancer Alliance covers north west and south west London. The organisation set out to understand why some groups of women experience poorer outcomes in breast and gynaecological cancer pathways. Evidence showed that minority ethnic groups, people from deprived communities, refugees, and women with additional needs often face barriers to early diagnosis and timely treatment. The question was clear: how can the system listen better, and adapt services to make them more equitable?

 

Olovus were commissioned to design and deliver an engagement programme. This programme brought the voices of both clinicians and communities into the conversation. We ran a mixed-method approach:

 

• 22 online interviews and focus groups with clinical and operational leads across nine acute trusts.
• 34 participants in community focus groups hosted by trusted organisations such as the Asian Resource Centre of Croydon and the Asian Women’s Cancer Group. We prioritised recruitment of women from ethnic minorities, people from deprived communities, and those with low English fluency.
• A situation review of available evidence and existing pathway models to ground the engagement in data and context.

 

The stories were powerful. Women described stigma in their communities where cancer is seen as a curse or death sentence. This makes it difficult to talk openly or seek help. Others highlighted practical barriers like childcare, transport, or the inability to take time off work without losing pay. For many, language was the biggest hurdle. Patients received appointment letters they could not read and struggled to explain symptoms. Many relied on others to interpret sensitive conversations.

 

Clinicians echoed these challenges. They cited poor awareness of women’s cancer, referral quality, and resource constraints. They told us how some patients wait months because they don’t want to be examined by a male clinician. Women with additional needs require longer appointments that the system doesn’t easily provide.

 

Despite the challenges, there was remarkable consensus about what could make a difference. Recommendations included:

 

• Ongoing community engagement and education to raise awareness and dispel myths.
• Improving the quality and completeness of GP referrals and managing patient expectations from the outset.
• Maximising patient engagement in the pathway through improvements to triage and booking.
• Supporting patients to confidently engage with digital technologies, while making sure access is equitable.
• Patient-focused diagnostic services, with a shift from hospital-based settings to accessible community, and improved flexibility and streamlining of appointments.
• Enhancing the support available to patients who face greater inequalities and access needs, for example developing stronger partnerships with charities and support groups to provide advocates, peer support, and culturally sensitive resources.
• Smarter use of patient-facing technologies balanced with non-digital alternatives.

 

The engagement produced clear, actionable recommendations. These are now being shared with RM Partners’ Clinical Operational Board, Breast and Gynaecology Pathway groups, and the People and Community Strategic Forum.

 

This work has given system leaders a detailed map of where inequalities occur and practical steps to close the gaps. Importantly, it has also built relationships with grassroots organisations and communities who are often underrepresented.

 

This project shows the value of genuine involvement. When women are supported to speak openly about their experiences, and clinicians are invited to reflect honestly on pressures and blind spots, the result is sharper insight and better solutions.

 

It is exactly the kind of work called for in the NHS Long Term Plan: tackling inequalities, strengthening community engagement, and shifting from treating illness to promoting prevention and early diagnosis.

 

As one clinician put it: “If we’d had a patient advocate with her from the start, she might not have come back months later with advanced cancer.”

 

And from RM Partners themselves:

“Olovus provided engagement expertise and brought an all-important independent perspective to the work of the alliance, focusing on health inequalities and understanding barriers to access in both breast and gynaecological cancer care. Olovus facilitated and coordinated focus groups and interviews with clinicians, senior stakeholders and community organisations across north-west and south-west London, navigating often complex cancer pathways and sensitive conversations with ease.

 

Their flexibility, organisation and expertise has supported the team to focus our interventions and inform the development of pragmatic and practical next steps to addressing health inequalities in diagnostic cancer care.”

 

Caroline Latta, Director at Olovus, said:

“We’re proud to have supported RM Partners in this work. Too often, the people who face the greatest barriers to care are the hardest to hear from. By working with trusted community organisations, and creating space for clinicians to reflect openly, we’ve been able to shine a light on where inequalities are happening and more importantly what can be done about them. This is exactly the kind of involvement that turns insight into change.”