We recognise the value of clinically‑led improvement programmes such as Getting It Right First Time (GIRFT) in identifying and addressing unwarranted variation in care, including in gastroenterology. Rather than being incorporated into the National Quality Strategy, which will set out overarching principles and priorities for improving quality, GIRFT recommendations are developed through detailed clinical engagement, analysis of national data, and close working with professional bodies, providers, and systems. Specialty‑specific recommendations from programmes such as GIRFT are used to inform delivery at national, regional, and local levels, rather than being incorporated as prescriptive elements of the strategy itself.

In the diagnosis and treatment of digestive conditions like small intestine bacterial overgrowth (SIBO) we expect health professionals to take into account best practice guidance, including that published by the National Institute for Care Excellence (NICE) and professional organisations.

In NICE’s Clinical Knowledge Summary on the assessment, investigation, and referral of chronic, which is more than four weeks' duration, diarrhoea in adults, health professionals are advised to consider SIBO when looking for features suggestive of an underlying cause such as systemic illness affecting gastrointestinal motility. The guidance is available at the following link:

https://cks.nice.org.uk/topics/diarrhoea-adults-assessment/management/chronic-diarrhoea-more-than-4-weeks/

The British Society of Gastroenterology provides resources and guidelines on SIBO, particularly in the context of irritable bowel syndrome (IBS). While not all individuals with IBS have SIBO, there's a significant overlap, with studies suggesting that up to 80% of IBS patients may also have SIBO. Additionally, the British Dietic Association provides resources and guidelines on dietary management for IBS, which can be relevant for SIBO due to the overlap in symptoms and potential dietary triggers.

The NHS.UK website offers extensive information for the public on gut health, covering topics from digestive health tips and healthy eating for a healthy gut to specific conditions that are associated with SIBO including IBS, coeliac disease, and diverticular disease. The site provides advice on diet and managing common digestive issues. The national charity Guts UK also offers information, support, and resources for people with digestive health conditions, including on SIBO.

The Getting it Right First Time gastroenterology programme aims to improve the diagnosis and management of digestive problems by streamlining referrals, promoting early specialist triage, and implementing proactive care. The programme focuses on ensuring that patients are seen by the right specialists promptly, leading to earlier diagnosis and more appropriate management of digestive issues.

Additionally, community diagnostic centres (CDCs) offer a variety of diagnostic tests and scans for digestive problems, providing faster, more convenient access to diagnostic services closer to patients’ homes. NHS England is continuing to roll out CDCs, with additional capacity being delivered in 2025/26.

We have prioritised cutting waiting lists and getting back to the standard that at least 92% of people should wait no longer than 18 weeks from referral to treatment. We have delivered an extra 2.5 million operations, scans, and appointments between July and December 2024 compared to the same period in 2023; this means that last month we hit our committment seven months early.

We recently published the Elective Reform Plan which sets out the reform and productivity efforts needed to return to the 18-week standard. One of the major commitments in the plan is to enhance clinically led pathways to shift care from hospital to community, including gastroenterology pathways.

Specifically, the plan commits to pathway reform starting in five areas, with gastroenterology being one. The commitment is to develop an integrated pathway across primary, community and secondary care for common gastroenterology conditions. We will also drive the rapid adoption of remote monitoring in appropriate gastroenterology pathways, which reduces consultant-led outpatient appointments by over 50%. Work is underway, including with the Royal Colleges, and further information will be forthcoming as plans are developed.

The plan also reinforces the Government’s commitment to work with patients, carers and their representatives to publish the standards patients should expect to experience while they wait for care, including for those waiting for gastroenterology services. We will continue to work with patients and carers to build on this work and establish a gold standard for experience.

We have prioritised cutting waiting lists and getting back to the standard that at least 92% of people should wait no longer than 18 weeks from referral to treatment. We have delivered an extra 2.5 million operations, scans, and appointments between July and December 2024 compared to the same period in 2023; this means that last month we hit our committment seven months early.

We recently published the Elective Reform Plan which sets out the reform and productivity efforts needed to return to the 18-week standard. One of the major commitments in the plan is to enhance clinically led pathways to shift care from hospital to community, including gastroenterology pathways.

Specifically, the plan commits to pathway reform starting in five areas, with gastroenterology being one. The commitment is to develop an integrated pathway across primary, community and secondary care for common gastroenterology conditions. We will also drive the rapid adoption of remote monitoring in appropriate gastroenterology pathways, which reduces consultant-led outpatient appointments by over 50%. Work is underway, including with the Royal Colleges, and further information will be forthcoming as plans are developed.

The plan also reinforces the Government’s commitment to work with patients, carers and their representatives to publish the standards patients should expect to experience while they wait for care, including for those waiting for gastroenterology services. We will continue to work with patients and carers to build on this work and establish a gold standard for experience.

We have prioritised cutting waiting lists and getting back to the standard that at least 92% of people should wait no longer than 18 weeks from referral to treatment. We have delivered an extra 2.5 million operations, scans, and appointments between July and December 2024 compared to the same period in 2023; this means that last month we hit our committment seven months early.

We recently published the Elective Reform Plan which sets out the reform and productivity efforts needed to return to the 18-week standard. One of the major commitments in the plan is to enhance clinically led pathways to shift care from hospital to community, including gastroenterology pathways.

Specifically, the plan commits to pathway reform starting in five areas, with gastroenterology being one. The commitment is to develop an integrated pathway across primary, community and secondary care for common gastroenterology conditions. We will also drive the rapid adoption of remote monitoring in appropriate gastroenterology pathways, which reduces consultant-led outpatient appointments by over 50%. Work is underway, including with the Royal Colleges, and further information will be forthcoming as plans are developed.

The plan also reinforces the Government’s commitment to work with patients, carers and their representatives to publish the standards patients should expect to experience while they wait for care, including for those waiting for gastroenterology services. We will continue to work with patients and carers to build on this work and establish a gold standard for experience.

Probiotic is a term commonly used to describe the effect of one or more strains of live bacteria used in food and food supplements. The Department has not made any assessment of the impact of prohibiting the use of the term probiotic.

The Department’s view is that the term probiotic would be considered a health claim. A health claim is any claim that states, suggests, or implies that health benefits can result from consuming a given food. Regulations governing the use of nutrition and health claims on foods require health claims to be authorised before they can be used on food or in a commercial context. The authorisation process involves scientific assessment of substantiating evidence. These regulations are in place to protect consumers from being misled by ensuring any health claims made are backed by robust scientific evidence.

The term probiotic would only be permitted as a health claim if a health claim is authorised for a specific strain of live bacteria. There are currently no such authorised health claims. The established process for authorising health claims allows industry to submit an application for a new health claim, and should they be authorised for a strain of live bacteria, then it could be possible to use the term probiotic.

A National Clinical Director provides clinical advice and leadership on the NHS England Internal Medicine Specialised Services portfolio, which includes specialised gastroenterology and liver disease. A National Speciality Advisor provides clinical advice more specifically to the hepatobiliary and pancreas programme.

The Getting It Right First Time (GIRFT) programme has invested in clinical leadership in gastroenterology, which is one of its priority workstreams. The programme will be establishing a liver disease programme in 2024/25, including recruiting to a clinical lead role.

The National Clinical Director for Cancer is leading work on on-the-spot liver scans, that has already found that around one in ten people in communities visited have advanced liver damage that needs further monitoring or treatment as it could lead to liver cancer.

NHS England is funding preventative interventions that support individuals to reduce the harm caused by alcohol use and obesity. To support this work, NHS England has invested in a National Clinical Director for Diabetes & Obesity and a National Speciality Advisor for alcohol dependence.

The Getting It Right First Time (GIRFT) programme data for gastroenterology is now available on the Model Health System, helping teams gauge their performance and work to recover services impacted by the pandemic. More than 70 metrics are available, relating to endoscopy, hepatobiliary, luminal gastroenterology, and nutrition services. These enable trusts and system users to see their performance across areas such as emergency admission rates and day case rates.

GIRFT is working with the NHS England Endoscopy Transformation Team to carry out visits to teams in the National Health Service regions across England, to encourage networking and quality improvement by utilising updated data metrics. A National Endoscopy Dashboard has been developed and is published on the NHS Futures website.

Joint work is ongoing between GIRFT and various specialty societies, such as the British Society of Gastroenterology (BSG) and Royal College of Physicians (RCP), helping to reinforce and disseminate recommendations from the report. This joint working has also resulted in the development of resources to support with implementation. These include:

- The BSG Quality Standards Framework;

- RCP Modern Outpatient Care guidance;

- GIRFT Clinically-led Outpatient Guidance; and

- National audit of ERCP (endoscopic retrograde cholangio pancreatography) practitioners & ERCP services.

GIRFT is also working with 51 trusts as part of a ‘Further Faster’ pilot to deliver rapid clinical transformation with the aim of reducing 52-week waits. The pilot brings together clinicians and operational teams with the challenge of collectively going ‘further and faster’ to transform patient pathways and working to reduce unnecessary appointments and improve access and waiting times for patients.

Clinical transformation groups have been established across 16 specialties, and some of the biggest reductions in waiting times to date among Cohort 1, encompassing 25 trusts, have been in gastroenterology. Trusts in the pilot have also been issued with a GIRFT Gastroenterology Further Faster Handbook to support their ongoing improvement.

Information on digestive health is published by the National Health Service and is available at the following link:

https://www.nhs.uk/live-well/eat-well/digestive-health/

The National Institute for Health and Care Excellence (NICE) has published best practice guidance, and a corresponding quality standard, on diagnosing and managing irritable bowel syndrome (IBS) in people aged 18 and over [CG61 and QS114]. These set out recommendations and quality standards for clinicians on the care for patients with IBS by promoting effective management using dietary and lifestyle advice, pharmacological therapy and referral for psychological interventions.

To assist with increasing the visibility of its guidance, NICE promotes its guidance via its website, newsletters and other media. It also publishes information for the public, which explains the care people with IBS should receive as set out in the NICE guideline.

The release of statistics in relation to hospital admissions in Northern Ireland is a matter for the Northern Ireland Department of Health.

This information is not held in the format requested.

The ‘Delivery plan for tackling the COVID-19 backlog of elective care’, published in February 2022, stated the ambition to reduce long waiting times for planned National Health Service treatments, including for patients with chronic and benign bowel conditions. In July 2022, two-year waits for elective treatments were virtually eliminated and the Department is working with NHS England on further ambitions in the plan.

From April 2023, providers will be asked to establish perioperative care co-ordination teams to create capacity for those who require more complex care in a higher acuity setting. The NHS is also providing information and support to patients while they await treatment through the My Planned Care platform, including those with chronic or benign bowel conditions.

No specific assessment has been made.

There are three main types of stoma related to the digestive and urinary system: colostomy, ileostomy, and urostomy.

The following table shows a count of completed surgical procedures for colostomy, ileostomy and urostomy undertaken within all National Health Service-funded hospital providers in England from 2017/18 to 2020/21. This does not represent a count of people, as the same person could have the same procedure on more than one occasion.

2017/18 2018/19 2019/20 2020/21

Colostomy 593 547 498 418

Ileostomy 563 498 472 451

Urostomy 2,013 1,856 1,784 1,020

Total 3,169 2,901 2,754 1,889

Source: NHS Digital, Hospital Episode Statistics

Some stomas are temporary and can be reversed. This data shows the total numbers that were introduced across the period. However, some of these may subsequently have been reversed. Data at a sub-national level has disclosure controls applied to protect patient confidentiality.

No specific assessment has been made.

The Getting It Right First Time (GIRFT) national specialty report on gastroenterology was published in September 2021. Inflammatory bowel disease (IBD) is one of the conditions covered under gastroenterological services in the report. The report sets out actions and recommendations to improve patient care in gastroenterology. The aim is to reduce unwarranted variation in treatments and services in, which will ensure consistent care is provided to IBD patients across the country.

The GIRFT programme is now embedded within NHS England and NHS Improvement’s programmes to improve quality and productivity, so that best practice is adopted throughout the NHS. NHS England and NHS Improvement are encouraging individual sites to evaluate how best to take forward these recommendations. The recommendation on IBD is estimated to reduce emergency admissions by 6,600 per year. The Department and NHS England and NHS Improvement expect National Health Service trusts and clinical teams to consider how best they can implement these recommendations for individuals to ensure the consistent and high quality care for IBD and other gastroenterological conditions.

The Getting It Right First Time (GIRFT) national specialty report on gastroenterology was published in September 2021. Inflammatory bowel disease (IBD) is one of the conditions covered under gastroenterological services in the report. The report sets out actions and recommendations to improve patient care in gastroenterology. The aim is to reduce unwarranted variation in treatments and services in, which will ensure consistent care is provided to IBD patients across the country.

The GIRFT programme is now embedded within NHS England and NHS Improvement’s programmes to improve quality and productivity, so that best practice is adopted throughout the NHS. NHS England and NHS Improvement are encouraging individual sites to evaluate how best to take forward these recommendations. The recommendation on IBD is estimated to reduce emergency admissions by 6,600 per year. The Department and NHS England and NHS Improvement expect National Health Service trusts and clinical teams to consider how best they can implement these recommendations for individuals to ensure the consistent and high quality care for IBD and other gastroenterological conditions.