Policy responses and statements
- Name of organisation:
- NHS Quality Improvement Scotland (NHS QIS)
- Name of policy document:
- Draft clinical standards: Bowel Screening Programme
- Deadline for response:
- 23 October 2006
Background: In August 2005, the Scottish Executive Health Department announced a new initiative to help tackle bowel cancer, with the roll-out of a national bowel cancer screening programme. The programme will commence in 2007 and will be phased in gradually over a 3-year period to all NHS boards throughout Scotland, targeting all eligible individuals (male and female) aged between 50-74 years.
The development of draft clinical standards for the bowel screening programme is the responsibility of NHS QIS, taking into account advice from the NSC and in consultation with NHS organisations. NHS QIS established a project group to take this work forward, chaired by Professor Robert Steele. The group considered a number of topics surrounding the pilot bowel screening pathway and from this starting point 7 key areas for clinical standards were identified for the development of standards:
- general principles
- call-recall
- the screening process
- pre-colonoscopy assessment
- colonoscopy and histopathology, and
- neoplasia yield
COMMENTS ON
NHS QUALITY IMPROVEMENT SCOTLAND (NHS QIS)
DRAFT CLINICAL STANDARDS: BOWEL SCREENING PROGRAMME
The Royal College of Physicians of Edinburgh is pleased to respond to NHS Quality Improvement Scotland on its consultation on Draft clinical standards: Bowel Screening Programme.
The Scottish office have taken on board the results of a pilot study for colon cancer screening based on faecal occult blood testing and a colonoscopy in positive patients. The pilot study conducted in Tayside, Grampian and Fife show that up to 40% of patients with positive faecal occult blood testing had an abnormality on the subsequent colonoscopy. Other studies have shown that screening programmes identify asymptomatic polyps, early cancers and significantly reduce mortality from bowel cancer. The first wave of colon cancer screening in England is starting to go online.
The evidence base for undertaking colon cancer screening is therefore secure, and in England and Scotland a similar process will be involved, in that stool testing kits will be sent to the general population and colonoscopy will be offered to those with positive tests. The major difference between England and Scotland is the screening population which, in Scotland, will be 50-74, contrasting with 60-69 in England.
This paper describes seven main clinical standards relevant to delivery of a screening programme within a health board. These standards address issues ranging from the general principle of bowel cancer screening, through the screening process, investigation of positive tests and anticipated yield at colonoscopy. The document achieves its aim of setting out clear, measurable standards and is thoroughly referenced. The standards set are achievable with the appropriate resources, that is, the need for ready access to high quality colonoscopy within 20 days of pre-colonoscopy assessment, which would undoubtedly stretch the present resources available in NHS hospitals.
One major difference between the Scottish and English systems is the colonoscopy. In England, screening colonoscopists are selected after a rather arduous process involving DOPS, success in a multiple choice quiz and demonstration of a high success rate and low complication rates in personal audit. In addition, Endoscopy Units in which colonoscopy will be done have to score highly in terms of global rating score, waiting times have to be minimal, and standards of safety and other aspects of the patient journey exemplary. The stringent criteria are not being applied in Scotland, and we hope that this does not result in difficulties, specifically, that screened patients wait minimally for their colonoscopy, whilst patients undergoing colonoscopy for symptoms have significant waits. This subject has been the cause of considerable debate within the QIS working group, and the conclusion has been that standards in Scottish Endoscopy Units are high, and that the current endoscopy diagnostic collaborative (funded by St Andrew’s House) is making inroads in improving standards and reducing waiting times.
With regards to the particular standards, we would make the following comments:
1a.3 The lead clinician should be central to the service delivery of the screening centre, and the role of the Public Health Consultant may be superfluous.
1a.4 “local datasets” needs clearer definition.
1a.5 ISD Scotland’s role needs to be clarified.
1a.6 The bowel screening co-ordinating group will need to meet more frequently than annually to have an impact.
2b Screening Update: the uptake of screening will require resources with regard to publicity, recall etc.
3c.4/3c.5 The timescales for informing GPs and the designated local NHS board contact: criteria 3c.4 (1 working day) is at variance with criteria 5a.3 (3 working days) on the desirable time indicated.
4b Quality assurance needs to be streamlined.
5b.5 Offering a date for colonoscopy at the time of assessment will prove difficult in many NHS hospitals at present, and will undoubtedly require resources to be implemented in full
6a.1/6a.2 Again, this will require resources in order to be achieved.
6b.1 Standards of colonoscopy have been discussed in an earlier paragraph
6c/6c.4 ‘Complete colonoscopy’ needs to be clearly defined. Alternative radiological imaging needs to be clarified, and will vary from trust to trust depending on local resources.
Undoubtedly, the introduction of a bowel screening programme in Scotland is a major step forward in the health care of the Scottish population. If it is to be carried out to the highest possible level with the least possible risk to patients, and in a timely fashion, these standards will have to be carefully adhered to, and the hospitals undertaking such procedures will need significant resources.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[23 October 2006] |
