(Title Image: Bowel Screening Wales)

Health & Social Care Committee

Endoscopy Services (pdf)

Published: 8th April 2019

“The introduction of the FIT (Faecal Immunochemical Test) test is a positive step as we believe bowel screening significantly reduces the risk of a person dying from bowel cancer. “While we accept demand has to be properly managed, we are disappointed that the thresholds for FIT testing are lower in Wales, and are concerned that without a clear plan to optimise the programme, Wales will fall further behind its counterparts in other parts of the UK.”

– Committee Chair, Dr Dai Lloyd AM (Plaid, South Wales West)

1. Participation in bowel screening is “alarmingly low”

All adults in Wales aged between 60-74 are sent a free home testing kit every two years which, if used correctly, can pick up early signs of serious bowel disease. However, as has been raised in the Senedd before, just 55.7% of people who are eligible actually took part during 2017-18. Women are also more likely to take part than men and participation is much lower in deprived areas (45.6%) than less deprived areas (63.3%).

As had been demonstrated in the saddest possible terms this year, early diagnosis of bowel cancer can genuinely make the difference between life and death. A number of witnesses said attitudes towards screening had to change as opposed to the screening system itself and there was a warning that traditional public information campaigns were expensive and don’t always work.

2. The Health Committee is concerned the threshold to receive a referral as part of a new test has been set too high in Wales

The Faecal Immunochemical Test (FIT) is being rolled out in Wales as of January 2019. The test detects evidence of blood (as haemoglobin) in faecal samples and is much more sensitive than previous methods, meaning possible cancer could be detected far earlier.

In Wales, if more than 150 micrograms of haemoglobin per gram of faeces are detected under FIT, a person will receive a referral and possible colonoscopy. However, the threshold in Scotland is 80 micrograms and in England 120 micrograms. The aim is for the Welsh threshold to be gradually lowered to 80 micrograms by 2023, though a lack of endoscopy capacity in Wales has been blamed for the delay.

3. Endoscopy services are overstretched

The introduction of FIT is expected to result in a 10% increase in demand for colonoscopies in Wales and despite a high-level review in 2014, very little progress has been made on funding and creating additional capacity in the service. The Welsh Government’s approach to demand was described as “reactive and short-term” (English: they only deal with problems when they arise, not actively try to prevent them).

Some health boards are contracting private providers to carry out procedures – though this happens across the UK. It places a strain on budgets and, while it reduces waiting times, it’s often more expensive than in-house endoscopy.

In a small bit of good news, the number of patients waiting more than 8 weeks for endoscopy services in Wales has halved since 2017. However, waiting times from month-to-month are more erratic and endoscopy waiting times have been blamed for a failure to meet certain cancer treatment targets.

One case study is given of a 55-year-old who, following inconclusive tests for bowel cancer, was put on the waiting list for endoscopy after their symptoms worsened. Their situation got so bad they were admitted to hospital as an emergency case, where an urgent colonoscopy discovered a tumour which was successfully removed. They were told they were only a few days from death.

….a few weeks later a letter arrived for the original endoscopy appointment, 9 months after referral.

There were a number of suggestions to improve the situation from witnesses, including 7-day-a-week endoscopies, the creation of a national endoscopy academy (similar to the much-praised radiology academy) and extra investment in endoscopy facilities – the facilities in the Betsi Cadwaladr board were marked out for particular criticism.