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This publication is available at https://www.gov.uk/government/publications/bowel-cancer-screening-programme-standards/our-approach-to-bowel-cancer-screening-standards
These revised national standards for the NHS bowel cancer screening programme (BCSP) replace previous measurable standards documented in quality assurance guidelines as from 1 April 2018 unless stated within the document.
Screening standards ensure that stakeholders have access to:
- reliable and timely information about the quality of the screening programme
- data at local, regional and national level
- quality measures across the screening pathway without gaps or duplications
They will also ensure a consistent approach across screening programmes and that data collection is beneficial.
NHS BCSP supports health professionals and commissioners in providing a high quality screening programme. This involves developing and reviewing the screening standards against which data is collected and reported annually. The standards provide a defined set of measures that providers have to meet to ensure local programmes are safe and effective.
Quality assurance (QA) is the process of checking these standards are met and encouraging continuous improvement. QA covers the entire screening pathway, from identifying who is eligible to be invited to screening, through to referral and treatment where required/appropriate.
1. Summary of changes
We have replaced the glossary in this document and link to PHE Screening’s central glossary of terms.
If you would like to see the meaning of an acronym, hover over it with your cursor and you will be able to see the full definition.
Standard 3: guaiac faecal occult blood test (gFOBT) kit turnaround time
Standard 4: bowel scope screening adenoma detection rate
New standard as bowel scope screening is a new component of the programme.
Standard 5: computed tomography colonography (CTC) as a diagnostic procedure
New standard to make sure that CTC is used as a diagnostic test only when appropriate and for a small proportion of patients.
Standard 6: specialist screening practitioner (SSP) clinic appointment waiting time
Previous minimum standard: 100%. Performance thresholds changed to 95% (acceptable) and 98% (achievable) to reflect screening centre performance against this standard and provide some flexibility to meet fluctuations in demand.
Standard 7: diagnostic procedure waiting time
Previous minimum standard: 100%. Performance thresholds changed to 90% (acceptable) and 95% (achievable) to reflect screening centre performance against this standard and provide some flexibility to meet fluctuations in demand.
Standard 8: time to attendance at diagnostic procedure
Standard 9: pathology turnaround time
Previous minimum standard: 100%. Performance thresholds changed to 90% (acceptable) and 95% (achievable) to reflect a more realistic standard and provide laboratories with some flexibility to meet fluctuations in demand. The turnaround time of polyps and cancers is now reported together, not separately as in previous version of standards.
Minimum standard: 100%
Standard 10: programme hub helpline answer rate
Standard 11: diagnostic procedure uptake rate
Standard updated to include all diagnostic procedures, not just colonoscopy.
Standard 13: caecal intubation rate
Previous minimum standard: 90%. Performance thresholds changed to 92% (acceptable) and 97% (achievable) to reflect screening centre performance against this standard.
2. NHS bowel cancer screening programme
The UK National Screening Committee (UK NSC) makes recommendations to ministers on screening policy.
It recommends we invite all people aged 60 to 74 to take part in bowel cancer screening every 2 years. It also recommends we invite people to take part in bowel scope screening, a one-off flexible sigmoidoscopy offered to people aged 55 years.
Screening aims to:
- detect at the earliest opportunity bowel cancers and polyps that could go on to become cancers
- maximise the success of treatment
- reduce mortality from bowel cancer
The BCSP has responsibility for implementing this policy. The programme service specifications (No. 26 and 26a) for the NHS providers are available as part of the public health functions exercised by NHS England.
The BCSP aims to make sure there is equal access to uniform and quality assured screening across England and that participants are provided with high-quality information so they can make an informed choice about bowel cancer screening.
3. Equity impact
Consideration should be given to all standards to establish whether differences in distribution of health determinants – including gender, age, ethnicity, socioeconomic status and other protected characteristics – and screening outcomes can be considered avoidable and unfair.
Review at a local level of performance by population group may indicate inequity in participants entering and or completing the screening pathway, or accessing services within optimal timescales. Local services can use the NHS England Equality Delivery System and the Department of Health and Social Health Assessment Tool to help consider how to improve equity.
4. Scope and terminology
This publication looks at standards that assess the screening process and allow for continuous improvement. This then enables providers and commissioners to identify where improvements are needed.
To clarify what is measured, each process standard has 3 parts:
- Objective: the aim of the standard.
- Criteria: what is being assessed.
- Measure: 2 thresholds (acceptable and achievable).
Structural standards are not included here.
Structural standards describe the structure of the programme and must be fully met.
Examples of structural standards include:
- provision of information to all participants
- providers will ensure that there are adequate numbers of appropriately trained staff in place to deliver the screening service in line with best practice guidelines and BCSP national policy
Structural standards are included in screening service specifications and monitored through commissioning and other QA routes. Providers and commissioners should review the service specifications to make sure structural standards are met by all screening services.
4.2 Performance thresholds
Performance thresholds are selected to align with existing screening standards and service objectives; 2 thresholds are specified:
The acceptable threshold is the lowest level of performance which screening services are expected to attain to assure patient safety and service effectiveness. All screening services should exceed the acceptable threshold and agree service improvement plans to meet the achievable threshold. Screening services not meeting the acceptable threshold are expected to put in place recovery plans to deliver rapid and sustained improvement.
The achievable threshold represents the level at which the screening service is likely to be running optimally. All screening services should aspire to attain and maintain performance at or above this level.
4.3 Threshold to be set
Standards where thresholds are not set are reviewed and updated when relevant data and other information such as research publications, become available.
5. BCSP screening pathway
The standards look at 4 areas to assess the pathway.
Theme 1: coverage/uptake
To maximise uptake in the eligible population who are informed and wish to participate in the screening programme.
Related standards are:
- standard 1: coverage
- standard 2: uptake
Theme 2: testing
To maximise accuracy of screening test from initial sample or examination to reporting the screening result.
Related standards are:
- standard 3: maximising performance of the screening test - gFOBT kit turnaround time
- standard 4: maximising performance of the screening test - bowel scope screening adenoma detection rate
Theme 3: time to diagnosis
To minimise any potential delay to an appropriate diagnostic test.
Related standards are:
- standard 5: CTC as a diagnostic procedure
- standard 6: SSP clinic appointment waiting time
- standard 7: diagnostic procedure waiting time
- standard 8: time to attendance at diagnostic procedure
- standard 9: pathology turnaround time
Theme 4: minimising harm
To minimise potential harms in those screened and in the general population.
Related standards are:
- standard 10: programme hub helpline answer rate
- standard 11: diagnostic procedure uptake rate
- standard 12: adenoma detection rate (gFOBT)
- standard 13: caecal intubation rate
- standard 14: scope withdrawal time
- standard 15: polyp retrieval rate
6. Relationship between standards and key performance indicators
Some standards are also KPls which focus on an area of particular concern. Each KPI is reviewed once it consistently reaches the achievable threshold. It then may be withdrawn as a KPI and remain as a screening standard, allowing entry of another KPI to focus on additional areas of concern. Alternatively the KPI thresholds may be changed to promote continuous improvement.
BCSP has 2 KPls derived from standards 1 and 2.
7. Reporting standards
Standards will be reported at the intervals detailed in this document. Performance reports are produced by the BCSP using data from the national bowel cancer screening system (BCSS).
8. Revising standards
Standards are reviewed every 3 years and when changes to the screening pathway occur.
9. Resources to support providers and commissioners
This document focuses on process standards to enable providers and commissioners to continuously improve the quality of the screening programmes.
Additional BCSP operational guidance is included in the service specifications numbers 26 and 26a.