Cancer waiting times standards in Scotland: clinical review

2. Comments from the Chair

Scotland's cancer strategy Beating Cancer: Ambition and Action, published in March 2016, included an aim to 'examine whether additional targets for treatment or diagnosis would improve outcomes for people with cancer.'

The publication of this blueprint for cancer care in Scotland provided an ideal opportunity to review Cancer Waiting Times ( CWT) Standards in Scotland to shape information that could significantly change and enhance the patient experience, while determining if any amendments to the standards would meet the needs of patients and the NHS for the future.

There is wide clinical agreement that the standards have been crucial in driving improvements in performance and patient care. However, while the introduction of new CWT standards in Scotland in April 2010 initially resulted in marked improvements in performance of cancer pathways, there has been deterioration in performance against the 62 day standard more recently. Latest statistics, at the point of publication (from October - December 2017), show performance for the 62 day standard at 87.1% and 94.5% for the 31 day standard.

I was asked to Chair a steering group to consider the current and future position of the CWT standards in Scotland. This multidisciplinary group comprised of NHS managers, ISD Scotland representatives, primary and secondary care clinicians and Scottish Government officials, reflecting a wide spread of geography and expertise.

A key milestone in the Review process was a large stakeholder event that took place in June 2017 to ensure the views of all interested parties were captured at an early stage. This was supported by a patient and public questionnaire and ongoing engagement with colleagues in the Scottish Cancer Coalition.

The Review process identified a significant challenge, especially to the 62 day standard with increasing numbers of patients going through the Urgent Suspicion of Cancer ( USC) referral pathway and thus impacting on diagnostics and other high risk patient groups. Conversely only small proportions of these referrals result in cancers being diagnosed (3-5%).

The Review process demonstrated at an early stage that the introduction and maintenance of CWT standards in Scotland had improved the collection of cancer related data and the efficiency of cancer pathways, while allowing comparisons within Scotland over time as well as with other countries. Thus, the retention of CWT standards was agreed in principal from the outset.

A selection of recommendations reflecting the main themes explored during the Review, and contained in this report, were produced and agreed as a framework for change.

Post review the initial action should be to fine tune the process to ensure that only higher risk individuals come in to the USC pathway. This will involve refining the referral guidelines for primary care, making triage of referrals smarter in secondary care, improving direct access to diagnostics from primary care and thus stratifying USC patients according to agreed clinical urgency.

There will of course be differences in the pace of adoption of these recommendations among NHS Boards. Progress may be monitored initially by the Ministerial Cancer Performance Delivery Group.

As Chair of this independent clinical review, I would like to thank everyone across the NHS, Scottish Government, public, third sector and beyond who has taken part and fed into this valuable piece of work to ultimately improve cancer outcomes for the people of Scotland. I would particularly like to thank the hard–working members of the steering group for all their enthusiasm and input.

If you have any comments in regards to the Review or this report please feel free to make contact via cancerdeliveryteam@gov.scot

Dr Valerie Doherty
Chair of Clinical Review of Cancer Waiting Times ( CWT) Standards