Endoscopy Services Update

As promised when the DHSC transferred the endoscopy procedures from Ramsey and District Cottage Hospital to Nobles I am keeping a watch on progress to make sure that the benefits the DHSC outlined at the start of the process are actually being realised.

There’s no sense in changing services if we don’t see an improvement out of it and so it’s important to make sure that improvements are being delivered and change isn’t being made for the wrong reasons.

The Minister’s answer to my question in the House of Keys this week is below:

The Hon. Member for Ramsey (Mr Hooper) to ask the Minister for Health and
Social Care –
If she will provide an update on the endoscopy service following the transfer
of the function out of Ramsey and District Cottage Hospital?

The consolidation of the DHSC’s endoscopy services was initiated in May 2017
following the identification of a significant patient safety issue associated with
the management of the recall of patients who were identified as requiring
regular endoscopy examinations following bowel cancer or family history of
bowel cancer – so called surveillance endoscopies.

In order to ensure that all patients who were awaiting a surveillance
endoscopy could be scheduled, the DHSC management team was required to
significantly increase the capacity of the endoscopy service in order to
accommodate these patients.

It was identified that running two separate endoscopy services on different
sites was inefficient, as doctors who were travelling to Ramsey District
Hospital from Noble’s were doing so in clinical time, and that utilisation of
doctors to undertake endoscopy procedures on the Noble’s site was poor due
to a lack of endoscopy nursing staff available to support.

Following the consolidation of services on the Noble’s site, within the newly
opened Endoscopy Unit, we identified that the number of endoscopy lists
could be increased from the original 13 per week (being provided across both
sites) to 18 per week provided on one site, with no additional investment
requirement. This was achieved through:

  • Changing the nursing skill mix within each endoscopy room in line with
    NHS guidelines – this released one registered nurse per room per
  • Improved utilisation of consultant teams – most consultant teams have
    more than one doctor who can undertake endoscopy. By staffing two
    rooms side by side, this meant that two doctors from the same team
    could operate side by side.

Following the implementation of the new timetable with increased capacity
from the 1st July, a significant and immediate increase in activity was
observed. An additional 387 procedures have been completed in the period
June 2017 to October 2017 compared to the same period in 2016.

The driver for the consolidation in service, namely the issues surrounding the
backlog of patients awaiting surveillance endoscopy, was resolved by
September 2017, when all patients who were deemed to require a
surveillance endoscopy had received one (or removed themselves from the
waiting list). No cancers were detected in any patient who had been waiting
for their surveillance endoscopy.

Now that the surveillance backlog has been cleared, the team are working
through the waiting list, which was 12 months long for routine endoscopy
procedures. Based on current levels of activity, we anticipate the waiting list
to be cleared by the end of March 2018, and that the waiting list will be at
approximately 6 weeks from April 2018.

Following the consolidation of the service, the equipment transferred from
Ramsey has been in constant use, becoming part of the equipment inventory
within the unit. In particular the ‘scope guide’ that displays on screen where
the endoscope camera is positioned inside the intestines, is particularly useful
when training junior doctors and our trainee Nurse Endoscopist to undertake
procedures independently.

The capsule endoscopy service (which involves the patient taking a pill which
contains a camera which takes pictures as it travels along the gastrointestinal
tract) transferred to Noble’s in July 2017 – we currently undertake 3-4 of
these procedures per month, which is equivalent to the activity previously
reported at Ramsey District Cottage Hospital. The Bravo service, which
involves placing a probe in the stomach to measure stomach acid commenced
in September 2017 and we are undertaking on average one procedure per
week as previously was the case.

Any thoughts?

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