Modernising the Bowel Screening Pathway in Wales

Innovative solutions to improve participant assessment, triage support and progression following a positive FIT result

Introduction

Bowel cancer is one of the most common cancers in Wales, with over 2,200 new cases diagnosed each year[1], and early diagnosis remains one of the most important factors in improving patient outcomes. It is more common as people get older, with most cases diagnosed in those over 50.

Bowel Screening Wales[2] plays a vital role in identifying people aged 50-74 who might be at increased risk of bowel cancer, through the routine use of an at home stool sample kit, known as Faecal Immunochemical Testing (FIT)[3]. Each year, more than 500,000 people are invited to participate in bowel screening, with around 12,000 participants receiving a positive FIT result and requiring further assessment[4] and investigation.

Following a positive FIT result, screening participants are informed to contact the national bowel screening administration team to make a mutually convenient appointment for a nurse-led pre-colonoscopy assessment. This assessment is predominantly undertaken by telephone and uses a standardised assessment form with questions designed to determine an individual’s suitability for colonoscopy, identify clinical risks and ensure participants receive the support they need before further investigation. The assessment lasts between 30 and 60 minutes, depending on the level of complexity. Appointments are available Monday to Friday, 9am to 4pm, and this is currently the only option available to screening participants.

The current process was established when the Bowel Screening Wales programme launched in 2008 and has remained largely unchanged since that time. Whilst the pathway continues to provide a safe and effective means of assessment, the environment in which it operates has changed considerably. Bowel Screening participation has increased, eligibility has expanded, workforce pressures have intensified and public expectations around digital access, communication and convenience have evolved.

Bowel Screening Wales is therefore seeking innovative approaches that can support service modernisation, improve participant experience, improve the timeliness of pre-colonoscopy assessments and strengthen the ability of NHS Wales to meet future demand.

The Challenge

Current pre-colonoscopy assessment processes remain heavily reliant on manual and telephone-based activity during routine office hours (Mon-Fri. 9-4pm). This can limit access for screening participants (especially those of working age), create pressure on specialist nursing teams, contribute to variation in waiting times and participant experience, and limit opportunities to make better use of participant information resources (i.e. current inability to signpost participants to digital resources and video content).

We are seeking innovative solutions that can improve access to timely assessments, provide increased flexibility for participants to undertake an assessment, enables participants to have more control over their engagement with the service, including the possibility of them booking their own appointment slots following assessment. In addition, the innovation should have the ability to enable the screening programme to triage participants for appropriate investigations and stratify individuals for timely interventions based on clinical need following a positive FIT result.

The challenge is outcome focused and does not prescribe a specific technology, product type or delivery model.

Applicants are encouraged to propose the approach they believe will best address the challenge and demonstrate how their solution could be adapted, developed or enhanced to meet the needs of Bowel Screening Wales.

We are not seeking to specify a single solution in advance. The purpose of this challenge is to support the development and demonstration of solutions that can address the underlying service need as described above whilst creating foundations for future improvement.

Desired Outcomes

We are interested in solutions that can deliver measurable improvements in one or more of the following areas.

Timely Access to Care

• Reduced time between a positive FIT result and completion of pre-colonoscopy assessment.
• Improved access to services during evenings and weekends.
• Improved timely access and progression through the pathway.
• Reduced avoidable delays to colonoscopy or other diagnostic procedures.
• Improved pathway visibility.

Participant Experience

• Improved communication and engagement with screening participants at the early stage of the pathway.
• Reduced anxiety and uncertainty during periods of prolonged waits for a nurse led pre-colonoscopy assessment
• Greater convenience and accessibility for participants who need to access services outside working hours
• More person-centred services by providing greater flexibility and the ability for   individuals to book subsequent appointments directly as deemed clinically appropriate

Workforce Capacity

• Better utilisation of specialist nursing capacity.
• Reduced administrative burden for clinical staff.
• Reduced contact with the central helpdesk.
• Improved workforce productivity across the multidisciplinary screening team.
• Increased service resilience via the adoption of automated and/or digital solutions

Equity and Accessibility

• Reduced variation in access across Wales.
• More consistent participant experiences.
• Improved accessibility for different population groups.
• Strong Welsh language provision.

Information and Decision-Making

• Better capture and use of participant information, with reduced reliance of printed and posted leaflets and letters
• Improved operational intelligence.
• Streamlined pathway management.
• Business intelligence to better evidence to support clinical decision-making, service planning, service improvement and evaluation.

Sustainability

• Affordable and scalable approaches.
• Improved productivity and efficiency.
• A realistic route to long-term adoption.
• Creation of a sustainable platform for future capability development.

Applicants should clearly identify which outcomes their solution is expected to influence and explain how impact will be measured.

Phase 2: Development and Real-World Demonstration

This challenge is being delivered as a Phase 2 Contracts for Innovation competition.

We are seeking organisations with existing technologies, products, platforms or solutions that require adaptation, enhancement or development to meet the needs of Bowel Screening Wales.

Projects should support the development, refinement and real-world demonstration of innovative approaches capable of improving participant assessment, triage and pathway management following a positive FIT result.

The expectation is that solutions will be deployed and evaluated in a real world setting where appropriate, enabling learning from practical implementation to inform ongoing refinement and future development throughout the project.

Successful projects are expected to generate practical evidence relating to:

• Participant experience.
• Clinical effectiveness.
• Workforce benefits.
• Operational impact.
• Affordability and sustainability.
• Adoption readiness.
• Future development and scalability.

Solutions are not expected to deliver a fully transformed end to end pathway during this project.

Applicants should describe:

• What they propose to deliver.
• How it will be tested and evaluated.
• How the solution could evolve in future.

Development Approach

Bowel Screening Wales is interested in solutions that can deliver an initial practical capability and generate value early in the project, whilst creating opportunities for further enhancement over time.

Projects may begin by focusing on relatively discrete elements of the pathway, such as information capture, participant assessment or triage support. Solutions should then be refined and enhanced through real world deployment, user feedback and service learning throughout the project.

Applicants are encouraged to describe how their solution could evolve incrementally during delivery, including the development of additional functionality where this would improve participant experience, service efficiency or pathway management.

Whilst we are not expecting applicants to deliver a fully featured end to end pathway solution during the short duration of this project, we are seeking practical solutions that can demonstrate value in a real-world setting, whilst creating foundations for future capability development. Therefore, applicants must consider relevant NHS Wales governance and accessibility standards that will be required to support their project delivery approach and future adoption. This includes compliance with the following:

• information governance and data protection
• clinical safety
• Cyber security and digital interoperability requirements; and
• any required medical device classifications.

Applicants should identify, in the relevant sections of the application form, any approvals/certifications that may be required to support their project deliverables, whilst also giving consideration to future requirements for implementation, deployment, and adoption within NHS Wales. Applicants should outline their current state of readiness and their approach to achieving and maintaining compliance during the delivery of the project. Applicants should also confirm what certifications are already in place and provide evidence.

Future Capability and Scalability

Whilst the initial focus of the challenge is pre-colonoscopy assessment, information capture and triage, applicants should describe how their solution could evolve over time and support future enhancement and built-in user evaluation where appropriate.

This may include areas such as:

• Participant communications.
• Appointment management.
• Workflow optimisation.
• Operational intelligence.
• Artificial intelligence.
• Wider screening and diagnostic pathway support.
• User acceptance testing and evaluation

We are particularly interested in solutions that have the potential to evolve beyond the immediate challenge scope and create replicable capability for NHS Wales.

This may include future application across other screening programmes, diagnostic pathways or participant-facing services where similar challenges exist.

Affordability, Sustainability and Adoption

Affordability and sustainability are central requirements of this challenge.

Applicants should demonstrate:

• Affordability beyond the funded project period.
• A realistic route to adoption within NHS Wales.
• Scalability across Wales.
• Opportunities to improve productivity and reduce service pressures.
• The overall value proposition for NHS Wales.

Solutions should demonstrate how they could transition into sustainable operational delivery should the project prove successful.

Wider Benefits for Wales

In addition to improving participant and service outcomes, applicants are encouraged to consider wider benefits their proposal may deliver for Wales.

These may include:

• Supporting people to remain healthy and economically active.
• Supporting workforce wellbeing and productivity.
• Reducing inequalities.
• Developing skills, capability and innovation expertise within Wales.
• Supporting bilingual innovation.
• Creating wider social, economic, environmental or community benefits.

Applicants may describe any wider benefits associated with their proposal where relevant.

Welsh Language Requirements

Wales is a bilingual nation, and Welsh language considerations must form an integral part of solution design.  Any successful solutions must include as part of the Phase 2 development both Welsh and English public facing content.

Applicants must demonstrate how their solution will:

• Support bilingual service delivery.
• Ensure Welsh and English users receive an equivalent experience across all functions, content, communications and interactions.
• Be bilingual by design, rather than relying on translation as a later enhancement.
• Support participants to interact with services in their preferred language.
• Provide participant facing content, communications and notifications in Welsh and English.
• Support the principles of the Active Offer.
• Consider Welsh language and accessibility requirements together throughout design, testing and implementation activities.
• Engage Welsh speaking users in testing and evaluation activities where appropriate.

Welsh language functionality should be embedded from project inception and must not be treated as a future enhancement or optional module.

Where solutions incorporate automation, artificial intelligence, decision support or advanced digital functionality, applicants should explain how Welsh language provision will be supported equitably and maintained as the solution evolves.

Applicants may find the following resources useful:

• Welsh Government Bilingual Technology Toolkit for a Good User Experience.
• Accessible Communication and Information Standards for Healthcare.

Solutions with broader multilingual capability are also encouraged where this supports accessibility, inclusion or the needs of diverse populations, provided Welsh and English provision remains fully supported.

In Scope

We are interested in solutions that can contribute to one or more of the following:

• Robust participant pre-colonoscopy assessment following a positive screening FIT result.
• Safe and clinically effective triage support and participant prioritisation.
• Participant and service data capture and secure information management.
• Effective and inclusive participant communication and engagement.
• Efficient signposting to digital information resources
• Appointment management, clinic scheduling support and pathway coordination.
• Workflow automation to enable delivery against approved screening pathways.
• Creation and availability of operational intelligence and analytics.
• Artificial intelligence or machine learning approaches to deliver safe and clinically effective care and assist decision making.
• Welsh language and bilingual service delivery.
• Improved accessibility, equity and consistency across Wales.

Out of Scope

We are not seeking projects that:

• Focus solely on increasing participation in bowel screening programmes.
• Are primarily academic or research studies with no credible route to implementation.
• Require extensive fundamental research before development can commence.
• Cannot demonstrate an existing technology foundation.
• Cannot demonstrate a realistic route to adoption within NHS Wales.
• Rely on English only participant-facing delivery.
• Has the potential to disadvantage screening participant cohorts
• Seek to replace appropriate clinical oversight or professional judgement.
• Are wholly dependent upon integration to national systems.

Funding Allocation and Project Details

Competition Type: Phase 2 Development and Real-World Demonstration

Total Funding Available: £ 300,000

Number of Projects Anticipated: up to 5

Portfolio Approach

Funding decisions may be made using a portfolio approach, recognising that complex challenges often require a range of complementary solutions rather than a single intervention. Consideration will be given to the overall balance of projects supported, the evidence generated and the potential for wider adoption and learning across Wales.

Project Duration

Projects are expected to commence in November 2027 and conclude by 31 March 2027.

Projects may include an initial phase focused on adapting or configuring an initial capability for deployment within the bowel screening pathway, followed by a period of real-world testing, learning, enhancement and refinement.

Application Requirements

Applications should clearly demonstrate:

• Understanding of the challenge.
• Maturity of the proposed solution.
• Expected benefits and outcomes.
• How impact will be measured.
• Welsh language approach.
• Affordability and sustainability.
• Future development roadmap.
• Project team, milestones and budget.
• Any key implementation, safety, governance, regulatory or technical considerations relevant to the proposed solution.

Shortlisting and Supplier Engagement

Applications will be assessed against the published evaluation criteria.

Following assessment, shortlisted applicants may be invited to participate in a face-to-face presentation and discussion session with representatives from Bowel Screening Wales, NHS Wales and relevant stakeholders.

This session will provide applicants with an opportunity to present their proposed solution, discuss expected benefits and adoption potential, and respond to questions from the panel.

The session may follow a format similar to a Dragon’s Den or panel discussion.

The presentation and discussion session is expected to take place in person, on a date to be confirmed, in either Cardiff or Wrexham.

Briefing Event

To register for the virtual Briefing Event, to be held online on the 2nd October, please follow the link below: Contracts for Innovation Cymru: Briefing Event for New Challenges 2026/2027

Once this date has passed, you may access the Briefing Event recording here:

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Application Process

Directions on how to enter this competition can be found via:  https://sdi.click/bowel-screening-1

Key Dates

For enquiries about this competition, please contact: Contractsforinnovationcymru@wales.nhs.uk

Long-Term Vision

The ambition of this challenge is not simply to replace a telephone assessment process with a digital alternative.

The longer-term opportunity is to create a sustainable, scalable and replicable capability that improves participant assessment and triage today whilst providing a foundation for future innovation across screening services in Wales.

The strongest applications will be those that can demonstrate practical value in the short term whilst also showing how the solution could grow, adapt and contribute to a more sustainable, equitable and intelligent screening pathway for Wales.

[1] Bowel screening – Public Health Wales

[2] Bowel screening – Public Health Wales

[3] About the bowel screening test – Public Health Wales

[4] Your bowel screening test results – Public Health Wales