New report recommends much-needed improvement to how we diagnose bowel cancer in England

Getting It Right First Time (GIRFT) is a national programme designed to improve the treatment and care of patients by looking in-depth at NHS services. Recently they published 18 reports, including one focused on gastroenterology, with the aim of supporting the NHS effort to restore routine care and help tackle waiting lists.

Gastroenterology, an area of medicine that focuses on the health of the digestive system, has developed and expanded at an incredibly fast rate over the last 30 years. This is due to a number of reasons, including the need for more tests to both diagnose and then treat gastrointestinal illness, including bowel cancer.

However, despite this rapid growth, the GIRFT gastroenterology report reveals a lack of investment in the endoscopy workforce, meaning that the numbers of staff have not increased to meet the rising demands on the service.

Like many areas of medicine, gastroenterology also suffers from problems with recruitment, with 43% of advertised vacancies remaining unfilled in 2018. The service relies on staff working additional hours and recruiting via agencies. The workforce was strained before the COVID-19 pandemic – but in its wake, the huge backlogs created in endoscopy will worsen workforce issues, increasing the likelihood of staff becoming ‘burnt-out’.

Much needed improvements to the bowel cancer screening programme over the coming years, including lowering the screening age to 50, will also increase demand on endoscopy services, and worsen capacity challenges further.

The report included a variety of recommendations, such as:

• better compliance to the NICE guidance for recognition and referral of people with suspected bowel cancer
• reduce the variation in the proportion of bowel cancers detected through colonoscopy referral
• more assessment of whether a colonoscopy is the most appropriate test for a patient
• investigating potential missed opportunities to diagnose bowel cancer earlier after being diagnosed as an emergency
• review the rate at which people develop bowel cancer after colonoscopy, and surveillance of people at high-risk of developing the disease

Bowel cancer is the fourth most common cancer in the UK and the second biggest cancer killer. However, it’s treatable and curable especially if diagnosed early.

Genevieve Edwards, Chief Executive of Bowel Cancer UK, comments: “We’re pleased this long awaited report has now been published, especially as endoscopy services have been significantly impacted by the COVID-19 pandemic. However, this report makes for grim reading and it’s now clear that urgent action is needed to improve endoscopy services which we hope will be taken swiftly.

“We welcome these recommendations as they will help optimise current capacity and pathways so the NHS can make the best use of resources, reduce unwarranted variation and improve patient experience. Yet, demand on these services will continue to rise therefore more needs to be done to expand endoscopy capacity to meet future demand.

“The Government committed to diagnosing 75% of cancers at early stage by 2028 and we hope they stand by this commitment to save more lives from bowel cancer. As a charity we are also funding studies to explore why some bowel cancer cases go undetected by colonoscopy which should help reduce the rate of post-colonoscopy cancers.”

• Read more about how we plan to tackle the endoscopy crisis in our End the Capacity Crisiscampaign

• Discover more about the Getting it Right First Time programme