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Today in the UK we take it for granted that our individual performance at endoscopy is regularly scrutinised by our colleagues in our own service, and nationally if we undertake colonoscopy or flexible sigmoidoscopy as part of the bowel cancer screening programme (BCSP). In addition, most aspects of the patient journey, endoscopy performance, the endoscopy environment, training and workforce are scrutinised by the Joint Advisory Group for Endoscopy (JAG), and in England, financial penalties are incurred by trusts which consistently fail to meet minimum assessed standards. Fifteen years ago this level of quality assurance and performance management would have seemed inconceivable, and indeed internationally that is still generally the case.
The UK can rightly be proud for leading the quality agenda in endoscopy internationally over the past 10 years, and as an example of improvement in performance, the British Society of Gastroenterology (BSG) colonoscopy audit undertaken in 19991 showed a dismal unadjusted caecal intubation rate of 76.9% compared with 92.3% in 2011.2 This was driven initially by a government desire to deliver a national BCSP with faecal occult blood testing and colonoscopy, based on improvements in colorectal cancer mortality in clinical trials.3–6 In order to achieve this, we had to improve colonoscopy performance as the previous level of caecal intubation was woefully inadequate for an effective screening programme and also the endoscopy service needed to improve in parallel. Waiting times for endoscopy of 3–6 months were fairly standard 15 years ago and much longer waits not uncommon. Booking processes were haphazard in many cases, and lists ran inefficiently. There was no standard assessment of safety issues such as decontamination or levels of sedation. Challenges remain today, but a template for this exists through the endoscopy Global Rating Scale, standards are monitored closely by JAG, and these have vastly improved over …
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