Scope of this report

Summary

Bowel cancer screening aims to reduce mortality and the incidence of bowel cancer both by detecting cancers and removing polyps, which, if left untreated, may develop into cancer.

The findings in this report relate to the quality assurance visit on 20 and 21 March 2023 to Humber and Yorkshire Coast Bowel Cancer Screening Service which is commissioned by NHS England Yorkshire and Humber Public Health Programmes Team (PHPT). Any commissioning findings are outside the scope of this report and will be followed up directly with the commissioner.

Quality assurance purpose and approach

Quality assurance (QA) aims to achieve and maintain national standards, promote continuous improvement in bowel cancer screening and support reducing health inequalities. This is to ensure all eligible people have access to a consistent high quality, effective, equitable and safe service wherever they live.

QA visits are carried out by the NHS England Screening Quality Assurance Service (SQAS).

The evidence for this report comes from the following sources:

• monitoring of routine data collected by the NHS England
• data and reports from external organisations
• evidence submitted by the provider(s) and external organisations
• discussion with the commissioner in advance of the visit
• information shared with the North East Yorkshire and Humber SQAS as part of the visit process

The screening service

Humber and Yorkshire Coast (HYC) screening service provides bowel cancer screening for an eligible population of approximately 246,151 and a registered population of 1,153, 839 across the geography. The Integrated Care Boards (ICBs) covered by the centre are Lincolnshire ICB and Humber & North Yorkshire ICB.

The screening service started inviting men and women aged 60 to 69 for faecal occult blood test (FoBT) screening in February 2007. In 2010 the service age extended the range covered to include 70- to 74-year-olds. Bowel scope screening began in 2017 inviting men and women aged 55. Bowel scope had been partly rolled out; however this service was nationally decommissioned in April 2021. In June 2019, the new faecal immunochemical test (FIT) screening was introduced. In March 2022 the centre age extended to include 56-year-olds and in August 2022 to include 58-year-olds.

Hull University Teaching Hospitals NHS Trust (HUTH) are the host Trust. North Lincolnshire & Goole NHS Foundation Trust (NLAG), and York and Scarborough Teaching Hospitals NHS Foundation Trust (YSTH) are the associated Trusts involved in service delivery.

Service co-ordination and administration takes place at Castle Hill Hospital (CHH), with a second administration site at Diana Princess of Wales Hospital (DPOW). The following table identifies the hospital sites involved in providing the HYC screening service.

Specialist screening practitioner (SSP) clinics were held at a number health centre and hospital sites. This provision stopped when the bowel cancer screening programme (BCSP) was paused as a result of Covid-19. All SSP assessments are currently carried out via telephone or tele-conferencing with face-to-face appointments available if required.

The screening programme hub based in Gateshead undertakes:

• the invitation (call and recall) of individuals’ eligible for FIT screening,
• the testing of screening samples, and
• onward referral of individuals needing further assessment.

This element of the pathway is outside the scope of this QA visit.

Findings

The service showed great resilience through the Covid-19 pandemic and managed to restore the service despite the Humber region being significantly impacted by high infection rates and local lockdowns. The Clinical Director (CD) is committed to the delivery of the BCSP and is well supported by an experienced and established leadership team.

The visiting team recognised many areas of improvement since the last QA visit in 2016, and the screening team should be commended for their hard work in developing the service.

The HYC BCSP leadership team have a good working relationship with the host Trust management colleagues and are in regular communication with the associated Trust management teams. This has been integral to the service successfully age extending to 56- and 58-year-olds.

At present, the programme does not have sufficient screening colonoscopists to provide a robust service and this is evident in the service’s below standard diagnostic waits. A workforce strategy for increasing the number of screeners needs to be developed to ensure the future of the service. This will require the support of both the host Trust and associated Trusts.

The pathology turnaround times are below standard at HRI due to low numbers of BCSP reporting pathologists. Efforts to engage more pathologists to carry out BCSP work should continue.

Links between the radiology and pathology services with the centre team need strengthening. More regular attendance at relevant BCSP meetings by the lead radiologist and lead pathologist; ensuring there is a lead radiographer contact at each site; and proactive engagement from the centre team will help this.

The team are carrying out excellent work around health promotion and SQAS would encourage this to be evaluated in order to demonstrate and share its effectiveness.

The service has no outstanding recommendations from their previous QA visit in 2016.

Immediate concerns

The QA visit team identified no immediate concerns.

High priority findings

The QA visit team identified 5 high priority findings as summarised below:

• The Service Level Agreement between HUTH and NLAG remains unsigned. This should be finalised and signed.
• The Joint Advisory Group (JAG) accreditation has been lost at CHH and HRI. Work should continue to ensure this is regained.
• To improve diagnostic test waits and to secure the future delivery of the service, the centre and its associate Trusts should develop a strategy for expanding the number of screeners.
• The Clinical Director (CD) has plans to retire. The centre should develop a workforce strategy, to include succession planning for CD.
• There were a number of essential audits missing from the radiology evidence submission. These are detailed in the recommendations table. The screening radiology service should ensure these audits are completed.

Examples of practice that can be shared

The QA visit team identified several areas of practice for sharing, including:

• The service has introduced the role of ‘administrator of the day’. This role ensures that specific duties are allocated to one person which then frees up the rest of the team to manage their workloads.
• All cancer cases undergo mismatch repair (MMR) or microsatellite instability (MSI) testing in both laboratories.
• The service have an SSP who leads on the health promotion work. They have a dedicated health promotion group who meet to discuss the planning and evaluation of health promotion activities carried out by the team.
• The service’s operational meeting is recorded, and the minute taker can refer if needed. This ensures no clinical details are missed.

Recommendations

The following recommendations are for the provider to action unless otherwise stated.

Next steps

The screening service is responsible for developing an action plan in collaboration with the commissioners to complete the recommendations contained within this report.

SQAS will work with commissioners to monitor activity and progress of the recommendations for 12 months after the report is published. After this point SQAS will send a letter to the provider and commissioners summarising progress made and will outline any further action(s) needed.

Appendix A: References

1. Bowel cancer screening accreditation Bowel cancer screening accreditation
2. Bowel cancer screening programme: guidelines for CTC imaging Bowel cancer screening imaging use
3. Bowel cancer screening programme: standards Bowel cancer screening programme standards
4. Bowel cancer screening: guidelines for colonoscopy Bowel cancer screening colonoscopy quality assurance
5. Bowel cancer screening: helping people with learning disabilities Bowel cancer screening helping people with learning disabilities
6. Bowel cancer screening: managing incidents Bowel cancer screening managing incidents
7. Bowel cancer screening: pathology guidance on reporting lesions Bowel cancer screening reporting lesions
8. Bowel cancer screening: programme overview Bowel cancer screening programme overview
9. Bowel cancer screening: programme specific operating model Bowel cancer screening programme specific operating model
10. Bowel cancer screening: specialist screening practitioner Bowel cancer screening specialist screening practitioner
11. Cancer screening: informed consent Cancer screening informed consent
12. Joint advisory group on GI Endoscopy The JAG
13. Key Performance Indicators NHS screening programmes Antenatal, newborn, young person and adult NHS population screening: reporting data definitions
14. Managing Safety Incidents in NHS Screening Programmes Managing safety incidents in NHS screening programmes   
15. NHS BCSP Quality Assurance arrangements for the NHS Bowel Cancer Screening Programme, Draft version 2.1 (December 2010)
16. NHS England Serious Incident Framework – Supporting learning to prevent recurrence (March 2015) Serious incident framework
17. NHS population screening: pathway requirements specifications Bowel cancer screening pathway requirements specifications
18. PHE Screening inequalities strategy PHE Screening inequalities strategy
19. https://fingertips.phe.org.uk/Public health profiles Public health profiles
20. Section 7a screening service schedules no 26 BCSP Schedules 2022-23 – NHS Public Health Commissioning & Operations – Future NHS Collaboration Platform