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
Bowel Screening can prevent premature death
Pilots in England and Scotland
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%
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.

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 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
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

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 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 Every two years
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 September 2009: 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