The Challenge for Scotland
Projections show that the number of people diagnosed with cancer is likely to rise to nearly 35,000 per annum between 2016 and 2020. This compares to around 30,000 patients per year between 2006 and 2010, reflecting the impact of Scotland's ageing population as well as improvements in diagnosis. More people will be living longer after their cancer diagnosis. There is therefore a need to ensure that appropriate rehabilitation and support services are in place. Targeted action continues to be a requirement to tackle persistent levels of inequality. People living in deprived areas are more likely to be diagnosed with cancer and have a higher death rate than those who live in more affluent areas.
Lifestyle factors such as smoking, poor diet, physical activity, obesity and excess alcohol consumption are important modifiable factors that contribute to the risk of getting cancer. The Scottish Government is implementing a wide-ranging programme of action to encourage healthy lifestyle choices, with a particular focus on tackling health inequalities. Community Health Partnerships have a critical role to play in ensuring an integrated response to these challenges which reflect the particular demands of local communities. The roll-out of the Human Papilloma Virus ( HPV) Immunisation Programme, represents a significant step forward in tackling cervical cancer.
Early Detection of Cancer
The earlier that cancer is diagnosed, the better the chance of a complete cure. The Scottish Government is committed to an evidence-based approach to screening, based upon the advice of the UK National Screening Committee and National Advisory Group in Scotland. The national screening programmes for cervical, breast and bowel cancers play a critical role in the national cancer strategy and opportunities will be taken to heighten public awareness of these programmes and target those groups who are less likely to attend or complete a screening programme. Screening programmes will continue to be developed in line with best practice. The Scottish Government is supporting the roll-out of the Scottish Bowel Screening Programme which will be fully implemented by the end of 2009.
Genetic and Molecular Testing for Cancer
A small number of cancers are caused by inherited genes that predispose an individual to a particular form of cancer, but it is increasingly understood that most, if not all, cancers arise from changes to the genetic material in individual cells. Scotland has a coordinated cancer genetic service based at four regional genetic centres and investment will ensure more genetic consultants, genetic counsellors, scientists and appropriate psychological support in order to further strengthen this service. A short-life working group including patients and other key stakeholders will also be asked to advise the Scottish Government on ethical issues surrounding consent, storage, and access to tissue samples.
Referral and Diagnosis
Key components of successful cancer management include early recognition and reporting of symptoms, expertise in identifying patients requiring prompt referral and rapid access to investigations and treatment. The Scottish Government will work with the Scottish Primary Care Cancer Group, NHS Health Scotland, health promotion teams, voluntary groups and others to assess how to improve public awareness of common cancer symptoms and encourage patients to present early. Priority also needs to be given to the development and auditing of electronic referral systems within NHSScotland to ensure that patients are referred quickly and appropriately between primary, secondary and tertiary care.
Cancer treatment can involve surgery, radiotherapy and chemotherapy or any combination of the three within a coordinated treatment plan. Effective service and workforce planning is required to ensure the appropriate capacity to deliver such treatments. This will be supported by regional and national audits, appropriate information systems and Managed Clinical Networks. Improvements will be made in horizon scanning to assess new opportunities to ensure that patients in Scotland continue to benefit from the latest technologies and techniques. Further action will be taken to improve the transparency and accessibility of the arrangements for introducing new cancer drugs into NHSScotland.
Living with Cancer
As Scotland's population ages, treatments advance and screening programmes prove increasingly effective at detecting cancers at an earlier stage, many more people will find themselves living with and beyond cancer. Many people affected by cancer in Scotland experience significantly lower levels of financial income as a direct result of their cancer diagnosis. The Scottish Government will work with the voluntary sector to improve the information and advice that is available to help them manage their conditions, sustain employment and access the benefits and support to which they are entitled. Funding will be provided through the new self-management strategy for Scotland to support a range of projects and organisations that support people to maintain their independence as much as possible and become genuine partners in the design and delivery of their care.
The publication of Living and Dying Well provides the basis for taking forward previous recommendations made by the Scottish Partnership for Palliative Care and Audit Scotland. For the first time Scotland now has a single, comprehensive approach to the development of palliative and end of life care services.
Improving Quality of Cancer Care for Patients
A wide-ranging approach to quality improvement is required in order to ensure that services are patient-centred, safe, effective, efficient, equitable and timely. Better Together, the new Scottish Patient Experience Programme, will prioritise action to improve cancer services on the basis of feedback from patients. By 2010, all of Scotland's tumour-specific networks will take part in national audit that will enable an ongoing programme of improvements to clinical practice, based on national indicators which allow benchmarking against other countries' approaches. As part of the programme of change designed to introduce the 18-week Referral to Treatment standard throughout Scotland by 2011, a new 31-day target will be introduced for cancer patients covering the period from the decision to treat to the start of treatment.
The delivery of this ambitious plan requires strong and effective clinical and managerial leadership. _A new Scottish Cancer Taskforce, chaired by the Deputy Chief Medical Officer, will oversee the implementation of the actions in this plan and will be charged with ensuring that the network of advisory and delivery groups is streamlined and fit for purpose.