The Bowel Screening Programme in Wales Hayley Heard Head of Programme

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

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

Bowel Screening Based on Faecal Occult Blood test Colonoscopy or radiological investigations offered if FOBt positive Reduces mortality from bowel cancer by 15% Screening programmes aim to enable us to diagnose disease in people who have no signs or symptoms of the disease. This is achieved by offering people a test to sift out those who are likely to benefit from further tests or treatments to reduce the risk of the disease or its complications. Screening programmes reduce the risk of disease, but they can’t reduce that risk to nothing. Some people will still go on to develop the disease even if they’ve had a negative screening test, while others who are picked up by screening may either still die of the disease or would have been diagnosed and survived anyway whether they were screened or not. Before we embark on any screening programme we need to know that it will, overall, reduce the burden of the disease in question. Always important to keep in mind the fact that screening programmes are inviting very large numbers of healthy people and that we must do them as little harm as possible. And screening programmes do do harm- see slide. So as well as knowing that a screening programme will reduce the burden of the disease, we also need to be sure that it won’t do more harm than good by its impact on the vast majority of those being screened who are healthy.

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

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

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

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

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

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

Phased Introduction by Age

Project

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

Suitability Criteria Local Assessment Centres Service requirements Environmental Equipment Training

Local Assessment Centres

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

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

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

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

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

The Test Testing Strategy Primary Test: Guaiac Secondary Test: Immunochemical Put your details on the test kit Collect your bowel movement Collect second and third samples within 10 days Post the kit to Bowel Screening Wales

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

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

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

Newspaper Advertisement

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

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

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

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

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

Results to date 22nd September 2009: 164,079 invitations 88,264 kits returned Uptake 60.2% Spoilt test kit 2% FOB positive 2.3%

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

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

Thank you