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Update on the introduction of the National Colorectal Screening Programme

An update on planning for the National Colorectal Screening Programme

Introduction

The National Cancer Screening Service (NCSS) is introducing a national colorectal screening programme called BowelScreen - The National Bowel Screening Programme.

Similar to BreastCheck, CervicalCheck and the upcoming Diabetic Retinopathy screening programme, the NCSS must ensure that quality assurance is paramount and all the essential elements are in place to ensure risks to patients are minimised and that the best clinical outcomes for patients are maximised.

BowelScreen - The National Bowel Screening Programme is different from the current programmes in a number of ways. It is the first call, re-call screening programme in Ireland to be offered to men as well as women. The screening test, known as a Faecal Immunochemical Test (FIT) test, is one that can be carried out at home. The completed test is posted directly for analysis to a laboratory contracted by the NCSS.

Organised population-based call, re-call screening for colorectal cancer is a complex and a layered process.  Planning is managed by the NCSS’s Colorectal Executive Management Team and supported by the NCSS’s Colorectal Operations Group.  Tendering, procurement, recruitment, accreditation of endoscopy units, ICT preparations, development of the quality assurance guidelines and all other elements are well underway.

Colorectal Cancer in Ireland

Colorectal cancer is the second most commonly diagnosed cancer in Ireland with in excess of 2000 cases each year and it is the second most fatal cancer.  By 2020, with our aging population it is estimated that there will be an increase in colorectal cancer of 79 per cent in men and 56 per cent in women.   Colorectal cancer screening aims to detect both cancerous and pre-cancerous conditions and over time will reduce mortality from the disease.

BowelScreen - The National Bowel Screening Programme

The programme offers free screening to men and women aged 55-74 on a two-yearly cycle. As 50 per cent of cancers within this age group are found in people aged 60-69 the programme will begin with this age cohort, a population of around 500,000.

Approximately 94 to 95 per cent of people will receive a normal FIT test (home-based test) result and will be invited for routine screening again in two years time. A small number, in the region of five to six per cent, will receive a not normal result and will require an additional test. They will be referred for a colonoscopy (an investigation of the lining of the bowel) to a Screening Colonoscopy Unit within a hospital contracted by the NCSS for provision of this service.

Over time the phasing of the programme will allow development of colonoscopy capacity to cater for the full 55-74 population.

Quality Assurance

In 2010, the NCSS established a Quality Assurance committee, comprising of four
subgroups - Programme and Administration; Endoscopy and Radiology; Histopathology; and Surgery. The members of each subgroup, who represent experts in each field, developed a set of quality assurance processes and standards for the national programme. 

An International Peer Review Panel was convened last year to examine the plans for the screening programme and the draft guidelines and to ensure the best of international evidence was incorporated into the process. 

The work of the QA committee is now complete and the Guidelines for Quality Assurance in Colorectal Screening recently published.

A Clinical Advisory Group has been established to support the ongoing development of the programme and provide ongoing clinical advice to the NCSS.

Service Provision

Procurement and tendering for the many aspects of service provision are complete and implemented to support the programme and include:  FIT kit supply and distribution, laboratory-screening service for the analysis and reporting of test results for FIT kits, mailing functions and  call handling services.
 
An academic partner is on board to provide an educational programme for clinical nurse specialists to train with the aim of becoming registered as Advanced Nurse Practitioners with An Bord Altranais.

A population register is one of the key elements of an effective screening programme and will be the basis inviting the eligible population for screening. 

Population communications

Clients of the screening programme will be supported by a freephone information line, support materials and comprehensive information on the website www.bowelscreen.ie. These will include written and pictorial resources and be supported by NALA – the National Adult Literacy Agency.

Health Professional communications

Information is currently being prepared to educate and support Health Professionals once the programme is launched. The NCSS is leveraging current links with Health Professionals through the BreastCheck and CervicalCheck programmes and in addition is liaising with the Irish College of General Practitioners to ensure the best approach for education is adopted for the primary care community in 2013 and 2014.

Screening Colonoscopy Units

In summer 2010, the NCSS requested Expressions of Interest from all publically funded hospitals that wished their Endoscopy Unit to be considered as a provider of screening colonoscopies to the national colorectal screening programme.  The HSE, through the NCSS then commissioned NHS JAG to carry out baseline assessments on 37 hospital endoscopy units. 

Following this, in January 2011, the NCSS made an initial selection of 15 candidate screening colonoscopy units. The NCSS has supported, and continues to support, the NHS JAG accreditation process for all 15 candidate sites. The accreditation process is for the purposes of quality improvement. 

Other units not initially selected may in time be included as screening colonoscopy units as part of the National Colorectal Screening Programme.

Each selected initial candidate unit has responsibility to take specific actions necessary to become a screening colonoscopy unit and in essence these include:

  • Achieve or be well on the pathway to achieving NHS JAG accreditation.
  • Demonstrate capability of meeting the needs of the screening programme in accordance with its Quality Assurance Standards.
  • Maintain the service requirements for symptomatic patients in endoscopy within national targets.
  • Have a working Endoscopy Reporting System (IT) in place with appropriate links
  • Provide support to a Clinical Nurse Specialist through their training with a view to becoming registered as an Advanced Nurse Practitioner with An Bord Altranais.

The NCSS links with colleagues at the Health Service Executive and the Special Delivery Unit, Department of Health in the development of  appropriate capacity in colonoscopy services nationwide to support the introduction, sustainability and growth of the screening programme, while maintaining and enhancing the capability of the symptomatic endoscopy service.

Conclusion

For more information on BowelScreen - The National Bowel Screening Programme see www.bowelscreen.ie

 

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