The Bowel Screening Programme in Wales

1. The Bowel Screening Programme in Wales Hayley Heard Head of Programme

2. Bowel Cancer in Wales • 2,200 people diagnosed every year in Wales • 1,000 people die of the disease every year in Wales • The third most common cancer in Wales

3. Evidence to Support Bowel Screening • 1991-1996 • Bowel Screening can prevent premature death • 2000-2002 • Pilots in England and Scotland • 2003-2006 • Can be delivered in a population based screening programme • 2005 • National Screening Committee recommendation

4. Bowel Screening • Based on Faecal Occult Blood test • Colonoscopy or radiological investigations offered if FOBt positive • Reduces mortality from bowel cancer by 15%

5. UK Perspective England • Pilot sites • 2006 - Geographical roll out • 5 hubs • 47 Screening centres live • 60-69 years • Planning to increase to 74 • Self referrals • Guaiac faecal occult blood test • Accredited screening colonoscopists • JAG approved units

6. UK Perspective Scotland • Pilot site • 2007 - Geographical roll out • 1 hub • Testing model - Guaiac and FIT • 50-74 years • No self referrals • Devolved management model • Screening colonoscopists not accredited • Units not JAG approved

7. UK Perspective Northern Ireland • Project Phase • Due to implement December 2009 • 60-69 years olds –74year olds by 2013 • Options appraisals: • Laboratory • Test • I.T. system • Local Assessment Centres • Accreditation of Colonoscopists

8. UK Perspective Wales • February 2007 Ministerial Announcement • July 2007 PID approved • October 2008 Programme implemented • National coverage • 1 hub • Testing model - Guaiac and FIT • 60-69 year olds – will increase to 50-74 years • No self referrals • Screening colonoscopists assessed and approved • Units not JAG approved

9. Screening Services in Wales • Breast Test Wales • Cervical Screening Wales • Ante Natal Screening Wales • Newborn Hearing Screening Wales • Bowel Screening Wales

10. Bowel Screening Wales Programme Aim • In the group of people invited for screening to reduce deaths from bowel cancer by 15%

11. Phased Introduction by Age

12. Project

13. Baseline Review • Expressions of interest requested • Local implementation teams • Questionnaire • Trust visits • Suitability criteria • Screening implementation plans

14. Suitability Criteria Local Assessment Centres Service requirements Environmental Equipment Training

15. Local Assessment Centres

16. Endoscopy Training and Capacity • Identify training requirements • Assessment model • Capacity for colonoscopy • Referral pathways • Protocols • Specialist Screening Practitioners

17. Screening Colonoscopist Assessment Three phase approach: • Pre assessment • Individual learning plan and support • Assessment: • Directly Observed Procedures • Multiple Choice Questions

18. Specialist Screening Practitioners • Nurses • 17 in Wales • Employed by Trusts • Induction programme • Msc module • Telephone assessment • Results • Hand over to MDT

19. Information Technology • Options appraisal • System design and development • Specification, commissioning and procurement of software, hardware and telephone systems • Oversee installation of IT system • Disaster recovery plan

20. Biochemistry • Option appraisal for type of test • Accommodation • Accreditation • Staff: • Job descriptions • Recruitment • Training

21. The Test Testing Strategy Primary Test: • Guaiac Secondary Test: • Immunochemical

23. Marketing and Communications • Corporate identity • Identify and engage stakeholders • Promote collaborative partnerships • Website • Develop communications strategy • Develop public information • Market programme • Media training • Launch

24. Marketing Considerations Aim for minimum 60% take up Initial target of 60-69 age group Focus on Informing the target audience Generating a response to the screening invitation Overcome the key barrier of embarrassment About bowel cancer About bowels and the test For men in particular

25. Invitations • Letter and folder by post • Bowel Screening Explained • Test kit • Card sticks • Return envelope • Instructions • Every two years • Layered Information • DVD

26. Newspaper Advertisement

27. Health Promotion and Community Information Community Pharmacies GP Surgeries Tenovus shops Community events

28. Professional Information • Developed for: • Primary care • Prison staff • Other healthcare providers

30. Quality Assurance • Programme aim, remit and scope • Policy, Standards and Protocols • Quality assurance manual • National Service Document

31. Operations and Administration • Procedures – call, recall, failsafe • Liaise with IT design team • Options appraisal for invitation • Staff: • Job descriptions • Recruitment • Training • Helpline

32. Programme Launch October 2008 • Stakeholder conference • 3 launch events • Media attention • Local champions • Welsh Assembly Government

33. Results to date 22nd September2009: • 164,079 invitations • 88,264 kits returned • Uptake 60.2% • Spoilt test kit 2% • FOB positive 2.3%

34. Results to Date • 1139 participants deemed fit for colonoscopy • 9.5% confirmed cancers 1.3% suspected • 33% participants on surveillance • 1.6% diagnosed with IBD

35. Ongoing Challenges • Uptake • Assessment of Screening Colonoscopists • Increasing age range • Surveillance programme

36. Thank you