Cancer Screening in Ireland

HSE’s National Cancer Screening Service Announces Initial Selection of Candidate Screening Colonoscopy Units and Outlines Accreditation Programme for all Endoscopy Units

The National Cancer Screening Service (NCSS), part of the HSE National Cancer Control Programme, is responsible for the development and implementation of Ireland’s first national population-based colorectal cancer screening programme. The programme is planned to be available to men and women aged 60-69 in 2012. In Ireland, colorectal cancer is the second most commonly diagnosed cancer and the second most common fatal cancer among both men and women. One of the significant aspects of colorectal cancer screening is that it can detect pre-cancerous adenomas and is therefore a true cancer preventative health measure.

Men and women aged 60-69 will be offered a free home testing kit known as a FIT test. Approximately 94 to 95 per cent of people who take part in the programme will receive a normal FIT test result and will be offered another home testing kit in a further two years. Approximately five to six per cent of people screened will receive a result that will require an additional test. They will be referred for a screening programme colonoscopy (an investigation of the lining of the bowel).

The NCSS today announced details of the 15 candidate colonoscopy units that have been initially selected to provide the colonoscopy requirements to the programme. The remaining units will focus on patients who are referred with symptoms.

The following 15 units have been selected as initial candidate screening colonoscopy units: Cavan General Hospital; Connolly Hospital, Dublin; Kerry General Hospital, Tralee; Letterkenny General Hospital; Louth County Hospital, Dundalk; Mayo General Hospital, Castlebar; Mercy University Hospital, Cork; Midland Regional Hospital, Tullamore; Mid-Western Regional Hospital, Ennis; Sligo General Hospital; South Tipperary General Hospital, Clonmel; St James’s Hospital, Dublin; St Vincent’s University Hospital, Dublin; The Adelaide and Meath Hospital Dublin incorporating the National Children’s Hospital, Tallaght and Wexford General Hospital.

This selection provides a good geographic access and supports the aim of having a network of accredited units in place by 2012. Any unit not initially selected may in time be included as a screening colonoscopy unit as part of the national colorectal cancer screening programme.

Achieving confirmed status as a screening colonoscopy unit will be contingent upon these 15 sites demonstrating sufficient capacity, reducing waiting times for all endoscopy procedures, adherence to clinical performance targets, quality standards and meeting accreditation requirements as determined by the NCSS Quality Assurance Committee during the course of 2011 and 2012.

The NCSS sought expressions of interest in January 2010 from all publicly funded hospitals that wished to be considered as a screening colonoscopy unit as part of a national programme. Thirty one hospitals in total expressed an interest. The HSE through the NCSS commissioned baseline assessment visits in those units.

The visits were conducted by the NCSS in partnership with the representative professional bodies, the Royal College of Physicians of Ireland, the Royal College of Surgeons in Ireland and the Joint Advisory Group on Gastroenterology (JAG) in the UK. All baseline visits were completed by 30 September 2010 and all hospitals received a follow-up review by 31 December 2010.

The purpose of the baseline assessment visits was to examine the likelihood of each unit achieving independent accreditation within 12-18 months and readiness to incorporate screening colonoscopies into their current service.

In response to the baseline assessment visits, each hospital has developed and implemented an action plan designed to improve the quality of service provided and is working towards achieving independent accreditation. Actions taken by hospitals include changes to management and leadership in endoscopy units, improved referral and pooling practices, better waiting list management and improved decontamination processes.

Since January 2010 the NCSS has focused on building sufficient capacity in colonoscopy services nationwide to prepare for the introduction of the screening programme, while maintaining and enhancing the capability of the symptomatic service.

A major quality improvement initiative, the National Quality Assurance Programme in GI Endoscopy, is being developed by the Royal College of Physicians of Ireland (RCPI) and the Royal College of Surgeons in Ireland (RCSI) in collaboration with the HSE and the NCSS.

Commenting on the initial selection, Tony O’Brien, Director of the National Cancer Screening Service said: “It is our goal to ensure that endoscopy units in Ireland, whether part of the national screening programme or not, are fully quality assured, and that timely access is provided for those men and women who require further investigation by colonoscopy or any other endoscopic procedure. While there has been much debate in recent years regarding access to colonoscopy to rule out cancer, it is worth emphasising that endoscopy plays a major role in diagnosing and monitoring benign conditions including peptic ulcers and inflammatory bowel disease.

The focus is on improving quality and access at all publicly-funded endoscopy units, not just for those referred for colonoscopy as part of the screening programme, but for all men and women who require a colonoscopy or any other diagnostic endoscopic procedure.

This will be achieved by building sufficient capacity in endoscopy services nationwide to sustain the implementation of the programme, while maintaining and enhancing the service. On the basis of achieving the necessary quality standards and accreditation, additional units may be included as part of the screening programme in time” he concluded.

Commenting on the quality improvement programme underway in hospitals, Dr Philip
Crowley, HSE National Director of Quality, Risk and Clinical Care, said; “By introducing this major quality improvement initiative we have asked independent experts to systematically and objectively review endoscopy services nationwide to identify areas of under-performance, instigate change and lay the foundations for a system of continuous quality improvement.

“Significant progress has been made by hospitals over the last 12 months and they have clear plans in place for further improvements to be made in the year ahead. This will not only pave the way for the roll-out of the colorectal cancer screening programme but will ensure that all of our endoscopy units are providing a high quality and standardised service to the public.”

The NCSS will have a service agreement with each of the selected screening colonoscopy units. The NCSS will be responsible for ensuring adherence to strict quality assurance standards at each of the units.