Guidance

Bowel cancer screening programme standards: reporting from 1 April 2025

Updated 15 April 2025

Applies to England

1. BCSP-S01: FOBt coverage

1.1 Description

The proportion of eligible people who were screened (adequately participated in FOBt bowel cancer screening) in the 30-month (2.5-year) reporting period.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

1.2 Rationale

To maximise timely participation of the eligible population (every 2 years).

The eligible population makes an informed choice about whether or not to participate in FOBt bowel cancer screening.

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.

The screening programme uses a faecal occult blood test (FOBt) to look for the presence of blood in faeces (poo) which would not be noticeable by eye. The type of test currently employed by the programme is a faecal immunochemical test, called a ‘FIT kit’ for short. A FIT kit is a type of faecal occult blood test.

The programme looks for blood because polyps and bowel cancers bleed. Finding blood does not diagnose bowel cancer, but means a further diagnostic test, such as a colonoscopy, is usually advised. More information on the bowel cancer screening programme can be found on GOV.UK.

1.3 Definition

Numerator: number of people screened (adequately participated in FOBt bowel cancer screening), in the 30-month (2.5-year) reporting period.

Denominator (cohort): number of people eligible for FOBt bowel cancer screening, on the last day of the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

1.4 Performance thresholds

• Acceptable level (60-74): ≥ 62.0%
• Achievable level (60-74): ≥76.0%
• Acceptable and achievable level (50-59): to be set

1.5 Caveats

If screening services do not offer timely screening (for example there is a significant delay in the offer of screening), this will adversely impact the coverage statistic.

There are a number of people resident in England who are not registered with a GP. These people are not called for screening. Screening centres have a responsibility to maximise access to screening for people in their population. They should support GP registration and/or employ programme-approved inclusion mechanisms, where appropriate.

There are also a number of people who are registered with a GP (and where the GP is included in the English screening programme) but who have an: unknown, no fixed abode or overseas address. These people are classified as eligible for screening and will be included in the cohort/denominator for the statistic. However, these people are likely to have their letters and/or test kits returned as undeliverable.

In order to be counted in this statistic, a person must on the last day of the reporting period:

• be registered with a GP practice
• not have a deduction reason (for example due to emigration or a date of death notification)
• not be ceased from the screening programme
• have a screening status of ‘in screening’, and
• be within the default or extended programme age range

It should also be noted that for the coverage measure, people are reported by the location they were resident in or the GP they were registered with at the time the report is run, not where they were resident or registered at the time of their eligibility or participation.

1.6 Data collection and reporting

Data source: Open Exeter: Cancer Screening Programme National Statistics (CSPNS).

Responsible for data quality and completeness: local screening provider, NHS England, BCSS, CSPNS.

Responsible for submission: not applicable as extracted from CSPNS (Open Exeter), by national BCSP.

Reported by: not applicable as extracted from CSPNS (Open Exeter), by national BCSP.

Published by:

• Public Health Outcomes Framework (PHOF): Region, upper tier authority (UTA), lower tier authority (LTA)
• GP Practice Profiles: Area Team, ICBs, GP practice (these are the reporting levels, not who publishes the data)

1.7 Reporting period

Reporting period: reported monthly for a 30-month (2.5-year) period, 6 months in arrears (reported in the 7th month).

Reporting frequency: quarterly.

1.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: 8 August 2018

2. BCSP-S02: FOBt uptake

2.1 Description

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

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

2.2 Rationale

To maximise uptake in the invited population.

2.3 Definition

Numerator: number of people screened (adequately participated in FOBt bowel cancer screening), within the invited screening episode, at the time of reporting.

Denominator (cohort): number of people invited for FOBt bowel cancer screening, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

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 initiative may increase participation, this participation may not count towards the calculation of uptake.

National uptake is reported 6-months in arrears (from the invitation date) to allow people adequate time to participate. However, services can review their provisional data more frequently and with shorter initial arrears periods.

2.4 Cohort reported by

Date of invite.

2.5 Performance thresholds

• Acceptable level (60-74): ≥ 62.0%
• Achievable level (60-74): ≥ 73.0%
• Acceptable and achievable level (50-59): to be set

2.6 Caveats

There is also another measure of uptake referred to as ‘GP practice profile uptake’. This statistic uses fundamentally the same definition of uptake described here (that is, reporting the proportion of invited people who were screened).

However, GP practice profile uptake is reported for a 1-year (12-month) cohort of invitees. Whilst GP practice profile data is released monthly, the cohort is always defined as the ‘number of people invited for screening in the previous 12 months’, meaning these data cannot be disaggregated to a smaller grouping, such as a quarter or month.

The GP practice profile uptake statistic (the rolling 1-year block of data) can be useful when looking at longitudinal uptake changes over time (as it ‘smooths-out’ any variation in uptake over the 12-month reporting period). Whereas the uptake calculation used in these programme standards (sometimes referred to as ‘operational uptake’) can give a more immediate picture of any changes, showing the variation in uptake for each month/cohort of data.

Operational uptake can also be more easily broken-out by subject attributes, such as gender, age or location groupings, or combined with external data sources such as ONS or census data, to provide uptake reporting by measures such as deprivation. This is why operational uptake is the measure used within these standards, however ‘GP practice profile uptake’ and its utility is acknowledged here.

2.7 Data collection and dissemination

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: National, programme hub, screening centre, ICB, GP practice (this is the reporting level, not who publishes the data).

2.8 Reporting

Reporting period: reported (published) quarterly, 6-months in arrears.

(Note: monthly data is often aggregated to report uptake for a quarter)

Reporting frequency: monthly, quarterly.

2.9 Review dates

• Date standard introduced: April 2006
• Date standard last updated: July 2019

3. BCSP-S03: FOBt uptake – inequalities standard (new)

3.1 Description

The proportion of invited people living in the most deprived areas of England (defined as decile 1 or 2, on the English indices of deprivation - IMD), who were screened (adequately participated in FOBt bowel cancer screening), within the invited screening episode, at the time of reporting.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

3.2 Rationale

To maximise uptake in the invited population.

People living in the most deprived areas of England are less likely to attend for screening, but have a higher mortality rate from bowel cancer. It is important for providers to engage with people living in more deprived areas to make sure they can make a personal informed choice.

This standard only focuses on one aspect of inequalities in access to bowel cancer screening. It is acknowledged that there are many sources of inequalities, and providers should work with commissioners to identify and reduce drivers of inequalities relevant to their local area. NHS bowel cancer screening: identifying and reducing inequalities has further information.

3.3 Definition

Numerator: number of people screened (adequately participated in FOBt bowel cancer screening) within the invited screening episode, at the time of reporting.

Denominator (cohort): number of people invited for FOBt bowel cancer screening, who, at the time of their invite lived in an area classed as ‘most deprived’ (decile 1 or 2) as per the English indices of multiple deprivation, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The indices of multiple deprivation (IMD) is the official measure of relative deprivation in England and is typically published every 4-5 years.

IMD is based on 39 separate indicators including: income, employment, education, skills and training, health and disability, crime, barriers to housing and services, and living environment deprivation.

These indicators are combined and weighted to create an overall measure of deprivation for people living in each Lower-layer Super Output Area (LSOA) in England.

Uptake measures do not include people who: - late-respond - over-age-self-refer - opt-back-in to the programme

This means that whilst an initiative may increase participation, this participation may not count towards the calculation of uptake.

National uptake is reported 6-months in arrears (from the invitation date) to allow people adequate time to participate. However, services can review their provisional data more frequently and with shorter initial arrears periods.

3.4 Cohort reported by

Date of invite.

3.5 Performance thresholds

• Acceptable level (60-74): ≥ 62.0%
• Achievable level (60-74): ≥ 73.0%
• Acceptable and achievable level (50-59): to be set

3.6 Caveats

None.

3.7 Data collection and dissemination

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: National, programme hub, screening centre, ICB, GP practice (this is the reporting level, not who publishes the data).

3.8 Reporting

Reporting period: reported (published) quarterly, 6-months in arrears.

(Note: monthly data is often aggregated to report uptake for a quarter)

Reporting frequency: monthly, quarterly.

3.9 Review dates

Date standard introduced: April 2025.

4. BCSP-S04: test: FOBt kit turnaround time

4.1 Description

The proportion of participant-returned FOBt kits that have been processed and read (‘resulted’) on or within 3 calendar days of being logged as returned to the bowel cancer screening programme hub.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

4.2 Rationale

Programme hubs should provide a timely result for each returned FOBt kit, so people can receive their FOBt screening result as soon as possible.

4.3 Definition

Numerator: number of participant-returned FOBt kits that have a result (are ‘resulted’) on or within 3 calendar days of being logged.

Denominator (cohort): number of participant-returned FOBt kits logged by the programme hub, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The day of logging is ‘day 0’ for this measure.

4.4 Performance thresholds

• Acceptable level (60-74): ≥ 98.0%
• Achievable level (60-74): ≥ 99%
• Acceptable and achievable level (50-59): to be set

4.5 Caveats

If a test kit is returned, but there is a delay before it is logged, this delay will not be captured by this measure.

FOBt results include: ‘spoilt’ and ‘technical fail’ results, as well as the more expected results of: ‘no further tests are needed’ or ‘further tests are needed’.

4.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: bowel cancer screening programme hub, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening programme hub (this is the reporting level, not who publishes the data).

4.7 Reporting period

Reporting period: reported for a 1 month period, 1 month in arrears.

Reporting frequency: quarterly and annually.

Cohort reported by: date test kit logged.

4.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

5. BCSP-S05: diagnosis/intervention: FOBt computed tomography colonography (CTC) usage

5.1 Description

The proportion of diagnostic tests performed within the FOBt cohort of the bowel cancer screening programme, where the test type was a computed tomography colonography (CTC), rather than an endoscopic test, such as a colonoscopy.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

5.2 Rationale

It is important that people who require a diagnostic test receive a quality procedure. Whilst colonoscopy is the gold standard diagnostic test within the 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.

5.3 Definition

Numerator: number of CTCs performed.

Denominator (cohort): total number of diagnostic tests performed (regardless of test type), within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

5.4 Performance thresholds

Monitoring statistic only – Screening Quality Assurance Service (SQAS) to investigate screening centre outliers, as necessary.

5.5 Caveats

None.

5.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

5.7 Reporting period

Reporting period: reported for a 1-month period, 1 month in arrears.

Reporting frequency: annually (at screening centre level).

Cohort reported by: date diagnostic test performed.

5.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

6. BCSP-S06: referral: FOBt time to first offered specialist screening practitioner fitness assessment appointment

6.1 Description

The proportion of people whose first offered specialist screening practitioner (SSP) fitness assessment appointment date was on or within 14 days of their referral date.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

A person can choose if they attend their first offered (or indeed any offered) SSP fitness assessment appointment. If the person attends the SSP appointment and is assessed as fit, it is again the person’s choice whether to proceed with diagnostic tests.

If a person is offered an initial appointment, but this appointment is then cancelled for a ‘screening centre reason’, for example: staff off sick, room availability, or the episode is interrupted, closed but then reopened, then the ‘clock keeps ticking’, and the number of days between the referral date and the newly offered SSP appointment is used (even if this new date is earlier). However, if the first offered SSP appointment is cancelled for a ‘patient level reason’, such as patient choice, the first offered date stands.

6.2 Rationale

To reduce anxiety, people who are referred (following an FOBt result of ‘further tests are needed’) should be offered a first SSP fitness assessment appointment in a timely manner.

6.3 Definition

Numerator: number of people whose first offered SSP fitness assessment appointment date was on or within 14 days of their referral date.

Denominator (cohort): number of people referred for a SSP fitness assessment, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

This measure only includes people who have had an FOBt result of ‘further tests are needed’ (within the episode) and have gone on to be referred for an SSP fitness assessment.

The day of referral is ‘day 0’ for this measure.

The offered appointment should be a reasonable offer. You can read Supporting Information: Reasonable Offer for more information.

6.4 Performance thresholds

• Acceptable level (60-74): ≥ 95.0%
• Achievable level (60-74): ≥99.0%
• Acceptable and achievable level (50-59): to be set
• Maximum number of days to first offered appointment ≤ 14 days

6.5 Caveats

None.

6.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

6.7 Reporting

Reporting period: reported for a 1 month period, 1 month in arrears.

Reporting frequency: quarterly.

Cohort reported by: date of referral (following an FOBt result of ‘further tests are needed’).

6.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

7. BCSP-S07: referral: FOBt time to first offered diagnostic test appointment

7.1 Description

The proportion of people whose first offered diagnostic test appointment date (colonoscopy or CTC) was on or within 14 days of their referral for diagnostic testing.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

7.2 Rationale

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.

7.3 Definition

Numerator: number of people whose first offered diagnostic test appointment date was on or within 14 days of their diagnostic test referral date.

Denominator (cohort): number of people referred for diagnostic testing, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

This measure only includes people who have had an FOBt result of ‘further tests are needed’ (within the episode) and have gone on to be referred for diagnostic testing - following an SSP fitness assessment.

The day of referral is ‘day 0’ for this measure.

A ‘first diagnostic test’ can be a colonoscopy or a CTC.

The offered appointment should enable sufficient time for bowel preparation and, if required, any medication changes.  

7.4 Performance thresholds

• Acceptable level (60-74): ≥ 90.0%
• Achievable level (60-74): ≥96.0%
• Acceptable and achievable level (50-59): to be set

7.5 Caveats

None.

7.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

7.7 Reporting

Reporting period: reported for a 1 month period, 1 month in arrears.

Reporting frequency: quarterly.

Cohort reported by: date of referral to diagnostic testing (that is, the date of the last attended SSP fitness assessment appointment within the episode).

7.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

8. BCSP-S08: FOBt time through pathway standard (new)

8.1 Description

The proportion of people referred following an FOBt result of ‘further tests are needed’, who receive their definitive diagnosis on or within 28 days of their referral date.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

Notes:

• A person who receives a test kit outcome of ‘further tests are needed’, is always referred for onward assessment (unless they have been marked as ‘deceased’ at the point the test kit is received into the laboratory).
• A referred person can choose if they attend their first, or indeed any offered screening assessments (following their FOBt test kit result referral). This means this measure is impacted by patient choice.

8.2 Rationale

To reduce anxiety, people who are referred (following an FOBt result of ‘further tests are needed’), should receive their definitive diagnosis – that is whether or not they have cancer, in a timely manner.

8.3 Definition

Numerator: number of people who receive their definitive diagnosis on or within 28 days of their referral date.

Denominator (cohort): number of people referred following an FOBt result of ‘further tests are needed’, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The day of referral is ‘day 0’ for this measure.

8.4 Performance thresholds

• Acceptable level (60-74): to be set
• Achievable level (60-74): to be set
• Acceptable and achievable level (50-59): to be set

8.5 Caveats

This report presents cohort data as defined by the referral date. The data presented are ‘prospective’, meaning that patients appear in the report as soon as they have been ‘referred’. This allows screening centres to ‘track’ patients through their pathway, allowing the centre to support a patient’s progression through the screening programme.

This is different to the 28-day faster diagnosis standard (FDS) reporting, which is reported at the point the pathway ends (end date). The 28-day FDS pathway may also exclude some people based on non-attended appointments. These exclusions are not made in this screening programme pathway report.

8.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

8.7 Reporting

Reporting period: reported for a 1-month period, 3 month in arrears Reporting frequency: quarterly (at screening centre level).

Cohort reported by: date of referral (following an FOBt result of ‘further tests are needed’).

8.8 Review dates

Date standard introduced: April 2025.

9. BCSP-S09: referral: pathology sample turnaround time

9.1 Description

The proportion of pathology samples where the elapsed time between ‘date received’ in the laboratory and ‘date reported’, falls on or within 7 days, out of all the samples received by the pathology laboratory (following endoscopic resection and retrieval).

This standard is reported for the NHS Bowel Cancer Screening Programme as a whole.

9.2 Rationale

To reduce anxiety, it is important that pathology samples received by the laboratory are reported in a timely manner, so pathology results can be given as soon as possible.

9.3 Definition

Numerator: number of pathology samples reported on or within 7 days of receipt.

Denominator (cohort): the number of pathology samples received by the pathology laboratory (following endoscopic resection and retrieval), within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The day of receipt is ‘day 0’ for this measure.

9.4 Performance thresholds

• Acceptable level (60-74): ≥ 90.0%
• Achievable level (60-74): ≥ 95.0%
• Acceptable and achievable level (50-59): to be set

9.5 Caveats

• Only samples resected at an endoscopic procedure are included in this standard, surgical resection specimens are not included.
• There may be a very small number of samples that are received by the pathology laboratory but then lost, for example, due to sample pot misplacement. Lost pathology samples are reported separately.
• Polyps which are optically diagnosed and then discarded (using the Programme approved Optical Diagnosis: Resect & Discard strategy), are excluded from this standard.

This standard now includes all NHS Bowel Cancer Screening Programme pathology samples received by the pathology laboratory, following endoscopic resection and retrieval. This includes samples from:

• the ‘FOBt Programme’, ‘Lynch Syndrome colonoscopy surveillance’ and ‘Bowel scope’). Previously only FOBt programme data was reported for this standard. Endoscopically taken biopsy samples are now also included in this measure. Previously only polypectomies were included.
• the measure now also includes all endoscopic samples where a cancer was detected.  Previously these samples were reported separately, and combined with the polyp measure, as required.

9.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

9.7 Reporting

Reporting period: reported for a 1-month period, 1 month in arrears.

Reporting frequency: quarterly.

Cohort reported by: date of endoscopy where the sample was resected and retrieved.

9.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

10. BCSP-S10: population: the proportion of answered helpline calls

10.1 Description

The proportion of bowel cancer screening helpline calls that were answered (including effective queue-buster calls), out of all the calls received by each of the programme hub’s telephone systems, during helpline operating hours.

The bowel cancer screening helpline is a single 0800 telephone number used across the whole of the English bowel cancer screening programme. The service is supplied to NHS England by BT (British Telecom). Calls are routed to the appropriate programme hub using the caller’s geographic location or by a selection made by the caller.

This standard is reported for the NHS Bowel Cancer Screening Programme as a whole.

10.2 Rationale

The bowel cancer screening helpline is a frontline service for the public to ask questions about the screening programme. It is important that callers are able to get through to a helpline operator, as any barriers to accessing help may reduce participation and/or result in a loss of confidence in the programme.

10.3 Definition

Numerator: number of answered helpline calls.

Denominator (cohort): number of helpline calls received (by each programme hub’s telephone system, during helpline operating hours) within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

‘Answered calls’ are defined as: live calls that are connected to a helpline operative at the time the call is placed. Hub responses to messages left on answerphones are not included. Each call received (including those from repeat callers) is counted separately.

Queue-buster calls are also included in the definition of ‘answered calls’. These are calls where a caller has chosen to receive a call back rather than waiting in the call queue. The queue-buster system holds the callers place in the queue and calls them back in their call waiting order. If the queue-buster call-back is not answered then that call is not counted as an ‘answered call’.

BT data is also reviewed on a quarterly basis, to ensure that the proportion of ‘ineffective calls’ is small. Increased proportions of ineffective calls are investigated with the relevant programme hub.

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 - other

10.4 Performance thresholds

• Acceptable level (60-74): ≥ 85%
• Achievable level (60-74): ≥ 94%
• Acceptable and achievable level (50-59): to be set

10.5 Caveats

Faults within the wider telephone network which prevent the connection of a call to a hub’s helpline system will not affect performance against this standard (as these calls will not have reached the hub’s call handling systems). These cases would be identified separately by the BT process described above.

Where there is a network fault which prevents calls being connected to a programme hub, helpline calls can be temporarily re-routed to the other programme hubs, to ensure calls from the public can still be answered.

Not all hubs have queue buster systems in place, however where these systems are in place it is not always possible to exclude these calls from the reports, so queue buster calls should be included in reporting.

10.6 Data collection and reporting

Data source: programme hub.

Responsible for data quality and completeness: programme hub.

Responsible for submission: programme hub.

Reported by: programme hub / Screening Quality Assurance team.

Published by: programme hub (this is the reporting level, not who publishes the data).

10.7 Reporting period

Annually (1 month in arrears).

10.8 Review dates

• Date standard introduced: August 2018
• Date standard last updated: August 2018

11. BCSP-S11: diagnosis/intervention: FOBt diagnostic test uptake

11.1 Description

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’.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

11.2 Rationale

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.

11.3 Definition

Numerator: number of people who go on to have a diagnostic test (one or more within the episode), at time of reporting.

Denominator (cohort): number of people who received an FOBt result of ‘further tests are needed’, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

A ‘diagnostic test’ can be endoscopic or radiological.

11.4 Performance thresholds

• Acceptable level (60-74): ≥ 81.0%
• Achievable level (60-74): ≥ 90.0%
• Acceptable and achievable level (50-59): to be set

11.5 Caveats

• A person can choose if they attend their first (or indeed any) offered SSP fitness assessment appointment. If the person attends the SSP appointment and is assessed as fit, it is again the person’s choice whether to proceed with diagnostic tests.
• The cohort (denominator) for this statistic includes everyone who received an FOBt result of, ‘further tests are needed’, including those who did not attend SSP assessment, as well as those who did attend SSP assessment but were then assessed as not fit for onward diagnostic testing, or chose not to proceed to diagnostic test.

11.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

11.7 Reporting

Reporting period: reported for a 1-month period, 6 months in arrears.

Reporting frequency: quarterly (at screening centre level).

Cohort reported by: date test kit was read (for test kits with a result of ‘further tests are needed’) Attendance at diagnostic testing after the cohort is first reported, will be included in future reports.

11.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

12. BCSP-S12: intervention/treatment: FOBt serrated polyp and adenoma detection

12.1 Description

The proportion of first (known as ‘index’) complete screening colonoscopies where at least one serrated polyp or adenoma was detected and resected, out of all the complete screening index colonoscopies performed.

This standard is reported for the FOBt cohort (only) within the NHS Bowel Cancer Screening Programme.

12.2 Rationale

To achieve the intended reduction in bowel cancer mortality, it is essential that serrated polyps and adenomas (which may develop into cancer over time) are removed. Serrated polyp and adenoma detection is an important quality measure for individual endoscopists working in the bowel cancer screening programme.

This measure has been adjusted to:

• include serrated polyps. Serrated polyps are now included as evidence has shown that serrated polyps (as well as adenomas) have an increased likelihood of turning into cancer overtime.
• to account for the introduction of ‘Optical Diagnosis’ within the programme.

12.3 Definition

Numerator: number of complete screening index colonoscopies performed, where at least one serrated polyp or adenoma was detected and resected.

Denominator (cohort): number of complete screening index colonoscopies performed, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

12.4 Performance thresholds

• Acceptable level (60-74): ≥ 60%
• Achievable level (60-74): ≥ 73%
• Acceptable and achievable level (50-59): to be set

12.5 Caveats and further definitions

Polyp definitions

An adenoma:

• Histological diagnosis: any BCSS recorded polyp with a Polyp Histology Type = ‘Adenoma’ or a Polyp Sub Type = ‘Tubular adenoma’, ‘Tubulovillous adenoma’, ‘Villous adenoma’
• Optical diagnosis: any BCSS recorded polyp with an optical diagnosis of ‘Adenoma’ and where Polyp therapy = ‘Resect & Discard’

A serrated polyp*

• Histological diagnosis: any BCSS recorded polyp with a Polyp Histology Type = ‘Serrated lesion’ or Polyp Sub Type = ‘Hyperplastic’, ‘Mixed polyp’, ‘Sessile serrated lesion’, ‘Sessile serrated lesion with dysplasia’, ‘Traditional serrated adenoma’
• Optical diagnosis: any BCSS recorded polyp with an optical diagnosis of ‘Serrated (Hyperplastic/SSL)’ and where Polyp therapy = ‘Resect & Discard’

*excluding diminutive (≤5mm) rectal serrated polyps. Guidance states that diminutive rectal serrated polyps should not be removed, therefore, if this polyp type is resected, it is not included in the calculation of this standard.

Where the phrase ‘detected and resected’ is used in this standard, this means:

• For polyps which received an optical diagnosis only: they must meet the above adenoma or serrated polyp definitions and have been resected and discarded at a complete screening index colonoscopy, in order for them to be counted in the calculation.
• For polyps which were resected at a complete screening index colonoscopy with the intention of sending them to pathology for histological confirmation, these polyps must have received a histologically confirmed diagnosis of an adenoma or serrated polyp (as given above), regardless of any optical diagnosis. If the polyp was resected with the intention of sending it to pathology, but was either not retrieved or lost (post retrieval), the polyp is not included in the calculation of this standard.

The cohort (denominator) for this standard includes only the first (index) colonoscopy within a person’s screening episode (surveillance colonoscopies are not included), and only where this index procedure is classified as ‘complete’.

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 less to find, reducing the detection rate for that procedure or clinician. Similarly, the subsequent procedure could be being performed as there is known pathology which requires removal, thereby artificially increasing the detection rate.

A ‘complete’ colonoscopy is defined as reaching the BCSS reported location of: ‘caecum’, ‘ileum’, ‘appendix’ or ‘anastomosis’. Photo or video evidence is not required as proof of ‘completion’ for this standard.

To ensure accurate reporting, this standard is only calculated once the episode of care is closed.

In addition to the serrated polyp and adenoma detection standard, services can see supplementary data lines, including:

• the total count of serrated polyps and adenomas detected and resected - this total count is also expressed per 100 procedures (screening index colonoscopy procedures), to facilitate comparisons
• a trimmed count of serrated polyps and adenomas detected and resected - this trimmed count is again expressed per 100 procedures (complete screening index colonoscopy procedures).

Providing a trimmed count limits any skewness which may be present in the data. Skewness can occur where, for example, many serrated polyps and/or adenomas are detected and resected during a single or small number of procedures. This is particularly relevant when reviewing data at clinician level.

12.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre, (this is the reporting level, not who publishes the data).

This measure is also monitored and reviewed at clinician level.

12.7 Reporting

Reporting period: reported for a 1-month period, 1 month in arrears.

Reporting frequency: quarterly (at screening centre level).

Cohort reported by: date of colonoscopy.

12.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

13. BCSP-S13: intervention/treatment: caecal intubation

13.1 Description

The proportion of colonoscopies where caecal intubation was achieved with photographic or video evidence taken, out of all the colonoscopies performed.

This standard is reported for the NHS Bowel Cancer Screening Programme as a whole.

13.2 Rationale

It is important that, where possible, 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 (reaching the caecum with the scope) is an important quality marker for individual endoscopists working in the bowel cancer screening programme. It presents the proportion of procedures performed where the entire bowel has been visualised.

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

13.3 Definition

Numerator: number of colonoscopies undertaken where caecal intubation was achieved with photo/video evidence.

Denominator (cohort): number of colonoscopies undertaken, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Caecal intubation is defined as reaching: the BCSS reported location of: ‘caecum’, ‘ileum’, ‘appendix’ or ‘anastomosis’, (note: ‘anastomosis’ in this context means ileo-colonic anastomosis).

Photographic or video proof of caecal intubation should always be taken (where equipment is available).

13.4 Performance thresholds

• Acceptable level (60-74): ≥ 92.0%
• Achievable level (60-74): ≥ 97.0%
• Acceptable and achievable level (50-59): to be set

13.5 Caveats

None.

13.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

This measure is also monitored and reviewed at clinician level.

13.7 Reporting

Reporting period: reported for a 1-month period, 1 month in arrears.

Reporting frequency: quarterly (at screening centre level).

Cohort reported by: date of colonoscopy.

13.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

14. BCSP-S14: intervention/treatment: scope withdrawal time

14.1 Description

The average (mean) time in minutes (whole minutes) taken to withdraw the scope, for all complete colonoscopies where no therapy was performed.

This standard is reported for the NHS Bowel Cancer Screening Programme as a whole.

14.2 Rationale

It is important that people attending for colonoscopy have their bowel examined as thoroughly as possible, to maximise the programme’s detection of cancers as well as other significant findings.

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 for colonoscopies where no therapy was performed, needs to be of sufficient duration to allow for a thorough inspection of the bowel. Tests where therapy was performed cannot be included in this measure, as therapies, including polyp resections and biopsies are often performed on withdrawal, elongating the withdrawal time taken.

14.3 Definition

Numerator: the total scope withdrawal time in minutes.

Denominator (cohort): number of complete colonoscopies where no therapy was performed, within the reporting period.

We calculate this measure by dividing numerator by denominator to give the average (mean) time in minutes (whole minutes) taken to withdraw the scope, for all complete colonoscopies where no therapy was performed.

14.4 Performance thresholds

• Acceptable level (60-74): ≥ 6 minutes
• Achievable level (60-74): ≥ 10 minutes
• Acceptable and achievable level (50-59): to be set

14.5 Caveats

• A complete colonoscopy is defined as reaching the BCSS reported location of: ‘caecum’, ‘ileum’, ‘appendix’ or ‘anastomosis’ (‘anastomosis’ in this context means ileo-colonic anastomosis).
• Withdrawal time is calculated from caecum, ileum, appendix or anastomosis to extubation.
• For the purposes of this report, ‘therapy’ is defined as the selection of any value (1 or more) from the therapy modality field in BCSS (under either the ‘polyp’ or ‘cancer’ information sections). ‘Therapy’ in this context also includes biopsies.

14.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

This measure is also monitored and reviewed at clinician level

14.7 Reporting

Reporting period: reported for a 1-month period, 1 month in arrears.

Reporting frequency: quarterly (at screening centre level).

Cohort reported by: date of colonoscopy.

14.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018

15. BCSP-S15: intervention/treatment: polyp retrieval

15.1 Description

The proportion of polyps retrieved, out of all those resected during an endoscopic procedure, where the intention was to retrieve the polyp.

This standard is reported for the NHS Bowel Cancer Screening Programme as a whole.

15.2 Rationale

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

Polyp retrieval is an important quality measure for individual endoscopists working in the NHS Bowel Cancer Screening Programme. The proportion of polyps which are not retrieved, where the intension was to retrieve the polyp, should be small.

15.3 Definition

Numerator: number of polyps retrieved.

Denominator (cohort): number of endoscopically resected polyps intended for retrieval, within the reporting period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

15.4 Performance thresholds

• Acceptable level (60-74): ≥ 95.0%
• Achievable level (60-74): ≥ 98.0%
• Acceptable and achievable level (50-59): to be set

15.5 Caveats

• Polyps which are optically diagnosed and then intentionally discarded are not included in this measure.
• ‘Intentionally discarded’ is indicated by a mandatory ‘retrieved’ field within BCSS.

15.6 Data collection and reporting

Data source: BCSS.

Responsible for data quality and completeness: local screening provider, BCSS.

Responsible for submission: not applicable as extracted nationally from BCSS.

Reported by: not applicable as extracted nationally from BCSS.

Published by: bowel cancer screening centre (this is the reporting level, not who publishes the data).

This measure is also monitored and reviewed at clinician level.

15.7 Reporting

Reporting period: reported for a 1-month period, 1 month in arrears.

Reporting frequency: quarterly (at screening centre level) Cohort reported by: date of colonoscopy.

15.8 Review dates

• Date standard introduced: April 2006
• Date standard last updated: August 2018