1. The Bowel Cancer Screening Programme Professor Tony Morris Director, National Endoscopy Training Centre, Liverpool President, British Society of Gastroenterology

2. What have these people got in common?

3. Plan of Talk Political background Pilot studies The plan for England Selection of sites for screening Who will do the screening? Remaining problems

4. Political Background BCSP announced by Alan Milburn 16,000 cancer deaths p.a. Poor survival rates c.f. Europe etc ‘Unaware’ of implications of introducing BCSP Long symptomatic waiting lists, poor colonoscopy performance Necessitated Modernisation Agency Endoscopy Project Mike Richards funded National Endoscopy Training Programme from English Cancer Plan (£10.2M promised)

5. Pilot Studies Two sites; Rugby and Dundee FOB and Colonoscopy based Proven system Trained endoscopists Extending project to wider age group

6. Plan for England 5 hub sites co-terminus with national IT regions Approximately 100 screening centres to be appointed over 3 years Screen age group 60-69 (10% of population) 3xFOB sent out from, and back to hub 2% +ve seen by Screening Nurses, colonoscopy arranged within 1 week 40% significant pathology Retested 2 yearly Eventual increase to include 50-69 age group

7. Selection of sites for screening Must get top marks for timeliness, and score next level for all other items on Global Rating Scale Urgents in 2 weeks, routine in 6 weeks Capacity for screening lists Selected by SHA’s, approved by BCSP 3 approved colonoscopists per centre

8. Endoscopy Global Rating Scale CUSTOMER CARE Equality of access & equity of provision Timeliness Choose and book Privacy and dignity Aftercare Ability to provide feedback to the service QUALITY AND SAFETY Appropriateness (Guidelines & Audit) Consent process & Patient information Safety Comfort Quality of procedure Communicating results to referrer

9. Who will do the screening? Colonoscopist who will do at least 1 list per week Must be doing 150 colonoscopies p.a. Quality markers submitted caecal intubation rate (>85%), complication rate(=national), sedation use,polyp detection rate(>20%) Computerised MCQ test (30questions,5stem) DOPS doing 2 cases observed by 2 examiners Currently 4 centres and 20 examiners (Leeds,Wolverhampton,Torbay,St Marks)

10. We need to look very carefully at what we do

11. Remaining problems No money released yet National Endoscopy Training Programme funding to end this year Nurse screeners to be appointed and trained Centres and hubs to be decided IT not finalised FOB kits not purchased Very slow roll out ? 2 centres this year

12. Bowel Cancer Screening, the Bad Guys?

13. Bowel Cancer Screening, the Good Guys

14. “To claim the programme is going ahead as planned is a distortion of the truth” Professor Alex Markham Chief Executive Cancer Research UK 29th March 2006

15. Any Questions?