Inquiry5

The Health and Social Care Committee held a short inquiry into endoscopy services to consider what further action is needed to implement the national endoscopy action plan, reduce waiting times, and ultimately improve patient outcomes and survival rates.

Background

The Fifth Senedd Health, Social Care and Sport Committee held an inquiry on endoscopy services in April 2019. It found that increasing demand for endoscopy and a lack of capacity in hospitals was driving long waiting times for endoscopy appointments, and called for the Welsh Government to develop and implement a national endoscopy plan at pace.

Waiting times for elective care across all specialties have grown significantly as a result of the COVID-19 pandemic. In April 2022 the Welsh Government published a plan for the recovery of elective services. The plan is supported by additional funding of over £170 million over three years, and includes implementation of the national endoscopy action plan.

The Minister for Health and Social Services provided an update on the Fifth Senedd Committee’s recommendations in September 2022.

Following a call for written evidence in autumn 2022 and oral evidence sessions on 2 February 2023 and 15 February 2023, we wrote to the Minister for Health and Social Services on 10 March 2023. The Minister responded on 25 April 2023.

Terms of reference

In particular, the Committee considered:

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>>>The impact COVID-19 has had on delivery of endoscopy services and the implementation of the national endoscopy action plan, and the implications of this for patient outcomes and survival rates.

>>>The priority given to endoscopy services in the Welsh Government’s programme for transforming and modernising planned care, including who is responsible for delivering improvements through the reconfiguration of services and new models of care (including additional endoscopy theatres, diagnostic centres and regional units), and how endoscopy services will feature in the new cancer action plan (expected to be published autumn 2022).

>>>Issues relating to recovering and improving waiting time performance, including: reducing waiting times for diagnostic tests and imaging to eight weeks by spring 2024 and support for people waiting for tests and follow up appointments; the active waiting list size for all current inpatient and day-case patients waiting for endoscopic procedures (by modality); the extent to which elective capacity is impacted by emergency activity, and whether there is sufficient data to understand the impact of emergency cases; whether high risk patients requiring ongoing surveillance endoscopic procedures are included in current demand and capacity planning models; the scope for upscaling lessons learned from previous waiting list initiatives such as insourcing, outsourcing or mobile units; and what the current demand and capacity modelling tells us about when a sustainable position can realistically be achieved.

>>>What barriers there are to achieving accreditation from the Joint Advisory Group on GI Endoscopy, including whether health boards are investing sufficient resource in developing the facilities and infrastructure for endoscopy services, decontamination services, and the progress that has been made in expanding the endoscopy workforce.

>>>The current position for optimising the bowel cancer screening programme (i.e. for increasing Faecal-Immunochemical Testing (FIT) sensitivity and age testing) and how this compares to other parts of the UK.

>>>The experiences of younger people and those most at risk of developing bowel cancer (i.e. those living with Lynch syndrome) and efforts to diagnose more patients at an early stage.

>>>Primary care access across different health boards to FIT for patients who do not meet the criteria for a suspected cancer pathway referral and how it is being used to help services prioritise patients and stratify referrals by risk (outpatient transformation).

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