Endoscopy services

Inquiry5

The 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.

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

29 November 2018

Read transcript

Watch on Senedd.tv

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

29 November 2018

Read transcript

Watch on Senedd.tv

3. Wales Cancer Network

Dr Tom Crosby, Medical Director of the Wales Cancer Network and Consultant Oncologist, Velindre Cancer Centre

 

29 November 2018

Read transcript

Watch on Senedd.tv

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

29 November 2018

Read transcript

Watch on Senedd.tv

5. Health Education and Improvement Wales

Dr Neil Hawkes, Consultant Gastroenterologist, Health Education and Improvement Wales

29 November 2018

Read transcript

Watch on Senedd.tv

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

29 November 2018

Read transcript

Watch on Senedd.tv

 

Business type: Committee Inquiry

Reason considered: Senedd Business;

Status: Complete

First published: 09/10/2018

Documents

Consultations