BOWEL CANCER FRAMEWORK FOR SCOTLAND
Bowel cancer is an important health issue worldwide and, in Scotland, it represents a major problem. It is the second most common cause of cancer death in this country, and the incidence, which is currently 53.5 per 100,000 of the population, increased by 12% in men and 2.1% in women between 1991 and 2000 (Information and Statistics Division).
Although the outcome of treated bowel cancer has improved over time, five-year survival is still in the region of 40%. If continuing improvements are to be made, a range of initiatives and actions are required across a range of areas and specialties, from prevention, through earlier detection, treatment, palliative care and ongoing research.
In this framework, the key components of a national bowel cancer service programme are outlined, under the headings of Basic Elements, Service Implications and Research Implications.
Significant work is already underway throughout NHSScotland to improve bowel cancer services. However, a formal over-arching framework would provide a national focus and add value in terms of collaboration and consistency. That is why this framework is being published. It brings together various elements aimed at improving bowel cancer services and ultimately outcomes for patients with bowel cancer in Scotland.
Cancer continues to be a top priority for the Scottish Executive and for NHSScotland. Working together with clinicians across cancer networks, the voluntary sector and patients, significant strides have been made in improving cancer services.
Of the additional 60m investment supporting implementation of the cancer strategy, Cancer in Scotland: Action for Change (SEHD, 2001), which has enabled more than 300 additional staff to be employed, in the community, in secondary care and in specialist cancer centres, 18m has been invested in earlier detection, 17m in improving treatment services so that waiting times are reduced and a continuous quality improvement ethos is embedded within day-to-day practice. This includes 4m for bowel cancer services that has been directly invested from Cancer in Scotland and a further 5.8m from New Opportunities Fund to support improvement in prevention, investigation and treatment.
A second bowel cancer network development workshop will be held on 23 April, focusing on the period up only to diagnosis. As the subject is so big it is planned to hold a second workshop later in the year focusing on the treatment and care of patients with colorectal cancer.
A great deal of additional effort and resource is also being invested in programmes of prevention and education aimed at lifestyle interventions that are known to make a difference to people's health.
The Cancer Challenge, or as it is more commonly known, the bowel cancer screening pilot, underway in Fife, Tayside and Grampian is now in its second round. The formal Evaluation Report on the UK Colorectal Cancer Screening Pilot in July 2003 confirmed the potential benefits of colorectal cancer screening. The Minister for Health and Community Care Mr Malcolm Chisholm, re-affirmed on 4 September 2003, and subsequently, the Scottish Executive's commitment, to introduce a national bowel cancer screening programme. The planning process to support the screening programme is expected to take some time and will be taken forward in conjunction with the service and will take into account advice from the UK National Screening Committee.
Endoscopy capacity is recognised across the country as a significant challenge for earlier diagnosis and investment is either being put in place or is planned in a number of NHS Board areas. This framework highlights the issues surrounding training and workforce planning as well as capacity and demand.
The purpose of this framework is not to draw conclusions, but rather to set a direction of travel. We need to bring together screening and symptomatic diagnostic services in order to plan in a co-ordinated way for the future. It is proposed that a new national steering group will be established to map out an agreed approach over the next three to five years to ensure that bowel cancer services are ready to support a national screening programme as well as meeting qualitative standards and targets, including waiting times.
As far as research is concerned, an additional 1m has supported the establishment of the Scottish Cancer Research Network and more than 2m is being invested by the Chief Scientist Office in the two Scottish National Translational Research Centres in Dundee and Glasgow (working together as a virtual centre) and in Edinburgh where there is a major research interest in the genetic aspects of bowel cancer.
Services for people at risk of or diagnosed with bowel cancer in Scotland are improving, but significant challenges remain. There is a national consensus that there are significant opportunities to enhance that progress. This framework provides a platform to do that.
Dr E M Armstrong
Chief Medical Officer