1. Insert name of presentation on Master Slide Bowel Screening in Welsh Prisons Hayley Heard Head of Programme

2. Session Aim Background Hard to reach groups Screening in prisons Public Health Wales Conference – Bowel Screening in Prisons

3. Programme Aim To reduce mortality from bowel cancer by 15% in the population invited for screening by 2020

4. Testing Men and women aged 60 - 74 years Resident in Wales Invite by date of birth Home faecal occult blood test kit Return in post Helpline Public Health Wales Conference – Bowel Screening in Prisons

5. Results Negative – recall 2 years Equivocal – FIT test Positive – assessment and colonoscopy Public Health Wales Conference – Bowel Screening in Prisons

6. Positive Results 2% (13,000 people to date) Specialist Screening Practitioner assessment Colonoscopy if fit CT Colonogram if unfit Public Health Wales Conference – Bowel Screening in Prisons

7. Colonoscopy 12,000 to date Local Assessment Centres Visualise the bowel Remove polyps Biopsy lesions Invasive procedure Public Health Wales Conference – Bowel Screening in Prisons

8. Outcome of Colonoscopy 60% polyps 10% cancer 30% routine recall Public Health Wales Conference – Bowel Screening in Prisons

9. Hard to Reach Groups Long stay care homes Psychiatric institutions Prisons Travellers Homeless

10. Public Health Wales Conference – Bowel Screening in Prisons Prisons Cardiff Usk Prescoed Parc Bridgend Swansea

11. Anticipated Issues G.P. Registration Duplication of invitation Bowel preparation Confidentiality Colonoscopy Public Health Wales Conference – Bowel Screening in Prisons

12. Initiating Screening Contact with all prisons Protocol, care pathways and data sharing agreements established

13. Public Health Wales Conference – Bowel Screening in Prisons Pilot 2 prisons Modified service delivery model Education programme Screening link person

14. Screening process: Identification and testing Prison Health Care Centre (PHCC) staff identify prisoner and inform BSW Invitation kit sent in batches to PHCC Results will be returned to prisoner via PHCC PHCC staff to discuss results with prisoner Public Health Wales Conference – Bowel Screening in Prisons

15. Screening process: Assessment, referral and diagnosis PHCC informed of assessment date SSP telephone assessment with PHCC staff present Prisoner notified about colonoscopy Random selection of site for colonoscopy Bowel preparation sent for PHCC to administer Public Health Wales Conference – Bowel Screening in Prisons

16. Prisons identify eligible prisoners List sent to Bowel Screening Wales Recall for FOB test in two years from the date test issued Target population called First invitation and test kit sent to prison healthcare centre Test kit not returned within twelve weeks Recall for FOB test in two years from date test returned No Abnormality detected FOB Test Kit returned G.P. & prisoner informed by prison healthcare team Equivocal result iFOB test sent Discuss with prison healthcare team No Response Positive result referral to local assessment centre Assessment by SSP Procedure at a local assessment centre if appropriate iFOB returned Non- responder letter sent to prison Healthcare centre Non- responder letter sent to prison Healthcare centre No response Public Health Wales Conference – Bowel Screening in Prisons

17. Results April 2012 – June 2013 Total kits sent55 Total returned kits32 Non-responders7 Spoilt test kits1 Equivocal results2

18. Public Health Wales Conference – Bowel Screening in Prisons Challenges Engagement with health care staff Varying viewpoints towards health care Concept of informed choice and consent

19. Next Steps Roll out to other prisons Evaluate pilot Publish findings Public Health Wales Conference – Bowel Screening in Prisons