The Scottish Capsule Programme (SCOTCAP) is an integral part of the national redesign of outpatient gastroenterology services as it enables early and effective screening in the community, avoiding unnecessary referrals for hospital outpatient appointments.

SCOTCAP was endorsed by the Programme for Government 2018/19 and is a large scale evaluation project undertaken in NHS Highland, NHS Grampian and NHS Western Isles.


SCOTCAP Service Evaluation was embedded within the CCE service, rolled out across three Health Board Regions, and was a multi-centre service evaluation of patients (presenting with GI symptoms to their GP and patients waiting for colonoscopy).

The aim of the evaluation was to explore the efficiency, acceptability and effectiveness of a new Managed Service Delivery Model when deployed across three Health Board areas across the North of Scotland, and to generate recommendations for further adoption and scale up. The Evaluation Phase of the SCOTCAP project concluded in March 2020.

CCE is a procedure which involves swallowing a capsule the size of a vitamin Pill. The capsule contains a digital camera which is swallowed and, on its journey, takes up to 400,000 images (32 per second), which are remotely reviewed and analysed. It is highly accurate, with the potential to be cost effective, less invasive, and more acceptable to patients, than existing procedures. It is not currently routinely used in Scotland for large Bowel investigations and could potentially be a viable and safe alternative to traditional colonoscopy.

This is recognised to be an ambitious programme of work testing boundaries and exploring the acceleration of innovation in Scotland. Fundamental to the success of this work was to bring together like-minded innovation partners from across sectors to drive forward the testing and evaluation of an Innovative Service Model Using Colon Capsule Endoscopy (CCE) in a real-world setting.

I think it is going to be another sweet in the sweet shop, another tool in the toolbox...

Professor Angus Watson

Consultant Colorectal Surgeon

Impact & Value
  • Enable early and effective screening in the community to address demand and capacity pressures within the NHS;
  • Reduce the total cost of gastrointestinal diagnostics and avoid unnecessary referrals for outpatient appointments;
  • Eliminate unnecessary travel for patients;
  • Deliver an Innovation Partnership Framework to support innovative procurement for Public Services in Scotland;
  • Generate economic growth and jobs in Scotland for SMEs with specialist experience in this area.

One of the unique business innovation aspects of the project is the creation of Scotland's first Innovation Partnership procurement contract across NHS Scotland. This has enabled commissioning bodies to "partner" and work collaboratively with private sector companies to both develop and test a new service within the community. Significantly, these services could be rolled out across Scotland without the need for a further procurement if the evaluation proved successful. In addition, this project tested and refined the business model working with the industry partner to create a successful managed service and secure further inward investment and economic development in the North of Scotland.

SCOTCAP Achievements

Progress to date
  • Delivery of a Service Evaluation of CCE in Scotland reaching over 450 patients and corresponding Service Evaluation

    • This involved facilitation, co-design, service design and change management expertise to ensure that service, technical and business innovation barriers were identified and overcome;

    • Academic Evaluation Reports from the University of Strathclyde examining patient acceptability and experience have been published reflecting positive outcomes and key recommendations to support wider scaling up across Scotland.

  • Supporting partners by increasing Service Readiness Levels; undertaking a series of one-to-one interviews and insight driven service design workshops with SCOTCAP stakeholders to capture key learning from the Innovation phase to further inform the service and business case;

  • Production of an interactive Service Model Blueprint and Report to support the next phase of implementation, the ‘Adoption Phase’.

  • The SCOTCAP Programme has been shortlisted for the Life Sciences Partnership Collaboration Award and won the 2019 Scottish Digital Health and Care Innovation Award, recognising excellence in this domain and partnership working with the service and industry. For 2020, SCOTCAP has been Shortlisted for the Holyrood Connect Innovation Award.

  • Evaluation was embedded within the CCE service rolled out across the three Health Board Regions and was a multi-centre service evaluation of patients (presenting with GI symptoms to their GP and patients waiting for colonoscopy). The evaluation was to explore the efficiency, acceptability and effectiveness of a new Managed Service Delivery Model when deployed across three Health Board areas across the North of Scotland.
I think the procedure would be very helpful to patients in the future, enabling them to be diagnosed near home and not have to travel the long distance to Raigmore Hospital.


Next Steps
  • Completion of the academic publication for the clinical evaluation from the Health Service Research Unit (HSRU), University of Aberdeen which has been delayed due to Covid-19 and the temporary closure of the Endoscopy Service.  This is now anticipated in Winter 2020.
  • DHI will continue to influence and provide support for the draft SCOTCAP business case being co-ordinated by NHS National Services Scotland. Insights and learning relative to the CCE service delivery model and change management have been provided by DHI to support the next phase of scale up. Timescales for completion of the business case have been revised in response to Covid-19 and to accommodate a review of evidence of CCE from Scottish Health Technologies Group published in August 2020
  • DHI has continued to provide change facilitation and Readiness for Adoption which has resulted in the development of range of implementation tools and resources based on the outcomes and experience from the evaluation phase.
  • In June 2020, it was confirmed that the new innovative SCOTCAP service delivery model developed will now be adopted by NHS Scotland as part of the Covid-19 Remobilisation plans for Endoscopy Services over the coming months not only benefiting NHS Scotland but the wider Life Sciences Community  generated economic growth and jobs for Industry/ SME’s specialising based in remote and rural regions in Scotland.  This National rollout is being overseen by National Services Scotland.

AICE Project

AI-Supported Image Analysis in Large Bowel Camera Capsule Endoscopy (AICE) is a £6 million transformative digital health project funded by Horizon Europe.

Led by a dynamic partnership of researchers and experts across 12 European organisations, AICE aims to simplify the way we detect colon cancer via an AI-assisted patient pathway that enables high-quality diagnostics, considers patient preferences, and is ethical and economical.

As seen with the ScotCap programme, at present images captured by colon capsule endoscopy (CCE) are reviewed by trained doctors. But AI offers the potential to speed up the process safely and ethically, making it more cost-effective, increase its use, and reduce waiting lists.

Furthermore, the AICE patient pathway will incorporate AI at the start of the process by analysing various factors and indicators, such as medical history, risk factors, and prior test results, to identify patients who would benefit most from CCE. As such, during the four-year AICE project, the multidisciplinary team will cover aspects such as validation and development of algorithms, the creation of a clinical support platform, clinical indications and guidelines, patient engagement (PREM and App), cost-efficiency, ethical considerations, and future implementation strategies.

The expected benefits include earlier initiation of treatment, less advanced staged cancers, fewer complications related to the diagnostic procedure, better patient acceptability and compliance, and a significant reduction in costs from both diagnostics and treatment. It also has potential to reduce the capacity pressures NHS health boards across the UK are experiencing.