Endoscopy services
Endoscopy services
Inquiry5
The
Fifth Senedd Health, Social Care and
Sport Committee held an inquiry into endoscopy
services in Wales in response to concerns about capacity constraints and
changes to the bowel screening programme, which it is anticipated will increase
future demand for services.
The
Fifth Senedd Committee published
its report in April 2019. The Welsh Government responded
in 2019.
The
Sixth Senedd Health and Social Care
Committee wrote
to the Minister for Health and Social Services on 8 July 2022 to seek an update
on the Fifth Senedd Committee’s recommendations. The Minister responded on 24
August 2022.
Background
Bowel
Cancer UK published its report 'A Spotlight on Bowel
Cancer in Wales: Early Diagnosis Saves Lives' in February 2018, which highlights serious
delays in diagnosis for bowel cancer in Wales. The report highlights that
bowel cancer outcomes in Wales are amongst the poorest in Europe
- Wales ranks 25 of 29 in Europe for five year survival.
The report
highlights that challenges exist in Wales around screening, endoscopy
capacity and quality, GP referral, implementation of NICE guidelines, and
symptom awareness.
Bowel
Cancer UK's report states that the majority of Health Boards in Wales
breach waiting times for tests that can diagnose bowel cancer and that an
alarmingly low number of eligible people take part in the bowel screening
programme. Screening is the best way to diagnose bowel cancer early but in 2016
only 53.4% of people eligible to take the bowel screening test in Wales
actually completed it. For those that need further hospital tests via
endoscopy, many will wait much longer than the eight week wait target.
Faecal Immunochemical Test (FIT)
From
2019, Wales will replace the current screening test with a simpler and more
accurate one called the Faecal Immunochemical Test (FIT), which is expected to
increase the uptake of screening, but there are concerns that endoscopy units
in Welsh hospitals are already struggling to cope with demand, and so while the
new screening test is a positive improvement, it could put more strain on an
already overstretched service.
In
Scotland, FIT replaced guaiac based FOBt (gFOBt) as the test for bowel
screening in November 2017. In a study looking at use of FIT in Scotland, it
was found that overall uptake was 58.7% for FIT, significantly greater than the
53.9% for gFOBT.
FIT
measures micrograms of human haemoglobin per gram of faeces. What is considered
to be a normal or an abnormal result can be changed by altering the numerical
FIT threshold. As a general statement, the lower the threshold, the more
sensitive the test will be and the more cases of cancer and adenoma that will
be detected, and ultimately deaths from bowel cancer averted. A highly
sensitive FIT would mean more people are referred for colonoscopy.
The
FIT sensitivity threshold planned within the Bowel Cancer Screening Programme
in Wales is 150ug/g and in Scotland, it is 80ug/g. The proposed starting
sensitivity threshold is 120ug/g in England.
The
new test was due to be implemented from age 60, but the UK national screening
committee has recently recommended that the test should available to people
aged 50-74, after it reviewed available evidence. The test is already being
used in Scotland from age 50.
Evidence sessions
Evidence session |
Date, Agenda and Minutes |
Transcript |
Video |
1. Bowel Cancer UK
and Cancer Research UK Lowri Griffiths,
Head of Wales, Bowel Cancer UK Asha Kaur, Head of
Policy and Campaigns, Bowel Cancer UK Andy Glyde, Public
Affairs Manager (Wales), Cancer Research UK |
|||
2. Public Health
Wales Hayley Heard, Head
of Bowel Screening Wales, Public Health Wales Quentin Sandifer,
Executive Director of Public Health Services / Medical Director, Public
Health Wales Sharon Hillier, Director of Screening,
Public Health Wales |
|||
3. Wales Cancer
Network Dr Tom Crosby, Medical Director of the
Wales Cancer Network and Consultant Oncologist, Velindre Cancer Centre |
|||
4. Cardiff and Vale
University Health Board and Powys Teaching Health Board Jared
Torkington, Outgoing chair of the Welsh Association for Gastroenterology and
Endoscopy (WAGE) and Consultant Colorectal Surgeon, Cardiff and Vale
University Health Board, Dr
Sunil Dolwani, Incoming chair of the Welsh Association for Gastroenterology
and Endoscopy (WAGE) and Consultant Gastroenterologist and Bowel Cancer
Screening lead, Cardiff and Vale University Health Board Dr
John Green, Chair of the Endoscopy Services Quality Assurance Group at the
Joint Advisory Group on GI Endoscopy (JAG) and Consultant Gastroenterologist
at Cardiff and Vale University Health Board Phedra
Dodds, Consultant Nurse Endoscopist, Powys Teaching Health Board |
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5. Health Education
and Improvement Wales Dr Neil Hawkes, Consultant Gastroenterologist,
Health Education and Improvement Wales |
|||
6. Welsh Government
Officials Andrew Goodall, Director General for Health
and Social Services / NHS Wales Chief Executive, Welsh Government Simon Dean, NHS Deputy Chief Executive,
Welsh Government Dr Chris Jones, NHS Deputy Chief Medical
Officer, Welsh Government |
Business type: Committee Inquiry
Reason considered: Senedd Business;
Status: Complete
First published: 09/10/2018
Documents
Consultations
- Endoscopy services (completed)