NHS Bowel Cancer Screening Programme: Piloting of Flexible Sigmoidoscopy — Advice to the NHS and Bidding Process

Objectives

The programme seeks to incorporate one-off flexible sigmoidoscopy screening into the NHS Bowel Cancer Screening Programme as a complementary method to faecal occult blood testing, reducing bowel cancer incidence and mortality and aiming to save around 3,000 lives annually.[1][2][3][4]It is intended to extend preventive screening while maintaining the quality and safety of symptomatic bowel cancer services and screening colonoscopy.[5]

• Continue bowel cancer screening for people aged 60 to 69 and complete extension to people aged 70 until their 75th birthday.[3]
• Introduce a one-off flexible sigmoidoscopy invitation for eligible people at age 55.[3][4][6]
• Roll out flexible sigmoidoscopy in stages, reaching 30% population coverage by March 2014, 60% by March 2015, and the remaining screening centres during 2015/16, with full roll-out envisaged in 2016.[2][4]
• Promote equitable access by identifying barriers to uptake among underserved groups and seeking pilot provision across the four clustered Strategic Health Authorities and, where possible, all five hub areas.[7][8]
• Enhance endoscopy, imaging and pathology capacity, quality assurance and coordinated service provision across screening-centre sites.[5][7]
• Maintain cancer waiting-time standards of 93% for the all-cancer two-week wait, 85% for the 62-day urgent general practitioner referral-to-first-treatment pathway, and 90% for the 62-day consultant screening-service referral-to-first-treatment pathway.[9]

Implementation

Delivery is based on approved local bowel cancer screening centres operating both the faecal occult blood test and flexible sigmoidoscopy programmes, supported by Programme Hubs, NHS Cancer Screening Programmes, regional quality assurance arrangements and phased national implementation.[3][6][5][8]The Department of Health committed £60 million between 2011 and 2015 for incorporation of flexible sigmoidoscopy into the programme, while centrally managed funding was intended to support piloting and roll-out.[2][7]

• Invite Strategic Health Authority clusters to nominate local screening centres for voluntary pilot and first-wave participation, with expressions of interest due by 29 February 2012, full bids by 30 March 2012, and decisions planned for April 2012.[1][8]
• Build on three 2011 pathfinder sites that tested invitation and appointment arrangements, followed by a pilot involving at least five local screening centres and successive rollout waves.[4]
• Assess bids through NHS Cancer Screening Programmes against screening performance, capacity and demand, carbon dioxide availability, endoscopy accreditation, waiting-time compliance and local readiness.[8][10]
• Require centres to provide two-year capacity and demand plans for both faecal occult blood testing and flexible sigmoidoscopy, including session numbers, site timetables, staffing, administration, appointments, clinic management and links to colonoscopy and pathology services.[10][9]
• Deliver invitations and appointments through the Bowel Cancer Screening System, using a one-off invitation process for 55-year-olds with arrangements for reminders, confirmation, cancellations, re-booking, non-response follow-up and screening-list management.[6][11]
• Expand access through sustainable endoscopy capacity, trained endoscopists, accredited units, community or alternative treatment settings where appropriate, and evening or weekend activity where needed.[6][5]
• Establish a single central pathology laboratory for flexible sigmoidoscopy polyps at each screening centre, supported by two to four nominated consultant histopathologists participating in the Bowel Cancer Screening Programme External Quality Assurance scheme and a named pathology lead for suspected colorectal cancer reporting.[5][7][9]
• Strengthen local management through a clinically involved centre director, designated clinical team sessions, a programme manager and administrative staff working with Programme Hubs.[6][9]
• Secure approval from the Regional Quality Assurance team or Director, the Trust chief executive, the screening-centre leadership and the relevant commissioner or commissioning organisation before implementation.[7][12]
• Maintain Joint Advisory Group on GI Endoscopy accreditation at all units providing screening colonoscopy, ensure colonoscopy and relevant appointments occur within 14 days, and apply national colonoscopy and computed tomography quality requirements.[5][10]
• Support sites through the National Office of NHS Cancer Screening Programmes and Regional Quality Assurance Directors, including development of the screening protocol and provision of information materials for sites, primary care and patients.[8]
• Participate in national evaluation, data collection and quality assurance, monitoring invitation volumes, uptake, attendance, waiting times, staffing and pathology capacity.[6][8][9]
• Transfer responsibility for piloting and roll-out to Public Health England from April 2013, subject to the Health and Social Care Bill, with funding expected to move to the NHS Commissioning Board for local commissioning from 2016/17 after full roll-out.[7][8]

Monitoring & Evaluation

Monitoring and assurance centre on phased implementation targets, service readiness, national quality requirements and local governance approvals. Coverage was intended to reach 30% by March 2014, 60% by March 2015 and remaining centres during 2015/16, with full roll-out envisaged in 2016.[2][4]Programme-level outcomes include reducing bowel cancer incidence and mortality and saving around 3,000 lives annually.[2][3][4]

• Monitor implementation against staged coverage targets, approval of local screening centres, extension of the eligible age range, and operational activity including invitations, uptake, attendance and screening-list requirements.[3][4][6]
• Track uptake and attendance using evidence from the flexible sigmoidoscopy demonstration, which recorded 55% uptake, alongside planning assumptions of approximately 50% attendance and 12 people per screening list.[6]
• Assess bids against evidence of screening performance, capacity and demand, carbon dioxide availability, Joint Advisory Group on GI Endoscopy accreditation, and compliance with waiting-time standards.[8][10]
• Require all relevant appointments and screening colonoscopies to be completed within 14 days, supported by two-year capacity and demand plans for faecal occult blood test and flexible sigmoidoscopy screening.[10]
• Maintain cancer waiting-time standards of 93% for the all-cancer two-week wait, 85% for urgent general practitioner referral to first treatment within 62 days, and 90% for consultant screening-service referral to first treatment within 62 days.[5][7][9]
• Maintain accredited endoscopy units and national quality requirements for colonoscopy and computed tomography, including specified waiting-time and Global Rating Scale standards before flexible sigmoidoscopy screening begins.[5]
• Require pathology services to use one designated laboratory for flexible sigmoidoscopy polyps, nominate two to four consultant histopathologists to the Bowel Cancer Screening Programme External Quality Assurance scheme, and identify a lead for suspected colorectal cancer reporting.[5][7][9]
• Evidence governance and readiness through Regional Quality Assurance approval, Trust chief executive and commissioner sign-off, signed bid proformas, meeting records, service timetables, staffing confirmation and pathology-capacity plans.[7][9][12]
• Participate in national evaluation, data collection and quality assurance procedures, while using an eight-week invitation pathway covering pre-invitation, invitation, reminders, confirmation, follow-up, subject listing and appointment.[8][11]

The evidence base includes independently evaluated pilots of faecal occult blood testing, which indicated a 16% reduction in bowel cancer mortality, and United Kingdom and Italian trials of flexible sigmoidoscopy.[2][3]The United Kingdom National Screening Committee concluded in April 2011 that flexible sigmoidoscopy met the criteria for a screening test.[3]A separate consolidated monitoring framework, evaluation timetable, formal indicator definitions, routine reporting arrangements and broader accountability framework are not specified beyond the operational, quality and governance requirements described.[3][4][6][5][7]

Costing & Financing

Financing combines a quantified Department of Health commitment with centrally managed funding for piloting and national roll-out. The Department of Health committed 60 million pounds sterling between 2011 and 2015 to incorporate flexible sigmoidoscopy into the NHS Bowel Cancer Screening Programme.[2]Funding for the pilot and roll-out was to be retained and managed centrally by NHS Cancer Screening Programmes, in line with

Improving Outcomes: A Strategy for Cancer

• Provide resources for expanded endoscopy capacity, trained endoscopists, accredited units, carbon dioxide insufflation, colonoscopy and computed tomography pathways, pathology provision, programme management and administrative support.[5][7]
• Support local delivery through capacity for additional clinics and posts, public awareness, primary-care education, population arrangements, polyp reporting and screening across wider geographical areas.[6][8]
• Assign responsibility for piloting and roll-out to Public Health England from April 2013, subject to passage of the Health and Social Care Bill.[7][8]
• Transfer funding to the NHS Commissioning Board for commissioning local programme elements from 2016/17, once flexible sigmoidoscopy is fully rolled out.[7][8]

Individual site allocations, detailed pilot costs, unit costs, overall programme budget beyond the 60 million pounds sterling commitment, additional funding sources, funding gaps and economic assumptions are not specified.[2][3][4][6][5][7][8][9][12]