1. Introduction

1.1. We (C the Signs) have developed this Self-Assessment Service so you access certain NHS Services through this website.

1.2. The Self-Assessment Service enables you to risk assess yourself to determine if you are eligible for specialist cancer referral pathways within the National Health Service (NHS) in England. These pathways are limited to certain cancers and specific criteria. They do not cover all cancer, and do not replace your existing local GP practice service or emergency services. The criteria for each pathway is set by the commissioning authority in the NHS with C the Signs Self-Assessment Service providing the platform to support the pathway.

1.3. If We need to contact you, We will do so by email, SMS or telephone call using the contact details you have provided. This will be limited to certain circumstances outlined below.

2. Other applicable terms

2.1. These Terms of Use refer to the following additional terms, which also apply to your use of the Self-Assessment Service:

• Our Privacy Policy, which sets out the basis on which We process any personal data We collect from you, or that you provide to Us.
• Our Cookie Policy, which sets out information about the cookies on Our site.

3. When these terms apply

3.1. By registering for and continuing to use the C the Signs Self-Assessment Service, you agree to be bound by these terms. Please also ensure you have read and agree to the terms and conditions of Our privacy policy and cookie policy.

3.2. We may, at any time and at our sole discretion, amend these terms for any reason. The latest version of our terms will be accessible through the Self-Assessment Service itself, and We will inform you via the platform or via email for any significant changes and request your continued agreement if We make any significant changes to these terms.

4. How to register to use the Self-Assessment Service

4.1. It is free to register for and use the C the Signs Self-Assessment Service. To use the Self-Assessment Service you must be registered with a GP surgery in England. Please also note that this service is only available in certain areas of England where the pathways have been commissioned.

4.2. If you access or attempt to access the Self-Assessment Service outside England or a commissioned area:

• We cannot guarantee you will be able to access the C the Signs Self-Assessment Service or that it will function correctly;
• You are responsible for complying with any local laws that apply to you in the country from which you are using the C the Signs Self-Assessment Service.

4.3. When available, you will need to create and maintain an account using the C the Signs Self-Assessment Service.

4.4. In order to use the C the Signs Self-Assessment Service you must be aged 18 years or older.

5. Accessing the Self-Assessment Service

5.1. You are responsible for making all arrangements necessary for you to access the C the Signs Self-Assessment Service, including but not limited to:

• a secure internet connection (see Cyber Aware website)
• an appropriate device, operating system and browser that meet the NHS minimum requirements found here: help and support page.
• using your own virus protection software (and regularly updating it).

5.2. The C the Signs Self-Assessment Service is only intended to be used by you. If you permit any other person to use your account, you:

• do so entirely at your own risk;
• must not share your user password with such persons;
• are responsible for their access and use of the Self-Assessment Service as if it were your access and use;
• must make sure such persons are aware of these terms and comply with them.

5.3. If you know or suspect that anyone other than you knows your user password to your C the Signs Self-Assessment Service account, you must promptly reset your password to something only you know.

6. Updates to the Self-Assessment Service

6.1. From time to time We may automatically update the C the Signs Self-Assessment Service, to improve performance, enhance functionality, reflect changes to the operating system, or address security issues.

6.2. If updates are not installed (e.g. to your browser) you may not be able to use the C the Signs Self-Assessment Service or you may find that its functionality and/or performance is impaired.

7. Details about the Services

7.1. The following services may be available to you through the C the Signs Self-Assessment Service. Not all services and features are available to all users. This depends on where you live and the services and systems your healthcare provider has chosen to commission in their area.

User Login

The login system for the Self-Assessment Service allows you to sign up to the platform and utilise the service. We will require you to enter your:

• Name
• Phone number
• Email
• Password

This also enables you to return to the platform to complete the assessment again or additional self-assessment pathways available to you from your local commissioning authority in the NHS.

Please also note that some questions in the Self-Assessment pathway algorithm will be used to create your patient profile (e.g. date of birth and gender) which will be stored and aid future risk assessments.

Self-Assessment Pathway

Specific cancer pathways have been constructed by C the Signs together with your local commissioning authority in the NHS (e.g. your local hospital). The criteria for these pathways have been set by the NHS alone.

You will be navigated through a series of questions which will help to determine if you are eligible for the pathway, as well as any essential information required for the NHS organisation to process your referral. The outcome of the Self-Assessment pathway will be shown to you as soon as your eligibility has been determined.

There may be different self-assessment pathways available for different symptoms or cancer types depending on what has been commissioned in your area.

Please note, that if you are ineligible for the pathway this does not mean you do not have cancer. Any symptoms of concern should always be discussed with your healthcare professional and/or emergency services if you are critically unwell.

Referral Form Generation and Transfer

In the process of completing the Self-Assessment pathway, a referral form (or letter) is generated with the information you enter. This includes both your demographic information (e.g. your name, date of birth, address, gender etc), as well as your medical information specific to the questions you have answered. It is critical to make sure the answers you give are accurate in order for the NHS organisation receiving the referral form to triage you appropriately.

The referral form generated will be transferred to the NHS Organisation who has commissioned the pathway (e.g. your local NHS hospital) to access all the information within it. They will then triage the referral to one of four possibilities:

• You are not eligible for the pathway due to additional factors not included in the Self-Assessment pathway that they have become aware of through your other medical history and will advise you on the next steps (e.g. to see your GP)
• Further information is required, in which case they will contact you (usually by telephone), to discuss any additional information they need.
• A test or investigation is required before a consultation with a clinician. This could be a blood test, urine test, stool test, scan (e.g. x-ray, CT, ultrasound, MRI or other), an endoscopy procedure (e.g. a colonoscopy), or any other test required. This will help to accelerate the diagnosis of your symptoms.
• A consultation with a clinician is required. Please note that the clinician you are reviewed by depends on the pathway and may include a consultant, other doctor, specialist nurse, physician’s associate or other clinical role. This is at the discretion of the NHS organisation receiving your referral.

Hospital Tracking Dashboard

The referral form generated, together with your demographic information (e.g. name, date of birth, NHS number, address) may be provided to the NHS organisation commissioning the service on a dashboard to track the referrals that have been completed. This allows them to ensure patients are not lost in the system and all patients who have been referred are followed-up to completion of their diagnostic journey (e.g. diagnosis of cancer or exclusion of cancer). 

Please note, these pathways are specific to cancer and for the majority of patients, cancer will NOT be the cause of their symptoms. Whilst NHS organisations will attempt to find a suitable diagnosis, you may only be told that your symptoms are NOT due to cancer as a result of these pathways.

In addition, automated processing of your data may occur using this dashboard, including messages sent to you, to ensure the pathway is followed accurately and to ultimately either rule out or diagnose cancer. A healthcare professional will always oversee this dashboard.

GP Record Updater

Where We have the consent of your GP practice, We can notify your GP when you have completed a Self-Assessment pathway. This can also be updated on your medical record within your Electronic Healthcare Record at the GP practice. 

This function will depend on the consent of your GP practice, as well as the specific configuration of the Self-Assessment pathway in your area.

GP Patient Record Integration

In partnership with certain NHS organisations in the commissioning of the Self-Assessment Service, C the Signs is able to access your GP practice record. This enables C the Signs to extract certain parts of your medical history to include on your referral form that is received by the NHS organisation commissioning the Self-Assessment Service (e.g. your local hospital). This includes but is not limited to: the conditions you are currently being treated for or significant medical events in your history, medications you are prescribed, or allergies you have. This ensures the NHS organisation receives a complete picture of your medical record to make the best decision on next steps when triaging your referral.

Please note, this is carried out with the specific consent of your GP practice itself.

Messaging Service

As part of the Self-Assessment Service, the NHS organisation commissioning (or C the Signs on behalf of the NHS organisation) may need to contact you directly (e.g. through SMS, telephone or email). This may be, but is not limited to:

• A test needs to be completed prior to an appointment
• Details of the consultation need to be sent
• You need to rebook a test or appointment. The NHS Organisation will message you through the C the Signs messaging service which will contact you through SMS (text message) or email. You may also be messaged from time-to-time by C the Signs for feedback on the service. You will be able to opt out of this service.
• You have failed to attend an appointment or test.
• Check you have attended or booked appointments or tests.

Using the Services

7.2. You must not rely on the C the Signs Self-Assessment Service as the sole means by which you (or those for whom you have any proxy access arrangements) continue to receive care from your doctor or other healthcare professional.

7.3. If you download, print or export any of your health or medical record data, you are responsible for ensuring that such data is held securely, and We will not be liable for any associated disclosure of sensitive and personal data.

7.4. In order for you to receive the intended benefits of the C the Signs Self-Assessment Service, you must ensure that all data provided by you is complete and accurate.

7.5. Your GP health records are created and kept up-to-date by your GP and remain under your GP's control. Your GP surgery may choose to authorise the C the Signs Self-Assessment Service to access key facts, such as your medical history, medications, and allergies etc, in order to provide these details within the referral form provided to the hospital or healthcare organisation receiving the self-assessment pathway referral. You will be unable to review this information within the C the Signs Self-Assessment Service platform itself. We are unable to modify your GP record or provide hard copies.

7.6. The C the Signs Self-Assessment Service:

• is not a substitute for seeking medical advice. Always follow any medical advice given by your healthcare professionals.
• is provided for limited cancer pathways, to assist you to manage specific symptoms you may or may not be experiencing to accelerate the diagnosis of cancer. The majority of patients referred on these pathways are NOT expected to have cancer.
• does not support all cancer pathways or cancer types, and so any persistent or unexplained symptoms not reflected in the pathways should be discussed with a healthcare professional (e.g. your GP).
• is not intended to be used where you are critically unwell, where emergency services (e.g. 999) or the NHS 111 service should be used.
• is not intended to be prescriptive or authoritative in respect of a diagnosis, condition or treatment, and is not intended to provide information on which you should solely rely.
• reflects current knowledge and practice of pathways in the NHS in England. However, medical knowledge and practice is constantly evolving and as such they may not reflect the latest knowledge or practice.

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7.7. Please note your GP or other healthcare professionals remain ultimately responsible for your health and well-being (including but not limited to any diagnosis or other healthcare advice). 

7.8. We are not responsible for any delay or lack of response by the healthcare provider to any referrals recommended through the C the Signs Self-Assessment Service.

7.9. Where We have assessed it to be useful to C the Signs Self-Assessment Service users, We may include links to national health and care websites that are not integrated with the C the Signs Self-Assessment Service. We do not monitor the content of such websites. Any link provided in the C the Signs Self-Assessment Service is solely for your convenience. We do not accept any responsibility for any third-party website or third-party applications.

8. Ending your use of the Self-Assessment Service

8.1. You may stop using the C the Signs Self-Assessment Service at any time. If you wish to cancel your account, you should contact us via email at support@cthesigns.co.uk. 

8.2. If you breach any of these terms We may prevent you from accessing the C the Signs Self-Assessment Service and suspend your account. We will notify you of this. If what you have done can be put right, We will give you a reasonable opportunity to do so.

8.3. If your account is cancelled:

• your access to the C the Signs Self-Assessment Service will stop;
• any personal data We hold about you will be dealt with in accordance with our data retention policy, which is set out in our privacy policy;
• all rights granted to you under these terms shall automatically cease without further notice (although your statutory rights - for example in respect of data protection as described in the privacy policy - are not affected).

9. Your right to use the C the Signs Self-Assessment Service

9.1. We own or have the right to use all intellectual property rights used for the provision of the C the Signs Self-Assessment Service, including rights in copyright, patents, database rights, trademarks and other intellectual property rights.

9.2. You have permission to use the C the Signs Self-Assessment Service for the sole purposes described in these terms. You need written permission from us to use these items in any other way.

9.3. Unless permitted by law or under these terms, you will:

• not copy the C the Signs Self-Assessment Service except where such copying is incidental to normal use;
• not rent, lease, sub-license, loan, translate, merge, adapt or modify the C the Signs Self-Assessment Service;
• not combine or incorporate your (or any other) account in any other programmes or services;
• not disassemble, decompile, reverse-engineer or create derivative works based on the whole or any part of the C the Signs Self-Assessment Service;
• comply with all technology control or export laws that apply to the technology used by the C the Signs Self-Assessment Service.

10. Prohibited Uses

10.1. You may not use the C the Signs Self-Assessment Service:

• to collect any data or attempt to decipher any transmissions to or from our servers;
• in a way that could damage, disable, overburden, impair or compromise our systems or security;
• to transmit any material that is insulting or offensive;
• in a way that interferes with other users;
• in any unlawful manner or for any unlawful purpose;
• in a manner that is improper use or inconsistent with these terms;
• to act fraudulently or maliciously by hacking into the C the Signs Self-Assessment Service;
• to transmit, send or upload any data that contains viruses, Trojan horses, worms, spyware or any other harmful programs designed to adversely affect the operation of computer software or hardware;
• in connection with any kind of denial-of-service attack;
• unless you are accessing its services via the C the Signs Self-Assessment Service website in a web browser;
• on any device or operating system that has been modified outside the mobile device or operating system vendor supported or warranted configurations. This includes devices that have been "jail-broken" or "rooted".

If you do any of the above acts you may also be committing a criminal offence, and We will report any such activity to the relevant law enforcement authorities. We will cooperate with those authorities by disclosing your identity to them.

11. Our liability to you

11.1. Although We make reasonable efforts to provide, maintain and update the C the Signs Self-Assessment Service it is provided "as is" and, to the extent permitted by law, We make no representations, warranties or guarantees, whether express or implied (including but not limited to the implied warranties of satisfactory quality and fitness for a particular purpose), that the C the Signs Self-Assessment Service or any particular services you access through the app (a) are accurate, complete or up-to-date; (b) will meet your particular requirements or needs; or (c) will always be available, error free, uninterrupted or free of viruses.

11.2. We are not responsible for external links to or from the C the Signs Self-Assessment Service and cannot guarantee these will always work. 

11.3. Nothing in these terms excludes or limits our liability for:

1. death or personal injury arising from our negligence;
2. fraud or fraudulent misrepresentation;
3. any loss or damage to a device or digital content belonging to you, if you can show that a) this was caused by us and b) We failed use to use reasonable skill and care to prevent this; or
4. any other liability that cannot be excluded or limited under English law.

11.4. Subject to clause 11.3 of these terms, We will not be liable or responsible to you or any person you use an Self-Assessment Service on behalf of for:

• any harm, loss or damage suffered where this is not caused by i) our negligence (for instance, if a healthcare professional makes a misdiagnosis of your condition, or prescribes the wrong medication, or you make any independent decisions based on the information provided in the C the Signs Self-Assessment Service We would not be liable); or ii) our breach of these terms;
• any loss or damage arising from an inability to access and/or use the C the Signs Self-Assessment Service in whole or in part;
• any business loss (including but not limited to loss of profits, revenue, contracts, anticipated savings, data, goodwill or wasted expenditure);
• any indirect or consequential losses that were not foreseeable to both you and us when you commenced using the C the Signs Self-Assessment Service (loss or damage is "foreseeable" if it was an obvious consequence of our breach or if it was recognised by you and us at the time We entered into the contract created by your use of the C the Signs Self-Assessment Service).

11.5. This clause 10 does not affect any legal rights you may have as a consumer in relation to defective services or software. Advice about your legal rights is available from your local Citizen's Advice or Trading Standards Office.

12. General

12.1. These terms, and any other terms or policies referenced, set out the entire agreement between you and us in respect of your use of the C the Signs Self-Assessment Service.

12.2. These terms do not give any rights to any third party to enforce any of these terms.

12.3. Each of the clauses and sub-clauses of these terms operates separately. If any part is determined to be invalid or unenforceable it will be superseded by a valid and enforceable provision that most closely matches the intent of the original and all other terms shall continue in effect.

12.4. Even if We delay in enforcing these terms, We can still enforce them later.

12.5. The laws of England shall apply exclusively to these terms and all matters relating to use of the C the Signs Self-Assessment Service, and dispute shall be subject to the exclusive jurisdiction of the courts of England.

13. Previous Versions

13.1 These Terms of Use may change from time to time but We will inform you if We make any significant changes via your email or directly through the platform.