Why are patients having to wait? Credit: Flickr/CC BY-NC-ND 2.0
Harriet Watson is a consultant colorectal nurse at Guy’s & St Thomas’ NHS Foundation Trust. This is her reaction to our new report on NHS endoscopy services, ‘Scoping the Future‘, and the recent positive announcement from the Department of Health as the Government signalled its backing for England’s new cancer plan.
Harriet Watson: “We know there are frustrated trainees out there trying to gain experience, become independent endoscopists, and help provide the solution”
I regularly train staff to carry out endoscopy procedures – looking inside a patient’s stomach or large bowel with a camera on a long tube. This is an important part of the way patients who have symptoms of bowel or stomach cancer are investigated.
This is vital work. And as the UK population ages, and more people develop cancer, we will need to do more of these endoscopic tests to diagnose more cancers, and diagnose them early.
So the NHS needs to have sufficient people and resources to carry out high-quality tests.
In order to become fully certified, all trainee endoscopists have to complete a set number of endoscopy procedures in sessions known as ‘lists’.
But time and time again, as I carry out the training, I hear the same conversations – that there’s a lack of formal opportunities in many Trusts for them to continue this training.
Demand is outstripping capacity
This is a particular problem with endoscopy to the large bowel – known as a colonoscopy – preferred by doctors and patients alike when investigating symptoms of bowel cancer.
Demand for colonoscopies is now outstripping our capacity. This is partly because of increasing cancer rates, but also thanks to the imminent introduction of the ‘bowel scope’ test into the National Bowel Cancer Screening Programme.
Yet we know there are frustrated trainees out there trying to gain experience, become independent endoscopists, and help provide the solution.
So it’s incredibly disappointing that there’s still a lack of capacity. Why should patients have to wait so long to have a colonoscopy?
Action is needed
Scoping the Future, a report recently published by Cancer Research UK, provides national evidence to back the concerns I hear on a daily basis: services under pressure, doing their best to manage increasing demand, with a lack of trained staff.
The report also shows that the NHS will need to carry out close to a million more endoscopies per year by 2020 from around 1.7 million per year now, to around 2.6 million. It’s a huge ask. Action is needed – and needed urgently – if the NHS is going to cope.
So how do we fix this?
Well, the new cancer strategy, which was published in July, offers some solutions, including setting out how much more money is needed for diagnostic tests. It’s important the strategy is implemented swiftly and the Government commits to the funding the service needs so that patients aren’t waiting too long for tests.
Health Education England is also developing a new national training scheme for non-medical endoscopists which will help ease the pressures on the workforce.
The announcement from the Department of Health in September showed that the Government is taking these concerns seriously.
On top of the new national training scheme, they have committed to training 200 more staff to carry out endoscopies by 2018. The Government hopes this boost to the workforce means they will be able to carry out up to half a million more endoscopies by 2020.
This also comes with investment in cancer tests and a new ambition for patients to receive a definitive cancer diagnosis, or an ‘all clear’, within 28 days of being referred by their GP.
Maintaining a balance
Clearly the underlying issues are complex, as many teams try to cope with the pressures of trying to meet cancer targets. As a result, managing waiting lists can then sometimes take priority over the training of new staff.
Maintaining this crucial balance is extremely challenging for leaders and managers of endoscopy services.
We now hope that NHS England, Health Education England and Public Health England will take this forward, as set out in the cancer strategy and following this signal from the Department of Health.
Extra funding, more training places and more support for staff are all key. After all, it is not just about cancer: patients with a whole range of stomach and bowel conditions and diseases will be diagnosed earlier if we get this right.
Harriet
We would like to thank everyone who’s supported our campaign to Test Cancer Sooner. We’ve collected over 24,500 signatures – an amazing response demonstrating public support for increased investment in early diagnosis.
We’re handing in the petition to the Chancellor, George Osborne, next week, and eagerly await the Spending Review in November where we hope to hear more details about investment in diagnostics.
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Comments
Professor Callum G Fraser October 27, 2015
Thank you for your response. Of course, the evidence to use quantitative faecal immunochemical tests for haemoglobin (FIT) in colorectal cancer screening programmes as the best currently available non-invasive test is overwhelming. It is to be hoped that the four UK countries will move rapidly to adoption of this technology, as is happening in Scotland now.
However, the “colonoscopy crisis” is not due to the screening programmes, rather to the ever increasing GP referrals due, in part, to the splendid work of charities involved in bowel cancer in increasing awareness and also to campaigns such as Detect Cancer Early and Be Clear About Cancer.
One answer to directing colonoscopy to those who would most benefit is to introduce faecal haemoglobin concentration measurements in laboratories everywhere and make this test freely available to GPs. Indeed, one could argue that this simple, inexpensive and hygienic test should be mandatory before referral to colonoscopy. If this test is “negative”, then it is unlikely that significant colorectal disease is present.
FIT are not only for screening for CRC, they are for primary care to use in assessment of the symptomatic.
Professor Callum G Fraser October 16, 2015
If the NHS adopted use of the newer faecal immunochemical tests for haemoglobin, commonly known as FIT, this would solve many of the colonoscopy demand problems. This simple test, which requires only one faecal sample collected into a hygienic device, has been proven to have high “negative predictive value” for significant colorectal disease (cancer, polyps – possible precursors of cancer – and inflammatory bowel disease. Thus, a “negative” test result provides considerable reassurance that colonoscopy is not required urgently or even at all. This test is inexpensive – less than 1% of the cost of a colonoscopy – and is simple to perform. Ubiquitous introduction would help to direct the scarce colonoscopy resource to those who would most benefit.
Sara Bainbridge October 23, 2015
Thanks for your comment – we are also in favour of adopting the faecal immunochemical test (FIT) as part of the bowel cancer screening programme. The National Screening Committee are currently consulting on their recommendation to introduce this (see the consultation here http://legacy.screening.nhs.uk/bowelcancer) and we will be responding in favour of replacing the current ‘faecal occult blood test’ (FOBT) with FIT. Of course, as you mention, people who have a positive FIT result would still need a colonoscopy (and of course people with symptoms too) – but FIT would be a great step forward for bowel screening, as it is a better test and been shown to improve uptake. You can find out more about our view in this blog: http://news.cancerresearchuk.org/2015/02/20/fighting-fit-scotlands-pioneering-change-to-its-bowel-screening-programme/
Sara Bainbridge
Policy Manager, CRUK
G.BARRETT October 14, 2015
Nothing achieves results better than publicity. It pays to make a fuss.
Dr David A. Agbamu October 28, 2015
Who is going to look at all the extra biopsies generated by the increase number of colonoscopies? There is a national shortage of histopathologists.
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Dr David A. Agbamu,
Consultant Histopathologist.