Introduction

On 3 February 1960, Harold Macmillan the British Prime Minister addressed the South African parliament in his ‘The wind of change speech’ signalling the growth of national consciousness being a political fact and the deep conviction about political destinies of free men and the odious aspects of current policies.1 Thirty-one years later, the Apartheid laws were repealed.

While we cannot equate the enormity of this geopolitical change with endoscopy, our ‘wind of change’ is blowing, providing opportunity, to describe, design and deliver success using the intelligence extracted from the National Endoscopy Database (NED) analysis2 and aligning this with the diagnostic strategy. One thing is clear, we need change.

Endoscopy is the gateway to most gastrointestinal (GI) cancer diagnoses and an essential tool in managing long-term GI pathologies, many of which carry risk for the development of future GI malignancy. Endoscopy is both a diagnostic and a powerful therapeutic tool allowing minimally invasive complex endotherapies by highly skilled operators.

The analysis of the NED by Beaton et al provides a broad visual canvas on the state of endoscopy in the UK.2 It is comprehensive and considered 1 639 640 procedures from 407 sites and 4990 endoscopists. The analysis considered sites by UK nation with England categorised using the NHSEI (NHS England and NHS Improvement) seven regional designations. Workforce was viewed through the lens of gender, specialty and trainee status. Selecting the time frame of March 2019–February 2020 eliminated the exogenous impact of the pandemic.

The NED records activity and not demand, however, the current backlog for diagnostics in England is significant with 1 568 964 waiting for the 15 tests monitored by NHSE (NHS England diagnostics waiting times and activity (DM01)).3 Endoscopy accounts for 182 640 of this backlog with 34.8% of patients waiting more than 6 weeks (NHSE …