The bowel cancer screening programme
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The Bowel Cancer Screening Programme. Professor Tony Morris Director, National Endoscopy Training Centre, Liverpool President, British Society of Gastroenterology. What have these people got in common?. Plan of Talk. Political background Pilot studies The plan for England

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The Bowel Cancer Screening Programme

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The bowel cancer screening programme

The Bowel Cancer Screening Programme

Professor Tony Morris

Director, National Endoscopy Training Centre, Liverpool

President, British Society of Gastroenterology


What have these people got in common

What have these people got in common?


Plan of talk

Plan of Talk

  • Political background

  • Pilot studies

  • The plan for England

  • Selection of sites for screening

  • Who will do the screening?

  • Remaining problems


Political background

Political Background

  • BCSP announced by Alan Milburn

  • 16,000 cancer deaths p.a.

  • Poor survival rates c.f. Europe etc

  • ‘Unaware’ of implications of introducing BCSP

  • Long symptomatic waiting lists, poor colonoscopy performance

  • Necessitated Modernisation Agency Endoscopy Project

  • Mike Richards funded National Endoscopy Training Programme from English Cancer Plan (£10.2M promised)


Pilot studies

Pilot Studies

  • Two sites; Rugby and Dundee

  • FOB and Colonoscopy based

  • Proven system

  • Trained endoscopists

  • Extending project to wider age group


Plan for england

Plan for England

  • 5 hub sites co-terminus with national IT regions

  • Approximately 100 screening centres to be appointed over 3 years

  • Screen age group 60-69 (10% of population)

  • 3xFOB sent out from, and back to hub

  • 2% +ve seen by Screening Nurses, colonoscopy arranged within 1 week

  • 40% significant pathology

  • Retested 2 yearly

  • Eventual increase to include 50-69 age group


Selection of sites for screening

Selection of sites for screening

  • Must get top marks for timeliness, and score next level for all other items on Global Rating Scale

  • Urgents in 2 weeks, routine in 6 weeks

  • Capacity for screening lists

  • Selected by SHA’s , approved by BCSP

  • 3 approved colonoscopists per centre


Endoscopy global rating scale

CUSTOMER CARE

Equality of access & equity of provision

Timeliness

Choose and book

Privacy and dignity

Aftercare

Ability to provide feedback to the service

QUALITY AND SAFETY

Appropriateness (Guidelines & Audit)

Consent process & Patient information

Safety

Comfort

Quality of procedure

Communicating results to referrer

Endoscopy Global Rating Scale


Who will do the screening

Who will do the screening?

  • Colonoscopist who will do at least 1 list per week

  • Must be doing 150 colonoscopies p.a.

  • Quality markers submitted

    caecal intubation rate (>85%), complication rate(=national), sedation use ,polyp detection rate(>20%)

  • Computerised MCQ test (30questions,5stem)

  • DOPS doing 2 cases observed by 2

    examiners

  • Currently 4 centres and 20 examiners (Leeds,Wolverhampton,Torbay,St Marks)


We need to look very carefully at what we do

We need to look very carefully at what we do


Remaining problems

Remaining problems

  • No money released yet

  • National Endoscopy Training Programme funding to end this year

  • Nurse screeners to be appointed and trained

  • Centres and hubs to be decided

  • IT not finalised

  • FOB kits not purchased

  • Very slow roll out ? 2 centres this year


Bowel cancer screening the bad guys

Bowel Cancer Screening, the Bad Guys?


Bowel cancer screening the good guys

Bowel Cancer Screening, the Good Guys


To claim the programme is going ahead as planned is a distortion of the truth

“To claim the programme is going ahead as planned is a distortion of the truth”

Professor Alex Markham

Chief Executive Cancer Research UK

29th March 2006


Any questions

Any Questions?


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