Marking the half way point for the Scottish cancer strategy: What has been achieved and what still needs to be done?
This month marks the half way point of the Scottish cancer strategy “Beating Cancer: Ambition and Action”. In recognition of this milestone, we have taken a look at what has been achieved since its publication in March 2016, and which actions need more attention.
What did the Scottish cancer strategy promise for bowel cancer?
The strategy committed £100 million over five years to tackle cancer across the patient pathway. It included sections on improving prevention, early detection, diagnosis, treatment, survival and after care for those affected by cancer. Every section identified key actions to be completed within the five years of the strategy.
A number of these actions directly affect patients with bowel cancer. These include:
- Replacing the current bowel screening test with the faecal immunochemical test (FIT)
- Examine the evidence from an ongoing trial to determine the need for a national roll-out of a flexible sigmoidoscopy one-off test that looks at the lower part of the bowel where most bowel cancers are found
- Invest an additional £2 million per annum in a new Diagnostics Fund to support swift access to diagnostics for people with a suspected cancer diagnosis
- Invest an additional £1 million per annum in additional scope capacity, which will see an additional 2,000 scopes per annum on a sustainable basis
- Increase by 40% the number of clinical (nurse) endoscopists in training, who will be in work by 2017
The implementation of these actions would mean that more people would have a better chance of an earlier diagnosis of bowel cancer when treatment has the best chance of working.
During the first half of the strategy there have been some notable successes. For example, in November 2017 the Scottish Bowel Screening Programme was the first in the UK to introduce the faecal immunochemical test (FIT) for bowel screening. This new, easier to use test already appears to be improving uptake in screening by around 10%.
In addition, the flexible sigmoidoscopy study has finished and been evaluated to determine whether a national roll-out of the one-off test would be valuable. The test looks for and removes any non-cancerous growths (polyps) in the lower part of the bowel that could develop into cancer over time. The report showed that a very low percentage of people were willing to participate in this screening test and that there would be a large financial and workforce implication to roll this programme out nationally. The study group therefore recommended that this one-off test should not be rolled out, and that the resources should instead be used to optimise the implementation of FIT.
What’s left to do?
However, some of these actions have not achieved what they had hoped. For people who may have bowel cancer, improving delays to diagnosis are still not where it should be. The strategy released £2 million per annum to health boards to prioritise funding for diagnostic services, as well as £1 million per annum for 2000 additional scopes per year. Despite this, the waiting times for diagnostic tests, including flexible sigmoidoscopy and colonoscopy, are getting worse. In June 2018, more than 6,000 of those (6,159) had been waiting more than six weeks.
The Scottish Government also promised to increase the number of nurse endoscopists available for work by 2017 by 40%, however this target wasn’t reached and only one additional nurse completed their training.
A national Clinical Lead for diagnostics has now been appointed by the Scottish Government and the endoscopy crisis is one of her priorities. The Scottish Government have also developed an endoscopy action plan and Bowel Cancer UK is looking forward to seeing this made public and supporting the implementation of this plan.
How we are helping
Bowel cancer UK, as a member of the Scottish cancer coalition, has been involved in many activities to help the Scottish government to achieve all the aims of the cancer strategy. We contributed to the FIT implementation and Communication groups, prior to disbanding. As a patient-centred organisation, we undertook the analysis and reported the findings of the patient experience surveys from the flexible sigmoidoscopy study. We also attend and contribute to various groups, including the Detect Cancer Early Programme Board. This September, we were part of the Cross Party Group on Cancer’s inquiry into the progress of the Scottish Cancer Strategy and were part of a panel of speakers providing feedback on the progress made in both the Early Detection and Improving Survival sections.
The next two and a half years will be challenging and if the aims of Beating Cancer: Ambition and Action are to be achieved there needs to be clear performance indicators for the outstanding actions.