This report focuses on programme performance in England during the screening year 2022 to 2023 (1 April 2022 to 31 March 2023) compared to the national bowel cancer screening programme standards. It also includes trend data from previous years where this is available.

These standards contribute to assessing the quality of the NHS Bowel Cancer Screening Programme (BCSP) across England. Publishing the data ensures stakeholders and the public have access to reliable and timely information on the quality and performance of the screening programme.

The standards focus on some of the important targets that providers have to meet and maintain, to make sure local screening services are high quality, safe and effective.

This report provides data on coverage, uptake, turnaround times for test kit processing, timeliness of first offered and first attended appointments, onward diagnostic tests, turnaround times for pathology samples and endoscopy clinical standards.

Two thresholds, the acceptable threshold and achievable threshold, are specified for each standard, where applicable. Where the data show that standards are not met, providers and commissioners should ensure appropriate action is taken. NHS England works to provide advice and support to this process.

Data for this report were extracted from BCSS, the bowel cancer screening IT system on 1 October 2024.

Throughout this report, consideration should be given to the impact of the COVID pause that occurred in March 2020, and the subsequent restoration period that affected all bowel cancer screening centres and programme hubs.

1. Overview of the NHS Bowel Cancer Screening Programme in England

The NHS Bowel Cancer Screening Programme was introduced in 2006 Initially, people aged 60 to 69 were invited to participate in the scheme. The programme started to expand in 2010 to cover those aged 70 to 74. April 2021 saw the start of the process to lower the eligibility age to 50, with completion expected in 2025.

An invite to take part in the programme is made to all eligible people, who are resident in England and are registered with a GP. Screening is carried out via a home testing kit, which participants return for laboratory analysis. The test – known as a faecal occult blood test, or FOBt - looks for the amount of blood in the faecal (poo) samples provided. If that is above a certain level, they will then be invited for further tests. Otherwise, they will be invited to take part in home testing in 2 years’ time.

A new home testing kit called a faecal immunochemical test (FIT) started to be rolled out across England from April 2019. FIT replaced the guaiac faecal occult blood test (gFOBt kit) which had been in use since the programme began in 2006. Prior to implementation the FIT pilot study suggested that the change in test kit type would lead to an increase in uptake, which can be seen from 2019-20.

If participants are invited for further tests, they will be assessed by a Specialist Screening Practitioner (SSP), who will advise as to which test is most appropriate. In the majority of cases, following this appointment, they will be referred for a colonoscopy. This is an examination of the lining of the large bowel, during which any polyps - an abnormal clump of cells – can be removed. Polyps are not cancers, but may develop into cancer over time. Polyps can be easily removed, which reduces the risk of bowel cancer developing. An adenoma is a specific type of polyp found in the bowel. Adenomas (along with other polyp types) have a greater likelihood of developing into cancer over time.

Following the conclusion of the diagnostic tests, participants will either be told that there is no trace of cancer, in which case they will be invited to take part in home testing again in 2 years’ time. Or, if they are given a cancer diagnosis, arrangements will be made to start treatment. Alternatively, they may be placed into surveillance, which means that they will receive a further invite for diagnostic testing at an appropriate time, and will not be offered home testing every 2 years.

In this report the pathway from invitation through to diagnostic testing is referred to as the ‘FOBt bowel cancer screening programme’ or simply the ‘FOBt programme’. People who have been referred to surveillance following participation in the FOBt programme, are described as ‘FOBt programme – surveillance’ patients.

Further details about the programme can be found here.

2. Summary for 2022-23

During 2022-23, the NHS Bowel Cancer Screening Programme in England invited 6,045,840 people to participate in FOBt screening, and of these people 4,113,860 adequately participated (i.e., ‘were screened’), giving an uptake percentage of 68.0%. Of those invited who adequately participated, 75,149 had a test kit result of ‘further tests are needed’ and were automatically referred. This gave a positivity figure of 1.83%. A further 175,263 people self-referred or opted back into the programme within the year (including ‘over-age self-referrals’ and ‘late responder self-referrals’). The programme sent a total of 6,364,653 test kits, and 4,330,098 test kits were read by the five programme hubs within the screening year. Coverage at the end of March 2023, that is the proportion of eligible men and women aged 60 to 74 invited for screening who had an adequate faecal occult blood test (FOBt) screening result in the previous 30 months, was 72.0%.

Across the programme Specialist Screening Practitioners carried out a total of 82,230 colonoscopy fitness assessment appointments. The programme also carried out a total of 83,468 diagnostic tests (endoscopic and radiological) from both screening and surveillance episodes (this count includes repeat procedures performed as well as those resulting from bowel scope screening and programme surveillance cases). Following endoscopic tests, the programme sent 158,476 resected polyps for pathological analysis within the year.

During the year 2022-23, the programme as a whole diagnosed 4,874 people with cancer.

3. BCSP-S01: Coverage

This section covers standard BCSP-S01.

Coverage is measured in the national screening programme to provide assurance that screening is being offered to the eligible population on a timely basis, and to maximise timely attendance of the eligible population (i.e. every 2 years). The eligible population makes an informed choice about whether or not to participate in all screening programmes, including bowel cancer screening. Coverage is defined as the proportion of the eligible population who are up to date with screening, that is to say, of all those eligible for screening, the number who have participated within the last 2.5 years.

Although bowel cancer screening is offered to eligible people every two years, coverage is reported for a 30-month (2.5-year) period, to allow people time to adequately participate in screening. This measure is then reported 6 months in arrears.

Coverage is an important indicator for the programme to achieve its aims of reducing incidence and mortality from bowel cancer.

The programme reports the proportion of eligible people who were screened (adequately participated in FOBt bowel cancer screening) in the 30-month (2.5 year) reporting period. With the cohort defined as the number of people eligible for FOBt bowel cancer screening on the last day of the reporting period.

3.1 FOBt bowel cancer screening coverage

For the 30-month (2.5 year) period ending March 2023, 72.0% (6,675,948 out of the eligible population of 9,273,320 aged 60-74) were screened (adequately participated in FOBt bowel cancer screening).

Table 1a: FOBt bowel cancer screening coverage, by reporting period ending each March.

Date *	No. eligible	No. screened in previous 30 months	2.5-year coverage %**
March 2014	8,146,603	4,561,464	56.0%
March 2015	8,254,054	4,726,134	57.3%
March 2016	8,396,386	4,904,123	58.4%
March 2017	8,554,660	5,060,429	59.2%
March 2018	8,692,600	5,172,802	59.5%
March 2019	8,830,019	5,339,727	60.5%
March 2020	8,947,911	5,748,186	64.2%
March 2021	9,119,744	6,027,522	66.1%
March 2022	9,176,223	6,452,369	70.3%
March 2023	9,273,320	6,675,948	72.0%

* for the 30-month (2.5-year) period ending in the quoted month

** excludes those with unknown local authority or are not resident in an England local authority

Table 1b: FOBt bowel cancer screening coverage, by region 30-month (2.5 year reporting period), period ending March 2023.

NHS Region	Coverage %
East of England	73.5%
London	63.5%
Midlands	71.8%
North East & Yorkshire	74.1%
North West	70.0%
South East	74.4%
South West	75.6%
England	72.0%

Figure 1: FOBt bowel cancer screening coverage, 30-month (2.5 year reporting period), England, period ending March 2014 to the period ending March 2023.

The line graph above (Figure 1) shows the increase in coverage, for the 30-month (2.5 year) reporting period ending each March. Coverage was first able to be reported for the 2.5-year period ending March 2014 and, as shown in the graph has steadily increased to the period ending March 2019. The graph then shows a more rapid increase in coverage, coinciding with the introduction of FIT during the first half of 2019-20.

4. BCSP-S02: Uptake

This section covers standard BCSP-S02.

An important objective of the NHS Bowel Cancer Screening Programme in England is to maximise uptake in the invited population. Uptake is defined as, of all the people invited, how many participated within the invited screening episode, at time of reporting.

The expected effectiveness of the screening programme in reducing bowel cancer mortality requires a minimum uptake of 52%.

It is important to note that uptake measures do not include people who: late-respond, over-age-self-refer, or who opt-back-in to the programme. This means that whilst an uptake improving initiative may increase participation, this participation may not count towards the calculation of uptake.

The programme reports the proportion of invited people who were screened (adequately participated in FOBt bowel cancer screening), within the invited screening episode, at time of reporting.

Uptake is formally reported monthly for a 1-month period, 6-months in arrears. However, services can review their provisional data more frequently, with shorter initial arrears periods. The data presented below are an aggregate of the monthly data, to present data for the screening year 2022-23 as a whole.

Performance thresholds
Acceptable level: greater than or equal to 52.0%.
Achievable level: greater than or equal to 60.0%.

4.1 FOBt uptake by NHS region

In 2022-23, 68.0% of the invited population (4,113,860 out of 6,045,840) adequately participated in FOBt bowel cancer screening. The invited population includes people aged 60-74 (the standard screening age range), as well as those who have been invited as part of the age extension programme - aged 56 and 58 years.

NB: The data presented here may appear very slightly different to those previously published. The uptake data presented here has allowed for longer response times, meaning the figures quoted are a fraction of a percentage higher than those previously published.

Table 2: FOBt uptake by NHS region, 2022-23.

NHS Region	Within Target %*
East of England	70.0%
London	59.1%
Midlands	67.7%
North East & Yorkshire	70.3%
North West	66.5%
South East	70.3%
South West	72.1%
England	68.0%

* based on region of screening centre

Of the 64 bowel cancer screening centres, 58 were on or above the achievable uptake threshold of 60%, 5 centres were between the acceptable and achievable thresholds (between 52% and 60%). No centres were below the acceptable uptake threshold of 52%. The lowest performer achieved 53.5%.

4.2 FOBt uptake by screening centre – Heat Map

Figure 2: FOBt uptake heat map by screening centre, 2022-23.

The map above (Figure 2) presents FOBt uptake by screening centre for the screening year 2022-23.

4.3 FOBt uptake by year

Figure 3: FOBt uptake by year, England, screening year ending March 2007 to the year ending March 2023.

The line graph above (Figure 3) shows the steady increase in uptake for the invited population since the start of the screening programme in 2006 up to the end of 2018-19. The ‘flip-flop’ or ‘saw tooth’ pattern that can be observed in the yearly data is due to how the screening programme rolled out, leading to different proportions of people who’d taken part before, being invited in alternate years. This affect can be seen to be lessening over time.

4.4 FOBt uptake by gender

Participation rates are higher among females compared to males. In 2022-23, 70.6% of females took part in the screening programme compared to 65.5% of males

4.5 FOBt uptake by age group

Figure 4: Recent FOBt uptake by invite month and age group, England, January 2021 to March 2023.

An age extension programme also started to be rolled out from early 2021-22, with services beginning to invite 56-year-olds for screening. The 58-year-old cohort followed in 2022-23. As screening centres went live during the course of the year, not all of the 58-year-old cohort was invited. Therefore, figures for this cohort have been excluded from this report. This change to the programme cohort has resulted in a slight drop in total eligible population uptake (as seen in Figure 3), indicating that younger age groups may be less likely to take up the screening offer - see also chart above (Figure 4). In 2022-23, uptake was 60.9% among 56-year-olds and 72.8% in 70 to 74-year-olds.

4.6 FOBt uptake by Index of Multiple Deprivation

Table 3: FOBt uptake by Index of Multiple Deprivation by Region

NHSE Region	Quintile 1 (most deprived)	Quintile 2	Quintile 3	Quintile 4	Quintile 5 (least deprived)	Overall Uptake*
East of England	55.9%	64.3%	69.5%	72.4%	75.5%	69.7%
London	52.2%	54.6%	59.4%	64.1%	69.7%	59.1%
Midlands	54.8%	63.5%	69.9%	73.6%	76.7%	67.8%
North East & Yorkshire	59.7%	68.4%	73.3%	76.3%	79.1%	70.4%
North West	55.3%	63.8%	70.0%	73.3%	76.6%	66.1%
South East	58.3%	63.2%	68.5%	72.5%	75.6%	70.5%
South West	59.3%	67.9%	72.2%	75.0%	78.0%	72.1%
England	56.4%	63.1%	69.0%	72.8%	76.1%	68.1%

* based on ICB view

The table above also shows uptake by index of multiple deprivation quintile and shows that people who live in the most deprived areas (quintile 1) are less likely to participate in screening than those who live in the least deprived areas (quintile 5). This trend can be seen across all NHS regions.

5. BCSP-S03: FOBt kit turnaround time

This section covers standard BCSP-S03.

FOBt kit turnaround time is measured by reporting the proportion of returned test kits that have been processed and read (i.e., ‘resulted’) on or within 3 calendar days of them being logged as returned to the programme hub, out of those that were readable. This is to ensure participants receive their test kit results as soon as possible.

Performance thresholds
Acceptable level: greater than or equal to 80.0%.
Achievable level: greater than or equal to 85.0%.

5.1 FOBt kit turnaround time by programme hub

In 2022-23, 100.0% (to one decimal place) of all readable test kits (4,283,383) were read within 3 calendar days of being logged as returned to the programme hub. 4,283,537 FIT kits were returned for analysis during the period. This data is reported by programme hub.

Table 4: FOBt kit turnaround time by programme hub, 2022-23.

Programme Hub	Read Within Target %
Eastern	100.0%
London	100.0%
Midlands and North West	99.9%
North East & Yorkshire	100.0%
Southern	100.0%
England	100.0% (to one decimal place)

All 5 hubs were above the achievable turnaround time threshold of 85%. 4 hubs achieved 100%, with the other achieving 99.9% (to one decimal place) for kits read within 3 calendar days.

5.2 FOBt test kit turnaround time by year

Figure 5: FOBt test kit turnaround time by year, England, screening year ending March 2007 to the year ending March 2023.

As can be seen in the line graph above (Figure 5), when the programme was using guaiac-based test kits (which were read manually by human eye), achievement of the performance threshold was more variable. Since the introduction of the new FIT kit, which is largely processed and read by machines called ‘analysers’, the proportion of test kits that are read on or within 3 calendar days has increased, with the programme achieving over 99% of all test kits being read within 3 calendar days, for the last 3 consecutive years.

6. BCSP-S06: Time to first offered SSP colonoscopy fitness assessment appointment.

This section covers standard BCSP-S06.

An SSP is a specialist screening practitioner. The SSP makes a clinical assessment as to whether a person with a test kit result of ‘further tests are needed’ is fit (healthy enough) to undergo a diagnostic test, usually a colonoscopy.

People who are referred (following an FOBt result of ‘further tests are needed’), should be offered a first SSP colonoscopy fitness assessment appointment in a timely manner, so they can discuss their test kit results and next steps within the screening programme.

The programme monitors this standard by reporting the proportion of first offered SSP colonoscopy fitness assessment appointments where the date of the first offered appointment was on or within 14 days of the FOBt referral date.

Performance thresholds
Acceptable level: greater than or equal to 95.0%.
Achievable level: greater than or equal to 98.0%.

6.1 Time to first offered SSP colonoscopy fitness assessment appointment by NHS region

In 2022-23, 98.4 % of all referred people (76,805 in total) were offered an SSP colonoscopy fitness assessment appointment date that was on or within 14 days of their referral date, out of a total of 78,049 people who were referred in the year (following a test kit result of ‘further tests are needed’).

Table 5: Time to first offered SSP colonoscopy fitness assessment appointment by NHS region, 2022-23.

NHS Region	Within Target %
East of England	99.8%
London	98.9%
Midlands	98.3%
North East & Yorkshire	99.2%
North West	99.2%
South East	99.8%
South West	92.1%
England	98.4%

Of the 64 bowel cancer screening centres, 54 were on or above the achievable threshold of 98%, one centre was between the acceptable (95%) and achievable thresholds; and nine centres were below the acceptable threshold, with the lowest achieving 72.4% .

6.2 Time to first offered SSP colonoscopy fitness assessment appointment by year, including SSP referral counts

Figure 6: Time to first offered SSP colonoscopy fitness assessment appointment by year including SSP referral counts, England, screening year ending March 2007 to the year ending March 2023.

The line graph above (Figure 6) shows the relatively steady / consistent performance of the programme against this standard, up until the new FIT kit was introduced. The FIT pilot study suggested that the change in test kit type would not only increase uptake, but would also increase positivity (at the employed threshold), and stated that both these factors would increase the number of people with a test kit result of ‘further tests are needed’, and so increase the number of people who would require SSP colonoscopy fitness assessment appointments.

The line graph shows (Figure 6) a drop in performance during the implementation of FIT, where this measure is seen to drop below the achievable level for the first time in many years. This corresponds with the sharp rise in the number of people needing SSP appointments. It then shows the recovery to above the acceptable target in the following years.

7. BCSP-S07: Time to first offered diagnostic test appointment

This section covers standard BCSP-S07.

Following an FOBt result of ‘further tests are needed’ and attendance at an SSP colonoscopy fitness assessment appointment, people who are fit (healthy enough) for onward diagnostic tests are then offered a first diagnostic test appointment date. A first diagnostic test can be either a colonoscopy or a computed tomography colonography (CTC).

To reduce anxiety, people who are referred for a diagnostic test (following an FOBt result of ‘further tests are needed’) should be offered their first diagnostic test appointment in a timely manner. This offer should also be reasonable, offering an appointment that would allow the person the necessary time to prepare for the procedure and take any required bowel preparation medications. The programme monitors this standard by reporting the proportion of first offered diagnostic test appointments, where the date of the first offered appointment was on or within 14 days of the diagnostic test referral date.

Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.

7.1 Time to first offered diagnostic test appointment by NHS region

In 2022-23, 85.6% of people (52,200 in total) referred for a diagnostic test were offered a first diagnostic test that was on or within 14-days of their referral date. This is below the acceptable threshold set by the programme. A total of 61,016 people were referred for onward diagnostic tests in the screening year.

Table 6: Time to first offered diagnostic test appointment by NHS region, 2022-23.

NHS Region	Within Target %
East of England	86.2%
London	93.7%
Midlands	84.7%
North East & Yorkshire	88.1%
North West	78.6%
South East	89.8%
South West	77.3%
England	85.6%

Of the 64 bowel cancer screening centres, 17 were on or above the achievable threshold of 95%, 10 centres were between the acceptable (90%) and achievable thresholds. There were 37 centres which were below the acceptable threshold, with the lowest achieving 43.7%.

7.2 Time to first offered diagnostic test appointment by year

Figure 7: Time to first offered diagnostic test appointment by year, England, screening year ending March 2007 to the year ending March 2023.

The line graph above (Figure 7) shows that other than a short period of time during 2013-14, nationally, the screening programme has rarely been able to achieve the acceptable threshold of 90% of people offered a timely first diagnostic test appointment. The graph also shows a significant dip in performance during the FIT test kit implementation year, coinciding with additional demand. The percentage of people being offered a first appointment on or within 14 days of their referral date appears to increase in subsequent years.

8. BCSP-S08: Time to attendance for first diagnostic test

This section covers standard BCSP-S08.

Evidence shows that the first offered diagnostic test date (reported in standard BCSP-S07) and the first attended diagnostic test date (reported in this standard - BCSP-S08) can vary significantly, due to a number of reasons.

People can reject their first offered diagnostic test appointment date and can request a more suitable (often later) date.

Offered appointments indicate screening centre capacity. Attended appointments represent patient experience / patient choice, (as well as screening centre capacity). Reviewing both measures together provides a picture of centre capacity and patient choice / patient behaviour.

This standard is monitored by reporting the proportion of people who attended their first diagnostic test appointment on or within 14 days of their referral for diagnostic testing.

8.1 Time to attendance for first diagnostic test by NHS region

In 2022-23, 50.6% of people (29,393 in total) attended a first diagnostic test on or within 14 days of their onward referral (following an SSP colonoscopy fitness assessment). A total of 58,084 people attended for a first diagnostic test in the screening year.

Table 7: Time to attendance for first diagnostic test by NHS region, 2022-23.

NHS Region	Within Target %
East of England	47.7%
London	59.8%
Midlands	54.5%
North East & Yorkshire	53.6%
North West	46.9%
South East	47.9%
South West	42.7%
England	50.6%

There are no thresholds set for this standard. Of the 64 bowel cancer screening centres, 33 achieved more than 50% with the highest achieving 78.7% of participants attending their diagnostic test on or within 14 days. There were 31 centres below 50%, of which 2 were below 25%, the lowest achieving 19.8%.

8.2 Time to attendance for first diagnostic test by year

Figure 8: Time to attendance for first diagnostic test by year, England, screening year ending March 2008 to the year ending March 2023.

The line graph above (Figure 8) shows the proportion of people attending their diagnostic test on or within 14 days, over time. It should be noted that any delays in first offered diagnostic test appointments (such as those seen in BCSP-S07 during the introduction of FIT), will also affect this measure.

9. BCSP-S05: CTC usage within the FOBt screening programme

This section covers standard BCSP-S05.

A computed tomography colonography (‘CTC’) is a test that uses CT scans to examine the large bowel. This type of test is sometimes also called a ‘virtual colonoscopy’. It is important that people who require a diagnostic test receive a quality procedure. Whilst colonoscopy is the gold standard diagnostic test within the FOBt bowel cancer screening programme, a CTC may be performed for a small proportion of patients who have specific clinical reasons. It is important that the proportion of CTCs is monitored, to ensure CTCs are being performed appropriately within the FOBt bowel cancer screening programme.

The programme reports the proportion of CTCs performed, out of all the diagnostic tests carried out in the programme, in order to monitor the use of this type of diagnostic test.

Performance thresholds
Monitoring statistic only – SQAS to investigate screening centre outliers, as necessary.

9.1 Proportion of CTCs performed within the programme by NHS region

In 2022-23, 6.2% (4,960 of 80,441) of all diagnostic test procedures carried out in the year were CTCs. Regional variation in the proportional usage of CTCs can be observed across England, with London having the highest percentage usage (8.1%), and the North East and Yorkshire having the lowest percentage usage (4.9%).

Table 8: Proportion of CTCs performed within the programme by NHS region, 2022-23.

NHS Region	CTC %
East of England	6.3%
London	8.1%
Midlands	6.4%
North East & Yorkshire	4.9%
North West	5.3%
South East	6.0%
South West	7.1%
England	6.2%

There are no thresholds set for this standard. Of the 64 bowel cancer screening centres, five achieved more than 10% with the highest at 14.8%. 21 centres achieved 5% or less with the lowest at 1.6%.

9.2 Proportion of CTCs performed within the programme by year

Figure 9: Proportion of CTCs performed within the programme by year, England, screening year ending March 2017 to the year ending March 2023.

The use of CTC has increased over the years, as use of the test and access to facilities has improved. Detailed CTC data for bowel cancer screening (in its current format), started to be captured at the beginning of 2016. No programme data is available for this measure before this date.

10. BCSP-S11: Diagnostic test uptake

This section covers standard BCSP-S11.

It is important that people who receive an FOBt result of ‘further tests are needed’, go on to have a diagnostic test, where appropriate for them.

This standard is monitored by reporting the proportion of people who go on to have a diagnostic test (one or more within the episode), out of all those who received an FOBt result of ‘further tests are needed.

Performance thresholds
Acceptable level: greater than or equal to 81.0%.
Achievable level: greater than or equal to 90.0%.

10.1 Diagnostic test uptake by NHS region

In 2022-23, 76.8% (60,362 of 78,605) of people who received a test kit result of ‘further tests are needed’, went on to have a (one or more) diagnostic test (colonoscopy or CTC) within the bowel cancer screening programme. Whilst there is some variation, all regions are below the acceptable performance threshold.

Table 9: Diagnostic test uptake by NHS region, 2022-23.

NHS Region	Diagnostic Test Uptake %
East of England	75.7%
London	73.8%
Midlands	78.6%
North East & Yorkshire	74.9%
North West	74.4%
South East	78.9%
South West	80.4%
England	76.8%

Of the 64 bowel cancer screening centres, none were on or above the achievable threshold of 90%, 14 centres were between the acceptable and achievable thresholds (between 81% and 90%). 50 centres were below the acceptable threshold of 81%, with the lowest at 63.4%.

10.2 Diagnostic test uptake by year

Figure 10: Diagnostic test uptake by year, England, screening year ending March 2009 to the year ending March 2023.

The line graph above (Figure 10) shows the gradual decline in diagnostic test uptake over the years since the programme started, with a more abrupt drop observed when FIT kits were introduced into the screening programme. The possible reasons for this are examined by NHS England, including: reviewing changes over time to the make-up of the invited population (as the programme has matured), inequalities and the existing health conditions and medical history of people now participating in FIT. In 2022-23, 69.7% of those in the most deprived quintile of the index of multiple deprivation (IMD), who were referred for tests, did go on to have a diagnostic test, compared to 82.0% in the least deprived quintile. So, those who live in the most deprived areas are less likely to participate in further diagnostic testing, compared to those in the most prosperous areas.

It is important to note that a person can only be referred for a diagnostic test if they are assessed as fit (i.e., healthy enough) to have a procedure (colonoscopy or CTC). It is then their choice whether or not to take part in this portion of the screening pathway.

11. BCSP-S12: Proportion of index colonoscopies where at least one histologically confirmed adenoma detected (FOBt)

This section covers standard BCSP-S12.

Adenoma detection is an important quality measure for individual endoscopists working in the bowel cancer screening programme. This measure indicates the endoscopist’s ability to remove (resect) and retrieve ‘novel’ (not seen before) polyps, which are then histologically confirmed (in a laboratory) to be adenomas.

This standard is monitored by reporting the proportion of first (known as ‘index’) complete screening colonoscopies where at least one histologically confirmed adenoma was resected and retrieved, out of all the complete screening index colonoscopies performed.

Reviewing complete screening index colonoscopies provides a ‘level playing field’ for the reporting of this standard. If subsequent procedures were included, polyps could have already been removed, meaning there would be fewer to find, reducing the detection rate. Similarly, the subsequent procedure could be being performed as there is known pathology which requires removal, thereby artificially increasing the detection rate. This is particularly relevant when reviewing data at clinician level.

Performance thresholds
Acceptable level: greater than or equal to 40.0%.
Achievable level: greater than or equal to 50.0%.

11.1 Proportion of index colonoscopies where at least one histologically confirmed adenoma detected by NHS region

In 2022-23, the national adenoma detection rate was 61.5%, which was above the acceptable and the achievable performance thresholds, with all regions above the achievable target. At least one histologically confirmed adenoma was resected and retrieved at 32,094 out of a total of 52,199 complete screening index colonoscopies performed in the screening year.

Table 10: Proportion of index colonoscopies where at least one histologically confirmed adenoma detected by NHS region, 2022-23.

NHS Region	Adenoma Detection %
East of England	62.0%
London	62.7%
Midlands	60.4%
North East & Yorkshire	62.7%
North West	62.3%
South East	60.9%
South West	59.9%
England	61.5%

Of the 64 bowel cancer screening centres, all were on or above the achievable threshold of 50%, with the lowest highest achieving 68.9% and the lowest achieving 55.7% of screening index colonoscopies where at least one histologically confirmed adenoma was detected.

11.2 Proportion of index colonoscopies where at least one histologically confirmed adenoma detected by year

Figure 11: Proportion of index colonoscopies where at least one histologically confirmed adenoma detected by year, England, screening year ending March 2008 to the year ending March 2023.

The line graph above (Figure 11) shows the gradual increase in adenoma detection over the lifetime of the screening programme, followed by a more recent jump in the detection percentage during 2019-20, following the introduction of FIT. As FIT is known to be a more sensitive test, this percentage increase was expected, following the change in test kit type.

This measure is also monitored locally at endoscopist level, to assure individual clinician performance.

12. BCSP-S09: Polyp pathology turnaround time

This section covers standard BCSP-S09.

To reduce anxiety, it is important that any removed polyps are reported in a timely manner, so definitive polyp pathology results can be given to the person as soon as possible. This standard is monitored by reporting the proportion of polyps where the elapsed time between date received in the laboratory and date reported is on or within 7 days.

Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.

12.1 Polyp pathology turnaround time by NHS region

In 2022-23, 88.4% of all polyps (140,114 out of 158,417) received into the laboratory were reported on or within 7 calendar days, which is below the acceptable performance threshold.

Table 11: Polyp pathology turnaround time by NHS region, 2022-23.

NHS Region	Within Target %
East of England	91.8%
London	94.0%
Midlands	87.5%
North East & Yorkshire	86.5%
North West	85.3%
South East	89.0%
South West	87.8%
England	88.4%

Of the 64 bowel cancer screening centres, 20 centres were on or above the achievable threshold of 95%, 13 centres were between the acceptable and achievable thresholds (between 90% and 95%). 31 centres were below the acceptable threshold of 90%, with the lowest achieving 51.0% of their pathology turnaround times within target.

12.2 Polyp pathology turnaround time by year

Figure 12: Polyp pathology turnaround time by year, England, screening year ending March 2014 to the year ending March 2023.

The line graph above (Figure 12) shows national performance of this target over the last 10 years. The graph shows a drop in performance during the FIT implementation year, coinciding with the additional workload seen in pathology. The additional workload occurred not only because of the increase in test kit uptake and positivity (meaning more people attended for endoscopic tests where polyps were removed) but also the increase in pathology yield that the new FIT test brings. The FIT kits have a lower false positive rate than guaiac test kits (that is, the FIT kit refers fewer people for a diagnostic test who go on to have a ‘nothing abnormal detected’ outcome), meaning more polyps are found in those people attending for endoscopic tests. The graph shows some recovery in 2020-21, and but has since fallen for the last two years, coinciding with the increase in eligibility as a result of the age extension programme.

Pathology turnaround time data for bowel cancer screening started to be captured during 2013. No data is available for this measure before this date.

13. BCSP-S13: Caecal intubation rate

This section covers standard BCSP-S13.

Caecal intubation (reaching the caecum with the scope) is an important quality marker for individual endoscopists working in the bowel cancer screening programme.

Where possible it is important that people attending for colonoscopy have the whole of their bowel examined, in order to maximise the detection of cancers as well as other significant findings. Reaching the caecum should be documented with a photograph or a video.

Caecal intubation should not be strived for at the detriment of patient comfort or safety.

This standard is monitored by reporting the proportion of colonoscopies where caecal intubation was achieved with photographic or video evidence taken.

Performance thresholds
Acceptable level: greater than or equal to 92.0%.
Achievable level: greater than or equal to 97.0%.

13.1 Caecal intubation rate with photo / video evidence by NHS region

In 2022-23 the national caecal intubation rate within the screening programme was 95.7%, which was above the 92% acceptable threshold but below the achievable threshold. All regions were above the acceptable target, but below the achievable target. This was 66,561 out of a total of 69,542 colonoscopies performed within the screening year.

Table 12: Caecal intubation rate with photo / video evidence by NHS region, 2022-23.

NHS Region	Caecal Intubation % *
East of England	96.5%
London	95.7%
Midlands	95.6%
North East & Yorkshire	95.7%
North West	94.7%
South East	96.1%
South West	95.9%
England	95.7%

* with photo / video evidence taken

All of the 64 bowel cancer screening centres were on or above the acceptable threshold of 92%, seven of which were also above the 97% achievable threshold, with the lowest achieving 93.2%.

13.2 Caecal intubation rate with photo / video evidence by year

Figure 13: Caecal intubation rate with photo / video evidence by year, England, screening year ending March 2009 to the year ending March 2023.

The line graph above (Figure 13) shows a rapid increase in caecal intubation rates from the start of reporting to 2010-11, largely due to improvements in access to photography and video equipment. Lower performance of this standard prior to 2010-11 does not necessarily indicate a lower completion rate, but indicates that fewer endoscopy suites had access to photographic or video equipment to capture evidence of completion. In the early years, visualisation of anatomical landmarks was more often used as completion proof.

This measure is also monitored locally at endoscopist level, to assure individual clinician performance.

14. BCSP-S14: Scope withdrawal time

This section covers standard BCSP-S14.

Scope withdrawal time is an important quality measure for individual endoscopists working in the bowel cancer screening programme. The time taken to withdraw the scope (from caecum to extubation) for colonoscopies where no abnormalities were found (often written as a ‘normal’ result or ‘nothing abnormal detected’ – NAD), needs to be of sufficient duration to allow for a thorough inspection of the bowel. Tests with a ‘non-normal’ finding cannot be included in this measure, as polyp resections and biopsies are often taken on withdrawal, elongating the withdrawal time taken.

This standard is monitored by reporting the average (mean) time in minutes (whole minutes) taken to withdraw the scope (from caecum to extubation), for all complete colonoscopies where the procedure outcome was normal (no abnormalities found).

Performance thresholds
Acceptable level: greater than or equal to 6 minutes.
Achievable level: greater than or equal to 10 minutes.

14.1 Scope withdrawal time (in minutes) for all normal (NAD) colonoscopies by NHS region

In 2023-24 the mean withdrawal time in minutes for all normal (NAD) colonoscopies was 10.6 minutes, which was above the achievable standard of 10 minutes. All regions reached the acceptable performance threshold of 6 minutes, and all but one (London) met the achievable performance threshold of 10 minutes.

Table 13: Scope withdrawal time (in minutes) for all normal (NAD) colonoscopies by NHS region, 2022-23.

NHS Region	Mean scope withdrawal time (in mins) *
East of England	11.2
London	9.3
Midlands	10.5
North East & Yorkshire	10.7
North West	10.9
South East	10.3
South West	11.2
England	10.6

* for all normal (nothing abnormal detected) colonoscopies

Of the 64 bowel cancer screening centres, all were on or above the acceptable threshold of a mean scope withdrawal time of 6 minutes, and 44 were above the 10 minute threshold. The quickest was an average of around 7.8 minutes 48 seconds and the longest an average of 14.6 minutes.

14.2 Scope withdrawal time (in minutes) for all normal (NAD) colonoscopies by year

Figure 14: Mean scope withdrawal time (in minutes) for all normal (NAD) colonoscopies by year, England, screening year ending March 2008 to the year ending March 2023.

The line graph above (Figure 14) shows the national mean number of minutes taken to withdraw the scope for all programme performed colonoscopies where nothing abnormal was detected (i.e., the procedure had a ‘normal - NAD’ outcome). This measure is also monitored locally at endoscopist level, to assure individual clinician performance.

15. BCSP-S15: Polyp retrieval rate

This section covers standard BCSP-S15.

In order to maximise the programme’s detection of cancers as well as other significant findings, all resected polyps should be retrieved, so they can undergo pathological analysis.

Polyp retrieval is an important quality measure for individual endoscopists working in the bowel cancer screening programme. The retrieval of some resected polyps can be quite complex, especially when using gas (CO2 or O2 / air) for colonic insufflation. The proportion of polyps that are resected but not retrieved should be small.

This standard is monitored by reporting the proportion of polyps retrieved, out of those resected during an endoscopic procedure.

Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.

15.1 Polyp retrieval rate by NHS region

In 2022-23 the national polyp retrieval rate was 97.8%, with all regions above the 95% achievable performance threshold. This equates to 158,476 out of a total of 162,109 resected polyps during the screening year.

Table 14: Polyp retrieval rate by NHS region, 2022-23.

NHS Region	Polyp Retrieval %
East of England	98.1%
London	98.2%
Midlands	97.7%
North East & Yorkshire	97.3%
North West	97.1%
South East	98.4%
South West	97.8%
England	97.8%

Of the 64 bowel cancer screening centres, all of them were on or above the achievable threshold of 95%, with the lowest achieving 96.1% and the highest 99.5% of polyps retrieved during the endoscopic procedure.

15.2 Polyp retrieval rate by year

Figure 15: Polyp retrieval rate by year, England, screening year ending March 2006 to the year ending March 2023.

The line graph above (Figure 15) shows programme improvement in performance against this standard over the years, suggesting that endoscopists have become more adept and skilled at retrieving the polyps they resect during an endoscopic procedure. This measure is also monitored locally at endoscopist level to assure individual clinician performance.

16. BCSP-S10: Effective calls received by the BCSP helpline

This section covers standard BCSP-S10.

As initial bowel cancer screening is carried out using a home testing kit which is sent and returned via the post, the programme offers a telephone helpline for people to ask questions about the programme, including their suitability for screening, or for advice regarding test kit completion. It is important that callers are able to get through to a helpline operator (i.e., that the call is ‘effective’), as any barriers to accessing help may reduce participation and/or result in a loss of confidence in the programme.

The bowel cancer screening helpline is a single 0800 telephone number used across the whole of the NHS Bowel Cancer Screening Programme in England. The service is supplied to NHS England by BT. Calls are routed to the appropriate programme hub using the caller’s geographic location or by a selection made by the caller.

The proportion of ‘ineffective calls’ should be small. Ineffective calls are those which do not reach the programme hub’s host telephone system. These calls are classified by BT as calls where: ‘called number busy’, ‘equipment engaged tone’, ‘ring tone no reply’, ‘out of service’, ‘caller early release’, ‘unknown’, ‘blank’ or ‘other’.

16.1 Effective calls received by the telephone helpline by programme hub

In 2022-23, 98.2% (565,029 out of a total of 575,101) of calls made to the bowel cancer screening 0800 telephone helpline number within the screening year were ‘effective’.

Table 15: Effective calls received by the telephone helpline by programme hub, 2022-23.

Programme Hub	Effective Call %
Eastern	99.6%
London	98.9%
Midlands and North West	99.3%
North East	97.4%
Southern	96.4%
England	98.2%

16.2 Effective calls received by the telephone helpline by programme hub by year

Figure 16: Effective calls received by the telephone helpline by programme hub by year, April 2022 to March 2023.

The line graph above (Figure 16) shows each hub’s effective call % by month, for the reported screening year. Whilst discrete drops in the effective proportion of calls can be seen for individual hubs during specific months, the overall proportion of effective calls remained high.