Improving diagnostic services for bowel cancer in Scotland

Endoscopy tests, such as a colonoscopy or flexible sigmoidoscopy, are key diagnostic tests for bowel cancer. They can detect cancer at the earliest stage of the disease, when it is more treatable, as well as prevent cancer through the removal of polyps during the procedure, so timely access to high quality tests is crucial.

Demand for these procedures has been increasing since the introduction of the bowel cancer screening programme and with the introduction of a new and more accurate screening test, faecal immunochemical testing, this is set to increase further. How this increasing demand will be met sets serious challenges for the health service in Scotland.It’s crucial that health boards have the capacity needed to meet demand and ensure patients are not waiting longer than the 6 week waiting time standard for diagnostics.

We recently raised this with the Scottish Cabinet Secretary for Health, Shona Robison MSP, in person and in a letter. Unfortunately after reading the response we still have concerns. Here are some excerpts of the response we received along with our analysis. Here are some excerpts of the response we received along with our analysis. You can read the full response from the Scottish Government here.

1. Demand and capacity

We called on the Scottish Government to make a full assessment of the projected increase in demand for endoscopy in Scotland and the capacity needed to meet this demand. To date no national assessment has been made in Scotland.

Scottish Government response:

“NHS Boards are responsible for planning and delivering services to meet the needs of their local population now and in future. The Scottish Government Health Directorate is actively supporting all Boards to better predict demand for NHS services and to plan for sufficient capacity to meet these demands over the coming years.”

This doesn’t address the need for a comprehensive national assessment on future demand and capacity. We need to hear more detail on how the Scottish Government is “actively supporting” health boards to better project demand and to plan sufficient capacity. We know that some health boards have an issue with recruitment and retention of their workforce, which impacts on a units ability to meet demand within waiting time standards.

“Detect Cancer Early programme is currently supported by £30 million additional funding with a further release of up to £9.2 million in 2015-16. It is anticipated that much of this funding will be used to provide additional diagnostic capacity.”

While additional funding is welcome, detail is needed on what and whether any objectives have been attached to the funding health boards have received through the DEC programme. It is not clear yet what improvements have been made as a result of this funding and what additional diagnostic capacity for endoscopy has been provided to units in Scotland. This is absolutely necessary to ensuring that funding is being used effectively and to measure success.

2. Improving quality

The Joint Advisory Group for gastro intestinal (JAG) accreditation scheme for endoscopy units, which is based on the Global Ratings scale quality improvement and assessment tool, has been instrumental in setting out clearly what constitutes best practice and good quality care. Currently no units in Scotland are JAG accredited. However the Scottish Endoscopy Raising Standards and Effectiveness programme (ENDORSE) aims to bring units up to JAG standards. Units complete the GRS assessment twice year, which has been funded by Healthcare Improvement Scotland (HIS). We called on the Scottish Government to ensure ENDORSE receives adequate funding to support its work to improve quality, safety and timeliness of endoscopy units.

Scottish Government response:

“Work is underway for endoscopy units and JAG UK to work more directly on the GRS census. This will develop links between JAG UK and NHS Boards, reinforce the links between the census and achievement of accreditation for endoscopy units and give units access to JAG UK support and expertise.”

We now know that HIS has withdrawn funding for GRS assessments. As of October 2015 health boards will have to fund their own GRS assessments. However the Scottish Government have confirmed that units will not be mandated to participate. Without a mandate and additional funding to help raise the quality of services we are incredibly concerned this will mean that accreditation will fall by the wayside.

We call on the Scottish Government to set out a clear timetable for health boards to achieve JAG accreditation with additional funding to help health boards to work towards accreditation.

What next?

We will continue to raise these issues with the Scottish Government. We hope to work with them and clinicians to ensure a sustainable endoscopy service that has the capacity to meet future demand.

If you want to get involved please sign up to our Campaign Supporters Network and we’ll be in touch to let you know how you can help.

Meanwhile you can read more about our “Right Test, Right Time” campaign here.

By Asha Kaur, Bowel Cancer UK Policy Manager