Implementing a new approach to delivering endoscopy services in Wales

This week a debate was held at the National Assembly in Wales on the Health and Social Care Committee’s recommendation for the Welsh Government to develop a national endoscopy action plan to tackle the capacity crisis in services that diagnose bowel cancer. During the debate the Government reaffirmed their commitment publicly to deliver this action plan, so it’s great that progress is being made.

This comes a year after we provided evidence to the committee’s inquiry into endoscopy services, where we highlighted the growing capacity crisis in Wales and the impact this is having on bowel cancer outcomes, which are currently amongst the poorest in Europe. While we’re pleased the Government have accepted the committee’s recommendation, it’s vital that the ambitions in the plan translates into action on the ground.

What is the problem?

Endoscopy services provide key tests that diagnose bowel cancer. However in Wales, not enough endoscopy procedures are being carried out to keep up with the current demand for these tests. The latest research, by the International Cancer Benchmarking Programme, comparing countries with similar health systems found that waiting times in Wales for tests that diagnose bowel cancer and commencing treatment are among the worst. Actions have been taken by the Welsh Cancer Network to improve waiting time targets such as the development of the Single Cancer Pathway. However, waiting time targets are still not being met. As of June 2019, over a quarter of patients waited eight weeks or more for an endoscopy procedure that can diagnose bowel cancer.

A new, more sensitive, bowel cancer screening test was fully introduced in September 2019, known as the faecal immunochemical test (FIT). Because this test is easier to use, it’s expected to increase the number of people taking part in screening. The improved accuracy of the test also means more people will be referred for an endoscopy procedure to either confirm a diagnosis of bowel cancer, receive the all clear or go on to be treated for another bowel condition. The introduction of this test is therefore expected to increase demand for endoscopy services in Welsh hospitals which are already struggling to cope.

In November 2018, we provided evidence to the Welsh Assembly, as part of the Health and Social Care Committee inquiry into endoscopy services, outlining the deep concerns that the current workforce, and infrastructure in Wales does not have the capacity to cope with the demand that the introduction of FIT into Bowel Screening Wales will bring. Now that FIT has been rolled out it’s vital that progress is made to implement the Health and Social Care Committee’s recommendations are taken forward.

What has the Health and Social Care committee called for?

The Health Committee published its report, in April 2019, recommending that the Welsh Government should work with the National Endoscopy Improvement Programme (a recently established group tasked with developing sustainable improvements to endoscopy services in Wales) to create and publish a national endoscopy action plan by October 2019 that addresses current and future demand for these services with clear timescales and targets for improvement. The Committee recommended that this plan should:

• Include a timetabled programme to optimise bowel cancer screening: this includes a timetable to increase the sensitivity of FIT and lower the screening age from 60 to 50 so that Wales does not fall further behind its UK counterparts.
• Address current capacity issues in endoscopy services and provide assurances that health boards will improve waiting times for endoscopy tests.
• Detail a more sustainable approach to achieving waiting time targets, given the short-term nature and costs of health boards’ insourcing and outsourcing endoscopy procedures.
• Review and develop a sustainable and national approach to managing those at high risk of bowel cancer, such as those with Lynch syndrome, who need regular endoscopic surveillance.
• Outline a national approach to ensure endoscopy services are able to cope with the anticipated increase in referrals from the Bowel Screening Wales programme, including new models of care to increase the number of endoscopists in Wales.
• Include opportunities for a non-medical accelerated training programme to expand the endoscopy workforce to meet the growing demand and outline details of how the different needs of a NHS staff will be met.
• Support health boards’ endoscopy services to gain quality accreditation by the Joint Advisory Group for Gastrointestinal Endoscopy (JAG) to ensure that endoscopy services are being delivered in line with best clinical practice.
• Come to a decision on how and when FIT should be introduced to primary care to support the diagnosis of bowel cancer in patients presenting with symptoms (known as symptomatic patients). You can find out more about FIT in symptomatic patients in a previous blog.
• Develop a more ambitious target for those taking part in the bowel cancer screening programme. As it stands the target is for 60% of all eligible participants to choose to take part in the bowel cancer screening programme. The new target should also include details of how and when this target will be revised and achieved; and actions to address health inequalities in screening, particularly to increase uptake among men in deprived areas.
• Build on the “Be Clear on Cancer” public awareness campaign to help improve uptake by raising awareness of the changes to the bowel screening programme.

What has the Government done?

The Welsh Government confirmed in June 2019 that they will develop an endoscopy action plan to tackle challenges facing endoscopy services in Wales. Following the debate this week the Government reaffirmed their commitment publicly to deliver an action plan that addresses the bullet points above.     

What happens next?

The National Endoscopy Action Plan for Wales is due to be published in October 2019. Whilst we are pleased that the new Endoscopy Programme Board is in place and an action plan is imminent, we are yet to see improvements in endoscopy waiting times and are concerned that the use of expensive insourcing and outsourcing of endoscopy procedures remains an established part of the solution to meet demand within health boards in Wales.

The urgency with which we need to reorganise services that diagnose bowel cancer has now reached crisis point so it’s vital that the forthcoming plan quickly translates to action on the ground. We welcome the Health and Social Care Committee’s commitment to review progress in 12 months’ time. In the meantime, we remain a committed partner to delivering a new programme to address the capacity crisis in endoscopy services.

• Read the Welsh Government’s Health and Social Care Committee’s full report on endoscopy services here.
• Read our report, Spotlight on Bowel Cancer in Wales, to find out more about challenges facing bowel cancer in Wales.
• Ask your AM to become a bowel cancer champion today to help drive change in the National Assembly.