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17 September 2019
Challenges facing Endoscopy Services in Wales
Bowel cancer is the fourth most common cancer in Wales. According to Bowel Cancer UK, approximately 2,200 people are diagnosed with bowel cancer in Wales each year and over 900 people die from the disease, making it the second biggest cancer killer. Bowel cancer outcomes in Wales are amongst the poorest in Europe – Wales ranks 25 of 29 in Europe for five year survival.
Bowel cancer is treatable and curable if diagnosed early. Screening is one of the best ways to identify cancer early; it can help to identify patients that should be referred for diagnostic tests such as an endoscopy.
Endoscopy is a procedure that examines the inside of the stomach or bowel and is used to investigate a wide range of possible medical conditions, including bowel cancer. The Committee focused on the capacity of endoscopy services in Wales in the context of changes to bowel cancer screening practices in Wales which will mean more patients being referred for endoscopic diagnostic tests.
In November 2018, the Health, Social Care and Sport Committee held an inquiry into endoscopy services in Wales, recognising that diagnosing bowel cancer early can achieve better survival outcomes for patients.
Bowel cancer screening in Wales is changing
The Committee heard that endoscopy services in Wales do not have the capacity they need to support changes to the bower cancer screening programme and the growing demand this is expected to put on services.
A fully optimised bowel cancer screening programme will see the screening age lowered from 60 – 74 years to 50 -74 years by 2023, using a new, more accurate and easier to use screening test – the Faecal Immunochemical test (FIT). A key feature of FIT is that the sensitivity of the test can be adjusted. The lower the threshold, the more sensitive the test is to blood in faeces and the more cancers and precancerous polyps are detected.
Improving the bowel cancer screening programme can only be a good thing for patients in Wales. Only half of those currently offered the screening test take up the offer. FIT is expected to see an increase in screening uptake simply because the test is easier to carry out.
With an increase in uptake, the more people will be referred for endoscopic diagnostic tests. Serious concerns were highlighted during the Committee’s inquiry about how prepared Health Boards in Wales are to meet this increased demand for services. Bowel Cancer UK referred to ‘the growing endoscopy crisis’.
At the time of the Inquiry, the Committee heard that the majority of health boards in Wales were breaching waiting time targets for tests that can diagnose bowel cancer early, and that endoscopy units in Welsh hospitals were struggling to cope with demand. The reason for the severe pressure on diagnostic units was said to be simply to do with not having the workforce to meet the growing demand on services.
A picture emerged of an NHS in Wales already struggling to meet current demand, and much needed changes to the bowel cancer screening programme adding further pressure to an already overstretched system.
National Action Plan for Endoscopy Services in Wales
In 2014, an Endoscopy Task and Finish group was established by Welsh Government to address the challenges identified in relation to diagnostic capacity. The group made specific recommendations for individual Health Boards to deliver that covered endoscopy waiting times and issues of capacity.
By the time the Committee held its inquiry, little progress had been made in implementing the recommendations. To help drive forward improvements at greater pace, the Committee made one, overarching recommendation
– that by October 2019, the Welsh Government should create and publish a national endoscopy action plan that addresses current and future demand for services with clear timescales and targets for improvement.
The Welsh Government accepted the recommendation.
Members of the Health, Social Care and Sport Committee will undoubtedly be monitoring Welsh Government closely – to make sure the action plan for endoscopy services is published within the six month timescale set out, and that it addresses the specific issues identified in the Committee’s report, including:
- improvements to the bowel screening programme
- waiting time performance
- workforce training and development
- facilities and infrastructure, and
- service planning;
The Committee will want assurances that endoscopy services in Wales are fit for the future, helping to ensure more people in Wales are diagnosed early and survive bowel cancer The Health, Social Care and Sport Committee published its report on Endoscopy services in Wales (PDF, 451KB) on 8 April 2019. The Welsh Government responded to the Committee’s report and a plenary debate will be held on 19 September 2019.
Article by Sarah Hatherley, Senedd Research, National Assembly for Wales