Public Health

AgencySCREENING MATTERS

Newsletter of the Northern Ireland Cancer Screening Programmes

Cancer Screening Workshop, November 2011 The Quality Assurance Reference Centre (QARC) held a cancer screening workshop in Knockbracken Health

Care Park on 10th November 2011. Its purpose was to generate draft recommendations on improving informed

choice about cancer screening to ensure that everyone who is eligible to participate can do so if they want to.

Uptake and coverage of the breast and cervical screening programmes is high, meets national standards, and is

comparable with levels achieved in other parts of the UK. However 20% – 25% of women invited to participate

in these programmes do not attend. Published research shows that socioeconomic factors and ethnicity can be

associated with poorer uptake. In conclusion there are other sub-groups who may not participate in cancer

screening, this can be due to organizational and communication issues or to individual factors.

The bowel cancer screening programme has been introduced more recently and is still being rolled out. It

currently has an uptake of 48%.

A wide range of stakeholders was invited to the workshop with 65 attending. As well as considering how to

promote informed choice in general across the three cancer screening programmes, participants also

considered the needs of the following population sub-groups:

• Minority ethnic groups;

• People living in deprived circumstances;

• People with learning difficulties;

• Lesbian, gay, bisexual & transgender groups;

• People with physical &/or sensory disabilities;

• Prisoners, and the Traveller community.

A discussion document produced for the workshop is available on QARC website at http://www.cancerscreening.hscni.net/publications/toc.html If you would like to respond to any of the issues raised in this document please forward your comments to claire.armstrong@hscni.net by 31 December 2011. The outputs from the workshop (and other comments received) will inform the development of a draft action plan in January 2012. Dr Adrian Mairs, QA Director for the Breast Screening Programme

Issue 22 Produced by QARC for Health Professionals in NI Cancer Screening Programmes Winter 2011

Belfast Trust Breast Screening Unit Text Reminder Service

On 25 October 2011, the National Cancer Director for the NHS in England, Professor Sir Mike Richards announced a review of the evidence underlying the breast screening programme. He will carry this out in partnership with Harpal Kumar, the Chief Executive of Cancer Research UK. Evidence will include randomised control trials and observational studies relating to breast screening. The overall aim of the review is to develop an up-to-date assessment of both the benefits and harms associated with breast screening programmes. There is strong evidence that breast screening does more good than harm and saves lives by detecting cancers earlier when treatment can be more effective. The harms, or limitations, of breast screening include false negative results, false positives, human error, any anxiety caused; and the fact that screening can find cancers which are treated but which may not otherwise have been found during a woman’s lifetime. It is important to note that the guidance on breast screening has not changed. All eligible women aged 50 and over are encouraged to attend for regular breast screening mammography. The review is expected to report in 2012.

Dr Adrian Mairs, QA Director for Breast Screening

Statistical data for quarter 1, Apr– Jun 2011 Uptake% 50-64 Eastern 73.3% Northern 77.2% Southern 74.7% Western 76.6%

Region 75.2%

Minimum Standard >70% Target 80%

Screen to assessment % within 3 weeks

Eastern 95.7% Northern 98.8% Southern 95.9% Western 95.4% Region 96.1%

Minimum Standard 90% Target 100%

Round Length % within 36 months, 50-64

Eastern 82.3% Northern 33.7%*

Southern 96.2% Western 98.2% Region 78.3%

Minimum Standard 90% within 36months Target 100%

*This low figure is the result of planned rescheduling of workload

In August 2011 Belfast Trust Breast Screening Unit introduced a text reminder service. Women who provide the screening unit with a mobile number, will receive a text reminder of their appointment. Staff now routinely ask women for mobile numbers. A reminder is sent out two days in advance of the scheduled appointment.

Text reminders have been proven to substantially reduce the number of missed appointments and the unit hopes that this will reduce the number of clients who fail to attend for their appointments.

Mjog the company providing the service are currently designing promotional posters which will be displayed in the Breast Screening Unit to encourage women to provide their mobile numbers. Mrs Georgie O'Kane, Screening Office Manager and Regional Link for NHAIS/NBSS

Client Satisfaction questionnaires were completed throughout Northern Ireland on both the static and mobile breast screening sites during the months of May and June 2011. 424 ladies took part in the survey, the results demonstrate that the service is well accepted by ladies throughout Northern Ireland, greater than 90% found the process easy with staff providing clear instructions, a friendly and helpful environment. Only 12 ladies found the procedure painful. Almost 100% of the respondents said they would encourage a friend, colleague or relative to attend. I would like to commend all staff for their continued efforts in providing a very worthwhile service. Marie McStay, QA Radiographer for Northern Ireland

Customer Satisfaction Survey May – June 2011

Appointment

The NHS Breast Cancer Screening Review

Public Health

AgencyIssue 22 Produced by QARC for Health Professionals in NI Cancer Screening Programmes Winter 2011

Attendance Almost 400 people attended the five events between 2nd February and 13th September 2011. The majority of attendees were from primary care with over 30 from acute/community backgrounds.

General Points Generally there was a very positive response to these events from attendees. Clearly there is a demand for update training on a regular basis, and we have received a number of requests for further events. Only 47% of primary care practices in NI were represented, and we now need to consider how future updates can best be delivered. Particularly to encourage a greater number of GPs to avail of training. National guidelines state that all smear takers should have update training every 3 years, and the primary care QA group will be developing a longer term plan to address this.

Breakdown of Attendees

162 practices were represented (47% of NI Practices) 12 from Sexual and Reproductive Healthcare Services 15 from hospital settings 4 from University Health Centre, QUB 2 Community Nursing

CERVICAL CYTOLOGY UPDATES for smear takers—feedback

Relevant to educational

needs

97% YES

Learn a great deal?

86% YES

Influence clinical practice?

90% YES Timely and well presented?

92% YES

Feedback data from the five update sessions

If you would like to submit a news item, or would like to publish the results of an audit in Screening Matters, please contact Ken McInnes on 02890 553949 or Public Health Agency QARC, 4th floor Champion House, 12-22 Linenhall Street, Belfast BT2 8BS. For further information and back issues, please visit our website at: www.cancerscreening.hscni.net.

DIRECT REFERRALS TO COLPOSCOPY BELFAST & SOUTH EASTERN HSC TRUSTS

Belfast Trust Cytology Laboratory is finalising plans to introduce a system for direct referral to colposcopy for women with abnormal cervical screening cytology. It is anticipated that this will go live in January 2012.

Over the last few months GPs in both Belfast and South Eastern HSC Trusts have been asked to nominate which colposcopy service they wish their patients to be directed to. The laboratory will directly refer women to the GPs nominated colposcopy service, avoiding the need for the GP to make the referral.

GPs will still receive a laboratory report, but it will state that the woman has been referred directly to colposcopy.

GP practices will receive electronic notification of results, ahead of the woman receiving notification through the postal system. GPs will still be able to refer women to colposcopy if they have concerns regarding the appearance of the cervix. Smear takers in Family Planning and GUM clinics will continue to receive postal notification of smear results. Direct referral offers a more streamlined service for women. Referral times for the Northern HSC Trust where the direct referral system was introduced in February 2010, have seen referral times drop from thirty days to nine.

CONGRATULATIONS to Staff Nurse Claire McCoy from Belfast Trust who has recently qualified as

a nurse colposcopist. She started her training in the Mater hospital and then completed her

training at the Bradbury Colposcopy centre. She successfully completed her training by

passing her OSCE exam in May 2011. We wish her all the best for the future.

QARC staff attended the Black and Ethnic Minority Conference hosted by the PHA in the Kings Hall, Belfast in October 2011.

The Conference had several keynote speakers including the Health Minister, Mr Edwin Poots and speakers from the Afiya Trust, Project London and Interpreting Services amongst others. QARC took the opportunity to promote the Breast, Bowel and Cervical Screening Programmes to attendees.

Black and Ethnic Minority Conference, Belfast, October 2011

Calling all Smear Takers/Health workers

UNSCHEDULED SMEARS

It has been brought to our attention that some postnatal women are being

advised to have a cervical screening test. The guidance on unscheduled smear

tests, including postnatal tests, is very clear and is outlined in the extract

below from the national smear-taker training manual.

Post-natal smears should only be carried out if the woman is within the

screening age range and is due her next smear test.

A6 What about unscheduled tests?

If a woman is in the age group to be screened, and has had a test in the previous routine screening interval, “additional tests should not be carried out”, even for any of the following reasons: • when attending for contraceptive advice or services. • when attending for advice on hormone replacement therapy. • during pregnancy or when attending for postnatal services. • women with genital warts. • in women with vaginal discharge. • in women with infection. • in women who have had multiple sexual partners or in women who are heavy cigarette

smokers

Cervical cease call audit A regional cease call audit is being undertaken to ensure that all women who have been ceased from screening have been done so appropriately. GPs who have still to submit cervical audit returns to the central screening office, please arrange to send these forms back ASAP.

If you have still not received the audit forms please call 02890-535-552 now. The screening office staff will provide further information.

Practices not responding to this audit, and have not previously submitted a signed document for each ceased patient, will have all ceased women returned to routine recall where their status cannot be validated.

labelling of LBC specimens Dr Michael Chambers Chair, Primary Care Advisory Group All four laboratories are voicing concerns about the continuing level of incidents regarding the incorrect labelling of vials in cervical cytology. This may come about for different reasons but please;

DO NOT print off, or label vials in advance of the patient’s attendance. ALWAYS DOUBLE CHECK the patient’s identity with the label before placing on the vial

CROSS CHECK it with the label on the form

Samples which have been incorrectly labelled cannot be safely processed by the laboratory and are likely to result in you having to bring the woman back for a repeat smear test. PLEASE PLEASE PLEASE - check the details on the label with the lady when you have taken the smear.

Bowel Cancer Screening Programme Quality Assurance

Public Health

AgencyIssue 22 Produced by QARC for Health Professionals in NI Cancer Screening Programmes Winter 2011

BOWEL BOWEL BOWEL BOWEL CANCER CANCER CANCER CANCER SCREENINGSCREENINGSCREENINGSCREENING

The Bowel Cancer Screening Programme (BCSP) Quality Assurance (QA) Leads have been appointed. The leads for Colonoscopy, Pathology, Radiology and for Specialist Screening Practitioners are shown in the QA structure diagram below. Each lead will be responsible for providing professional advice to the PHA and for the coordination of QA activities with professionals within the BCSP. A QA Committee has been established which will include all speciality leads and will be chaired by Dr Tracy Owen, the QA Director. Each lead will chair a sub-group of staff within the screening programme for their respective specialty. The quality assurance structure ensures accountability and that the benefits of screening outweigh any harm.

ACTIVITY UPDATE APRIL 2010-NOVEMBER 2011

Belfast Trust population

The Bowel Cancer Screening Programme has commenced in Belfast HSC Trust in November 2011. Invitations have been issued to the eligible population of 60-69 year olds. Specialist Screening Practitioners (SSP) have been appointed and completed training. The Trust will provide assessment by SSP for those patients with a positive screening result and then colonoscopy, or an alternative investigation, as required.

The Screening Programme is due to commence in the Southern HSC Trust from January 2012 which will complete roll-out across Northern Ireland.

Roll out of Bowel Cancer Screening Programme

Invites issued and processed 103,837

Unsuitable for screening 1,229

Current Participants 95,060

Non Responders 49,545

Responders 45,515

Uptake to date 48%

Outcome number

Screen detected cancers 80

Polyps High risk

Intermediate risk

Total on polyp

surveillance programme

77

145

222

Mrs Grace Ings took up post on 1st November working within the Quality Assurance Reference Centre (QARC) within the PHA. Grace’s background as an endoscopy scheduler for the South Eastern Trust means she is already familiar with the Bowel Screening Programme. Her role will be to identify and provide information to support quality assurance of the programme. Grace will support local and national audits and the identification and review of interval bowel cancers. Grace will also provide support to research projects relevant to screening.

Director of Public Health Dr Carolyn Harper

SSP Lead Susan Hughes

Pathology Lead Dr Maurice Loughrey

QA Director Dr Tracy Owen

QA Committee

Colonoscopy lead Dr William Dickey

New Information Support Officer for the Bowel Cancer Screening Programme

Radiology Lead Dr Myles Nelson