To ask the Minister of Health for his assessment of bowel cancer (i) prevalence; (ii) survival rates; and (iii) treatment waiting times, with reference to how these compare to other parts of the UK and the Republic of Ireland.

Prevalence

Northern Ireland Cancer Registry prevalence data suggests that at the end of 2019 there were approximately 8,861 colorectal cancer survivors living in Northern Ireland. (Colorectal Fact Sheet, Northern Ireland Cancer Registry-Factsheet colorectal.pdf (ncri.ie))

Survival

Most recent data from the NI Cancer Registry data suggests that 81.1% of people diagnosed with colorectal cancer in NI survive for one year and 61.5% survive for 5 years (based on patients diagnosed 2010-2014). Office for National Statistics data for patients diagnosed in England 2013-17 suggests one and five year survival of approximately 80% and 60% respectively. One year survival data is not available for the Republic of Ireland but the 5 year survival is comparable at 62.2%.

(The 31 day standard aims to ensure that patients wait no longer than 31 days between the decision to treat and commencement of first definitive treatment. The 62 day standard aims to ensure that patients wait no longer than 62 days from receipt of referral to the commencement of first definitive treatment).

It is acknowledged that performance against cancer waiting times in Northern Ireland is poor. Performance on the 31 day standard for colorectal cancer consistently sits at around 95% against a target of 98%. In 2021/22, 31 day performance was 95%; the equivalent figure in England was 93%. Performance against the 62 day standard has been consistently low ranging from 47% in 2018/19 to just 18% in 2020/21 (the equivalent figure for England for 2020/21 was 50%), Essentially the 31day standard reflects the treatment pathway, and performance, whilst still below the stated target of 98%, is consistently high. The fact that we are significantly underperforming on the 62 day pathway therefore reflects challenges, not within the treatment pathway, but within the diagnostic pathway.

Within colorectal cancer pathway the main diagnostic tools are colonoscopy and CT scans. COVID impact aside, Northern Ireland has had significant demand capacity gap within scopes for some years which until recently Trusts have attempted to manage year to year using non-recurrent funding. I have recently announced recurrent funding to support 20 additional regional scopes sessions at LVH and 10 additional sessions at Omagh. It is hoped that some of these sessions will commence by October. When fully implemented this investment will give capacity for 9,000 additional scopes per year. It is anticipated that this will have a significant impact on regional waiting time for scopes.

In addition to this the service is taking forward a range of other measures to help address back logs.

Theatre Utilisation for endoscopy lists – At a regional level we are currently delivering 85% run time against a 90% target. Improvement work is underway to look at how we increase efficiency to allow more capacity within current resources.

Independent Sector insourcing – Belfast and South Eastern Trusts have established insourcing arrangements that utilise their endoscopy suites at weekends. Northern and Western are due to commence this in Quarter 3 of this year, with the assumption at present that this will allow for an additional 2,100 scopes before the end of March.

Waiting List Initiatives In House – The three Trusts not currently insourcing are providing their own WLI sessions at weekends. In Quarter 2, this will give approximately another 850 procedures for those Trusts.

Direct sends to IS – Northern, Southern and Western Trusts are all currently sending patient to a local independent sector provider to provide additional capacity. Cumulatively, this will provide in the region of an additional 2,000 scopes before the end of March. These patients are a mix of priorities, but any capacity we can deliver for other urgent patients give Trusts the flexibility to schedule more red flag scopes in house.

In addition to the work on scopes, we have supported 15 additional CT sessions per week across the region in 2021/22 and this will continue in year.

In addition to the above measures, Northern Ireland has taken forward or is progressing a number of service developments aimed at improving colorectal cancer survival.

Northern Ireland has been at the forefront of use of quantitative Faecal Immunohistochemistry testing (qFIT) as a way of identifying patients at a high risk of colorectal cancer. This simple poo test was first introduced within the hospital setting in May 2020 in response to COVID to enable us to prioritise precious scopes capacity, which was significantly reduced throughout COVID. Since then the Northern Ireland Cancer Network (NICaN) has revised its referral guidance for suspect colorectal cancer to include the use of qFIT testing which is now readily available in primary care. This change in practice enabled Northern Ireland to increase its colorectal cancer diagnoses during COVID despite the impact of the pandemic on both referrals and scopes.

Lynch testing – in line with NICE guidance Northern Ireland expanded the provision of testing for Lynch syndrome to all patients with a colorectal cancer diagnoses from 2019. This test can help identify patients who may have an inherited genetic condition that puts them at increased risk of several cancers. The ability to identify people who are Lynch positive enables us to offer cascade testing to family members so that they can be placed on surveillance to allow earlier diagnosis.

One of the things that impacts cancer survival is stage at diagnosis. If we can diagnose early, survival improves. Public awareness of signs and symptoms of suspect cancer is key. One of the grants awarded from the Cancer Charities Fund which I established in 2021 was given to Cancer Research UK for the delivery of a 3 year cancer awareness programme. The programme is currently being developed in partnership with NICaN and the Public Health Agency and the first phase will begin in the autumn.

Finally, PHA has commissioned the Northern Ireland Cancer Registry to undertake an audit of colorectal cancer care, looking at key standards of care. The results of that audit should be available later this month and should provide useful information in terms of those areas where we can further improve.

Despite this progress, we recognise there is more to do system wide. The HSC is under great pressure, with increasing demands on cancer diagnostics and more urgent referrals. Diagnosing and treating cancer early gives patients the best chance of surviving their cancer, but it depends heavily on having enough staff and funding in place to make this a reality. Ultimately, sustainable improvements in cancer wait times and survival will rely on sustainable investment in services and will depend on our ability to fund the Cancer Strategy (2022) and the Elective Care Framework (2022).