Screening for bowel cancer Country: United Kingdom Partner Institute: London School of Economics and Political Science Survey no: (5)2005 Author(s): Adam Oliver Health Policy Issues: New Technology, Quality Improvement, Benefit Basket Current Process Stages Idea Pilot Policy Paper Legislation Implementation Evaluation Change Featured in half-yearly report: Health Policy Developments Issue 5 1. Abstract The NHS Plan published in 2000 committed the Government to introducing a new national screening programme for bowel cancer. This new screening programme will be introduced in April 2006. 2. Purpose of health policy or idea The UK Labour Government has committed itself to programmes that help to prevent cancer and those that improve services for people who have this disease. Consequently, the Government will introduce a new national bowel cancer screening programme for people in their sixties. 37.5 million is being committed to develop this new programme over the next two years, and it will begin in April 2006. Main objectives Two methods of screening for bowel cancer have been piloted: (1) faecal occult blood testing (FOBt); (2) flexible sigmoidoscopy (FSIG). FOBt involves analysing stool samples for blood content, and has been shown in pilot studies to cut the death rate for bowel cancer by up to 15%. It is this method that is to be gradually introduced for people in their sixties from April 2006. Large scale pilots of undertaking FSIG on people in their late fifities is ongoing. Ten new endoscopy training centres have been established in order to create the human resources necessary to implement the new screening programme, and by the end of 2005 these centres would have trained at least 345 new endoscopists. Type of incentives 37.5 million over two years is being allocated to set up NHS Bowel Cancer Screening. Much of this money will be used to train the endoscopists needed to run the new service. Groups affected People in their sixties - 1 -
3. Characteristics of this policy Degree of Innovation traditional innovative Degree of Controversy consensual highly controversial Structural or Systemic Impact marginal fundamental Public Visibility very low very high Transferability strongly system-dependent system-neutral To early to tell. If it does significantly reduce cancer mortality and does not prove to be too expensive, then clearly it will be a worthwhile programme. 4. Political and economic background The new programme is part of the current Government's vision in 'modernising' the NHS, and was promised in the NHS Plan published in 2000. The NHS Plan outlines the Government's intentions in developing the NHS over the 2000-2010 period. Complies with Other - Need to comply with the NHS Plan Change based on an overall national health policy statement 5. Purpose and process analysis Idea Pilot Policy Paper Legislation Implementation Evaluation Change Origins of health policy idea The idea was put forward in the NHS Plan, and is part of the Government's commitment to reduce the overall cancer mortality rate. Thus, the Government drove the idea, and has allocated the resources from central funds in order to establish this new programme. Initiators of idea/main actors Government Civil Society Approach of idea The approach of the idea is described as: renewed: First voiced in the NHS Plan in 2000-2 -
Stakeholder positions The central Government has decided to introduce this programme, and, as far as I can tell, has met little resistance. Methods to tackle cancer recieve general public approval. Actors and positions Description of actors and their positions Government Ministers for Health very supportive strongly opposed Civil Society Bowel Cancer Screening group very supportive strongly opposed Influences in policy making and legislation The Government has decided to add this programme to the NHS benefits package. The programme stems from the NHS Cancer Plan, launched by the Department of Health in 2000 with a view, over ten years, to rejuvinate, reorganise and standardise NHS cancer services. As far as I know, no formal legislation was required in order to introduce the new bowel cancer screening programme. Legislative outcome Actors and influence Description of actors and their influence Government Ministers for Health very strong none Civil Society Bowel Cancer Screening group very strong none Positions and Influences at a glance Adoption and implementation The bowel cancer screening programme will be gradually introduced on a national level for people in their sixties from April 2006. Pilots will be ongoing for people in their late fifties. Monitoring and evaluation The programme will no doubt be monitored for its success (or otherwise) but details on exactly how monitoring will be organised have not yet been forthcoming. I suspect that uptake, outcome and value for money will all be assessed in due course. Results of evaluation Not yet applicable, although pilot studies have suggested that the bowel cancer mortality rate could be reduced by up to 15% when the programme is available for people in their sixties. - 3 -
6. Expected outcome Too early to tell. Both uptake and general effectiveness will of course both determine whether the new programme will be considered good value for money. Quality of Health Care Services marginal fundamental Level of Equity system less equitable system more equitable Cost Efficiency very low very high Too early to tell. 7. References Sources of Information http://www.dh.gov.uk/policyandguidance/organisationpolicy/modernisation/nhsplan/fs/en?content_id=4082690 &chk=/du1ud http://www.dh.gov.uk/publicationsandstatistics/pressreleases/pressreleasesnotices/fs/en?content_id=4092376 &chk=f1jw5w - 4 -
Author/s and/or contributors to this survey Adam Oliver Suggested citation for this online article Adam Oliver. "Screening for bowel cancer". Health Policy Monitor, March 2005. Available at http://www.hpm.org/survey/uk/a5/3-5 -