Publication - Strategy/plan

Bowel Cancer Framework for Scotland

Published: 20 Apr 2004
Part of:
Health and social care

Bowel cancer is an improtant health issue worldwide and, in Scotland, it represents a major problem. In this framework the key components of a national bowel cancer service programme are outlined.

29 page PDF

362.8 kB

29 page PDF

362.8 kB

Bowel Cancer Framework for Scotland
Page 4

29 page PDF

362.8 kB



"To increase the probability of treatment success while at the same time minimising patient anxiety and stress, delays in investigation, diagnosis and subsequent treatment of cancer must be eliminated wherever possible." Cancer in Scotland: Action for Change (2001).

Feedback from patients has frequently confirmed that waiting for appointments to be seen at out patient clinics, waiting for appointments for investigations, waiting for results and waiting for treatment adds considerably to their anxiety and stress. Moreover, speed of access is considered to be one of the main reasons for dissatisfaction with the NHS. The Scottish Executive is therefore committed to a programme of national targets that are designed to alleviate patient and public concerns and to improve diagnosis and treatment services by driving down waiting times for everyone with cancer. Every part of the patient pathway, from referral, through investigation, diagnosis and subsequent treatment requires to be carefully examined and appropriate changes made to secure real and lasting improvements.

In planning to meet the target that, "By 2005, the maximum wait from urgent referral to treatment for all cancers will be two months", NHS Boards also need to take into account the possible impact of the introduction of a national bowel screening programme. Local Health Plans are a public statement of each Board's plans for their local health services. National waiting times targets are monitored and for the 2005 target systems are currently being put in place to assess performance against it.

In the three years since publication of Cancer in Scotland, 18m additional investment has brought significant reductions in waiting times across the country. However, to assist further an additional 1m, over and above that, has been invested in the Cancer Service Improvement Programme (CSIP) that aims to accelerate the pace of change and bring further improvements to existing systems and processes across the three regional cancer networks.

In both the West of Scotland and the North of Scotland CSIP facilitators are working with bowel cancer networks to look at further sustainable improvements that can be made across their respective regions. It is anticipated that services will be reorganised and/or altered in a variety of ways that will enhance patients' experiences and further reduce waiting times. A redesign programme is also underway in West Lothian.

As noted elsewhere in this framework, the provision of endoscopy/colonoscopy services and workforce shortages represent significant challenges both for symptomatic and for potential screening services. Waiting times for colonoscopy are variable across Scotland. Innovative approaches to the delivery of these services are required if the range and type of services required are to be delivered for patients and for the well population eligible for screening.

The Centre for Change and Innovation is planning to hold a national convention in September to facilitate clarification of, and consensus on, the immediate, medium- and longer-term priorities including options for increasing capacity and training provision within NHSScotland.

So as to avoid unnecessary duplication of effort and to ensure a collaborative approach, these are issues that need to be considered at three levels; locally, regionally and nationally involving clinicians, workforce planning and NHS Education for Scotland colleagues.


What is required?

What is already happening?

Next steps

Service Implications

Prompt, high quality investigations

  • Development of investigation protocols based on symptom complexes

  • Provision of adequate endoscopy services across the country with appropriate investment in training, staff and equipment

  • Provision of structured endoscopy training

  • Improvements in services through redesign

Endoscopy services

  • Almost 4m from Cancer in Scotland over 2001-04 has been invested in endoscopy equipment, staffing and additional sessions, for example:
    - Outreach diagnostic service in Grampian
    - Increase capacity and improve services in Argyll and Clyde to support West of Scotland Bowel Cancer Awareness Campaign
    - Colonoscopy equipment and additional sessions in Lothian

  • Establishment of a bowel unit in Fife (NOF funded)

  • Forth Valley - training for radiographer-led ultrasound and barium enema examinations (NOF funded)

  • West Lothian - open access clinic following redesign initiative

  • North Glasgow - endoscopy staffing, training and equipment (NOF funded)

  • South Glasgow - new endoscopy suite, facilitate supervision and training of new endoscopists and extend role of nurse colonoscopy (NOF funded)

Endoscopy training

  • Ninewells Hospital in Dundee undertakes its own training in the surgical skills unit

  • There is a training course in England for nurses for endoscopy/colonoscopy training covering the theoretical part of the course with clinical practice being supervised in their workplace

  • Provision of training - the Scottish Project Board for the Colorectal Cancer Screening Pilot and the National Services Division has prepared a Colonoscopy Training Report which includes proposals as to how such training might be carried out


  • West of Scotland and North of Scotland Cancer Service Improvement Programme (CSIP) facilitators supporting staff to implement guidelines and make changes which will result in as much as 2 weeks' reduction in waiting times across the patient journey

  • Scottish Executive, NHS Boards, Regional Planning Groups and Regional Cancer Advisory Groups to consider what further action may be necessary to support symptomatic and screening services for the future

  • Access to, and availability of, endoscopy/colonoscopy services represent considerable challenges and will be a significant feature of such consideration

  • Collaboration with local, regional and national workforce planning and NHS Education for Scotland (NES)

  • The Centre for Change and Innovation are planning to hold a national convention in September to facilitate clarification of and consensus on the immediate, medium-and longer-term priorities including options for increasing capacity and training provision within NHSScotland

Service Implications

Robust Support Services, e.g. Radiology and Pathology

  • A meeting has been organised jointly by the SEHD, Royal College of Radiologists, Scottish Radiological Society and the Society of Radiographers to discuss the role of radiology in the patient pathway and review experiences across Scotland. This will include an interactive workshop on understanding and using capacity and demand theory in radiology

  • CSIP has identified areas for improvement in radiology and pathology in some areas, e.g. reducing time for pathology reports, introduction of dedicated weekly CT slots

  • Workforce development arrangements being put in place at national, regional and local level

  • 24 additional radiology and 16 additional pathology training posts have been established between 2001 and 2003

  • Investment in 2004 to support PathAlba, the Scottish pathology telemedicine network that allows microscopic images of pathological samples to be examined by colleagues in other parts of the country

Cancer in Scotland investment to pump prime a managed clinical network for pathology initially in North East Scotland - the aim is to extend the network across Scotland to facilitate, among other things, enhanced sharing of expertise and role redesign