BACKGROUND AND INTRODUCTION. Purpose of the Bowel Cancer Screening Specification 1.1. The purpose of this specification is to ensure that there is a consistent and equitable approach to the provision and monitoring of bowel cancer screening across England. 1.2. This document is designed to outline the service and quality indicators expected by NHS England from the NHS Bowel Cancer Screening Programme (NHSBCSP) in order to ensure that a high standard of service is provided to NHS England’s responsible population. It therefore sets out the specific policies, recommendations, and standards that the NHSBCSP expects services to meet. 1.3. The service specification is not designed to replicate, duplicate, or supersede any relevant legislative provisions which may apply, e.g. the Health and Social Care Act 2008, or the work undertaken by the Care Quality Commission. In the event of new guidance emerging, the specification will be reviewed and amended with as much rapidity as possible, but, where necessary, both NHS England and Service providers should work proactively to agree speedy variations of contract ahead of the production of a revised specification. 1.4. This service specification needs to be read in conjunction with the current NHSBCSP guidance and recommendations. These can be found on the cancer screening programmes website: ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇/topic/population-screening- programmes Aims, objectives, and health outcomes 1.5. The aim of the NHSBCSP is to reduce mortality from bowel cancer. This will be achieved by delivering evidence-based, population-based screening programmes thati: identify the eligible population and ensure efficient delivery with optimal coverage are safe, effective, of a high quality, externally and independently monitored, and quality assured prevent cancer where possible, and lead to earlier detection, appropriate referral, and improved outcomes are delivered and supported by suitably trained, competent, and qualified, clinical and non-clinical staff who, where relevant, participate in recognized ongoing CME, CPD, and EQA schemes have audit embedded in the service. 1.6. In line with good management practice and experience and in order to ensure appropriate and efficient use of NHS resources, the programme as a whole should: identify and invite those eligible for screening at appropriate intervals provide the invited population with the information they require, in the form in which they require it, so that they are able to make an informed choice about whether or not to participate ensure that GPs are informed of screening in their area and of the final outcomes of screening for each of their patients serve whole populations (all ages) numbering no less than 500,000 and up to about one million. 1.7. The provider should: provide people who participate with a high quality, effective, and people-centred service optimise participation rates and maximise accessibility of the service for all groups in the community allow people to opt out of the service, on a single occasion or permanently provide adequate numbers of appropriately trained, qualified, and competent staff to carry out high-quality screening implement screening tests that are acceptable to those who undergo them minimise any adverse physical/ psychological/ clinical aspects of screening (e.g. discomfort, anxiety, unnecessary investigations). 1.8. The provider should: detect asymptomatic abnormalities undertake assessment and diagnosis of individuals with abnormal results in appropriately staffed and equipped settings follow up individuals in accordance with national protocols where further investigation is required accurately diagnose invasive cancers and adenomas, discussing cases in MDTs where appropriate, and refer individuals for urgent treatment outside the programme when cancer is detected ensure that test results are communicated clearly and promptly follow appropriate protocols to monitor individuals according to BCSP/BSG guidelines ensure that individuals needing neither treatment nor surveillance are returned to routine screening recall, and that individuals with incidental findings are provided with appropriate advice and referral if necessary 1.9. The programme as a whole should: maximise the number of cancers detected minimise the number of cancers presenting between screening episodes maximise the number of adenomas detected maintain minimum standards of screening set out in Appendix 1 and 2 participate in both approved national routine audits and ad hoc audits to evaluate overall programme performance. 1.10. The provider should: ensure effective and timely communication with the individuals who are invited, screened, assessed, or treated ensure effective and timely communication with clinical multidisciplinary teams, other screening centres, NHS England, the Bowel Cancer Screening Programme and Screening Quality Assurance Service (SQAS) teams within Public Health England (PHE) and the Health and Social Care Information Centre work within a seamless and integrated pathway build robust failsafe measures into all stages of the pathway ensure that the NHSBCSP recommendations for handling safety concerns, safety incidents and serious incidents are adhered to, in addition to local reporting procedures. 1.11. The provider and the SQAS within Public Health England should work collaboratively to: regularly audit and evaluate the programme to ensure that the service is delivered in a safe, effective, timely, equitable, and ethical way, in accordance with national policy and NHSBCSP standards, guidelines, internal and external quality assurance arrangements, and risk assessments monitor, collect, and report statistical data and other relevant information to relevant bodies, and use this to: promote continuous improvement in service performance and outcomes; give formal feedback to NHS England and the population served by the programme; and provide key information and models of good practice/ innovation/ achievement to those working in the area of bowel cancer screening. Minimum data requirements for NHS England are shown in Appendix 1 and 2. The provider should: participate willingly in multidisciplinary quality assurance visits organised by the cancer SQAS team within Public Health England. 1.12. The provider should: use the programme’s IT systems to manage people through the screening process, and to capture key screening data/ outcomes promptly and accurately, supporting local and national quality assurance and cancer registration processes and programme evaluation comply fully with local, NHSBCSP, and NHS information governance requirements relating to the confidentiality and disclosure of patient information and system/information security. 1.13. The provider should: ensure that staff are appropriately trained and supported by national continuing professional development and skills frameworks, enabling them to develop their skills, competencies, and potential. Only approved/ accredited training courses should be used contribute to nationally-approved research into the screening and diagnosis of bowel cancer, to inform screening practice and policy ensure that all pathology laboratories dealing with screening programmes are formally accredited by UKAS or equivalent ensure that pathologists reporting patient material on behalf of the NHSBCSP participate routinely in the NHSBSCP EQA scheme ensure that pathologists reporting material on behalf of the NHSBCSP adhere to RCPath/NHSBSCP reporting guidelines. 1.14. The provider should refer to and comply with the safety and safeguarding requirements as set out in the NHS Standard Contract. 1.15. The programme as a whole aims: to reduce the number of people in the target population who die from bowel cancer by 16% to maximise detection of bowel cancer at stages 1 and 2 (PHE domain 2) to maximise detection of adenomas which, if left untreated, could develop into bowel cancer to refer people promptly to treatment services to achieve high coverage levels across all eligible groups in society to minimise adverse physical/ psychological/ clinical aspects of screening (e.g. anxiety, unnecessary investigation).
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Sources: NHS Public Health Functions Agreement, NHS Public Health Functions Agreement
BACKGROUND AND INTRODUCTION. Purpose of the Bowel Cancer Screening Specification
1.1. The purpose of this specification is to ensure that there is a consistent and equitable approach to the provision and monitoring of bowel cancer screening across England.
1.2. This document is designed to outline the service and quality indicators expected by NHS England from the NHS Bowel Cancer Screening Programme (NHSBCSP) in order to ensure that a high standard of service is provided to NHS England’s responsible population. It therefore sets out the specific policies, recommendations, and standards that the NHSBCSP expects services to meet.
1.3. The service specification is not designed to replicate, duplicate, or supersede any relevant legislative provisions which may apply, e.g. the Health and Social Care Act 2008, or the work undertaken by the Care Quality Commission. In the event of new guidance emerging, the specification will be reviewed and amended with as much rapidity as possible, but, where necessary, both NHS England and Service providers should work proactively to agree speedy variations of contract ahead of the production of a revised specification.
1.4. This service specification needs to be read in conjunction with the current NHSBCSP guidance and recommendations. These can be found on the cancer screening programmes website: ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇/topic/population-screening- programmes Aims, objectives, and health outcomes
1.5. The aim of the NHSBCSP is to reduce mortality from bowel cancer. This will be achieved by delivering evidence-based, population-based screening programmes thati: identify the eligible population and ensure efficient delivery with optimal coverage are safe, effective, of a high quality, externally and independently monitored, and quality assured prevent cancer where possible, and lead to earlier detection, appropriate referral, and improved outcomes are delivered and supported by suitably trained, competent, and qualified, clinical and non-clinical staff who, where relevant, participate in recognized ongoing CME, CPD, and EQA schemes have audit embedded in the service.
1.6. In line with good management practice and experience and in order to ensure appropriate and efficient use of NHS resources, the programme as a whole should: identify and invite those eligible for screening at appropriate intervals provide the invited population with the information they require, in the form in which they require it, so that they are able to make an informed choice about whether or not to participate ensure that GPs are informed of screening in their area and of the final outcomes of screening for each of their patients serve whole populations (all ages) numbering no less than 500,000 and up to about one million.
1.7. The provider should: provide people who participate with a high quality, effective, and peoplepublic health functions agreement 2016-centred service optimise participation rates and maximise accessibility of the service for all groups in the community allow people to opt out of the service, on a single occasion or permanently provide adequate numbers of appropriately trained, qualified, and competent staff to carry out high-quality screening implement screening tests that are acceptable to those who undergo them minimise any adverse physical/ psychological/ clinical aspects of screening (e.g. discomfort, anxiety, unnecessary investigations).
1.8. The provider should: detect asymptomatic abnormalities undertake assessment and diagnosis of individuals with abnormal results in appropriately staffed and equipped settings follow up individuals in accordance with national protocols where further investigation is required accurately diagnose invasive cancers and adenomas, discussing cases in MDTs where appropriate, and refer individuals for urgent treatment outside the programme when cancer is detected ensure that test results are communicated clearly and promptly follow appropriate protocols to monitor individuals according to BCSP/BSG guidelines ensure that individuals needing neither treatment nor surveillance are returned to routine screening recall, and that individuals with incidental findings are provided with appropriate advice and referral if necessary
1.9. The programme as a whole should: maximise the number of cancers detected minimise the number of cancers presenting between screening episodes maximise the number of adenomas detected maintain minimum standards of screening set out in Appendix 1 and 2 participate in both approved national routine audits and ad hoc audits to evaluate overall programme performance.
1.10. The provider should: ensure effective and timely communication with the individuals who are invited, screened, assessed, or treated ensure effective and timely communication with clinical multidisciplinary teams, other screening centres, NHS England, the Bowel Cancer Screening Programme and Screening Quality Assurance Service (SQAS) teams within Public Health England (PHE) and the Health and Social Care Information Centre work within a seamless and integrated pathway build robust failsafe measures into all stages of the pathway ensure that the NHSBCSP recommendations for handling safety concerns, safety incidents and serious incidents are adhered to, in addition to local reporting procedures.
1.11. The provider and the SQAS within Public Health England should work collaboratively to: regularly audit and evaluate the programme to ensure that the service is delivered in a safe, effective, timely, equitable, and ethical way, in accordance with national policy and NHSBCSP standards, guidelines, internal and external quality assurance arrangements, and risk assessments monitor, collect, and report statistical data and other relevant information to relevant bodies, and use this to: promote continuous improvement in service performance and outcomes; give formal feedback to NHS England and the population served by the programme; and provide key information and models of good practice/ innovation/ achievement to those working in the area of bowel cancer screening. Minimum data requirements for NHS England are shown in Appendix 1 and 2. The provider should: participate willingly in multidisciplinary quality assurance visits organised by the cancer SQAS team within Public Health England.
1.12. The provider should: use the programme’s IT systems to manage people through the screening process, and to capture key screening data/ outcomes promptly and accurately, supporting local and national quality assurance and cancer registration processes and programme evaluation comply fully with local, NHSBCSP, and NHS information governance requirements relating to the confidentiality and disclosure of patient information and system/information security.
1.13. The provider should: ensure that staff are appropriately trained and supported by national continuing professional development and skills frameworks, enabling them to develop their skills, competencies, and potential. Only approved/ accredited training courses should be used contribute to nationally-approved research into the screening and diagnosis of bowel cancer, to inform screening practice and policy ensure that all pathology laboratories dealing with screening programmes are formally accredited by UKAS or equivalent ensure that pathologists reporting patient material on behalf of the NHSBCSP participate routinely in the NHSBSCP EQA scheme ensure that pathologists reporting material on behalf of the NHSBCSP adhere to RCPath/NHSBSCP reporting guidelines.
1.14. The provider should refer to and comply with the safety and safeguarding requirements as set out in the NHS Standard Contract.
1.15. The programme as a whole aims: to reduce the number of people in the target population who die from bowel cancer by 16% to maximise detection of bowel cancer at stages 1 and 2 (PHE domain 2) to maximise detection of adenomas which, if left untreated, could develop into bowel cancer to refer people promptly to treatment services to achieve high coverage levels across all eligible groups in society to minimise adverse physical/ psychological/ clinical aspects of screening (e.g. anxiety, unnecessary investigation).17
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