Publication - Strategy/plan

Bowel Cancer Framework for Scotland

Published: 20 Apr 2004
Part of:
Health and social care

Bowel cancer is an improtant health issue worldwide and, in Scotland, it represents a major problem. In this framework the key components of a national bowel cancer service programme are outlined.

29 page PDF

362.8 kB

29 page PDF

362.8 kB

Bowel Cancer Framework for Scotland
Page 5

29 page PDF

362.8 kB



Cancer in Scotland (2001) reaffirmed patients' right to access clinically effective treatment, delivered safely and with minimum disruption to their lives and that to achieve this effective multi-professional and multi-disciplinary team working was essential.

The three regional cancer groups have made much progress over the last three years. Multi-disciplinary team working and tumour specific cancer networks are in place for most cancers and in most geographical areas. This is true for bowel cancer, with all regions having recognised groups of clinicians working together across institutional and geographical boundaries, in line with the accepted definition of a managed clinical network (NHS HDL (2002) 69).

All three networks audit their services and outcomes in accordance with the requirements of NHS Quality Improvement Scotland (NHS QIS) (previously Clinical Standards Board for Scotland (CSBS)) bowel cancer standards. This emphasis on improving quality is recognised throughout the world as having the potential to improve outcomes for patients, as well as bringing improvements in services.

As part and parcel of the continuous quality improvement cycle that is the founding principle of managed clinical networks, it is the role of Scottish bowel cancer networks to ensure that patients have access to the best possible diagnostic and treatment services with consistency of approach in the management of bowel cancer, including evidence-based aftercare and rehabilitation.

NHS QIS has developed a Quality Assurance/Accreditation Framework for cancer services. Each of the three regional networks are planning for NHS QIS accreditation during the summer of 2004. This QA/Accreditation process will further define the improvements expected by each of the bowel cancer networks.

For any cancer service a highly trained and effective surgical workforce is essential. It is known that the quality of surgery in Scotland is already high. However, there is always room for further improvement and Royal Colleges, along with NHS Education for Scotland and workforce planning and development colleagues may wish to consider whether there is a need to plan for a programme of training in highly specialised surgical techniques unique to bowel cancer, for example meso-rectal excision.

Currently, arrangements are being put in place in England to support such a programme. Laparoscopic surgery is also a highly specialised field (although not unique to bowel cancer). Training in bowel surgery is already available in several units across Scotland. However, to ensure that training programmes continue to support surgical services as they grow and develop, the Surgical Royal Colleges have been debating changes to surgical training which would probably mean strengthening of specialist training in colorectal surgery. This has also been discussed at the Joint Committee on Higher Surgical Training and the Senate of Surgery for Great Britain and Ireland and will be discussed further at a meeting to be held in the spring. Although the outcome is awaited, there are a number of Scottish surgical units that are well placed to support any new models of advanced bowel surgical training that may subsequently emerge.

Capacity and demand modelling will help inform need for HDU beds and other specialised care that is essential for patients undergoing bowel surgery.

Planning for radiotherapy provision for the longer term is currently being reviewed by a dedicated working group set up by the Scottish Executive Health Department. It is anticipated that this work will take approximately one year.

As far as chemotherapy provision is concerned, following the recommendations of the Scottish Medicines Consortium (SMC) and National Institute for Clinical Excellence/NHS QIS guidance it is a matter for Regional Cancer Advisory Groups, regional planning groups and their constituent NHS Boards to plan appropriately for the introduction of new drugs.

NHS Boards must ensure that drugs or treatments recommended by SMC are made available to meet clinical need within three months of the publication of that advice or within the timeframe specified within any national implementation plan for that drug or treatment.

This advice does not override or replace the individual responsibility of health professionals to make appropriate decisions in the circumstances of their individual patients, in consultation with the patient and/or guardian or carer.

Where the SMC consider that a drug is unique and innovative NHS Boards must make provision for this drug to be made available also according to clinical need. This is in line with HDL (2003) 60.


Basic Elements

  • Good technique and appropriate patient selection

  • Short waiting times for surgery

  • Functional multi-disciplinary teams (MDTs)

  • High quality radiotherapy

  • High quality chemotherapy

  • Short waiting times for treatment

What is required?

What is already happening?

Next steps

Service Implications - Surgery

Good technique and appropriate patient selection

  • Appropriately trained and accredited surgeons

  • Training and accreditation programme - increasing emphasis on laparoscopic surgery may be required

Waiting times for surgery in line with 2005 target and NHS QIS (CSBS) standards

  • Sufficient numbers of trained surgeons

  • Sufficient staffed theatre time

  • Sufficient numbers of ward and HDU beds

  • Eliminate delays in process from diagnosis to surgery

Waiting times

  • Work ongoing to enable reporting of performance against the 2005 target

  • CSIP facilitators in North and West of Scotland working with networks to implement changes resulting in a reduction in the number of steps in the process

Nationwide surgical audit

  • Scottish Audit of Surgical Mortality (SASM)

  • Workforce planning and development implications assessment

  • Surgical Royal Colleges discussing possible changes to surgical training

Waiting times

  • Assessment of MCN performance against NHS QIS (CSBS) standards and national target for 2005

Research Implications - Surgery

Good technique and appropriate patient selection

  • Research into defining technique that is associated with good outcomes - this includes operative technique and post-operative care

  • Continued trials of laparoscopic surgery

Service Implications - MDT

Audit of MDT activity

Audit of bowel cancer ongoing in all three bowel cancer networks. Audit data published in West and South East Scotland annual reports

First national report across three regional networks published April 2004

Service Implications - Oncology

High quality radiotherapy

  • Appropriately trained Clinical Oncologists

  • Appropriate access to radiotherapy

  • Sufficient numbers of LinAcs

High quality chemotherapy

  • Appropriately trained Clinical/Medical Oncologists

  • Appropriate use of effective drugs - requires urgent reassessment of NICE/NHS QIS guidance

  • Short waiting times for treatment

  • Sufficient staffing, for example Clinical and Medical Oncologists, Pharmacists, Therapy Radiographers, Cancer Nurses and Radiation Physicists


  • SIGN/Royal College of Radiologists guidelines


  • SIGN/Joint Council for Clinical Oncology (JCCO) guidelines and Scottish Executive Guidance

Waiting times

  • Assessment of MCN performance against NHS QIS (CSBS) standards

  • Work ongoing with ISD to support routine reporting of performance against the 2005 target


  • Scottish Executive supporting ongoing Radiotherapy Equipment modernisation programme that has seen more than 33m committed since 1997 with state of the art linear accelerators now in place in all five Scottish Cancer Centres

  • Scottish Executive Radiotherapy Activity Planning Project underway for period to 2010-14, that includes workforce and capacity planning and modelling


  • Updating HDL (2002) 22 on the safe administration of intrathecal cytotoxic chemotherapy

Research Implications - Oncology

High quality radiotherapy

  • Research into appropriate use of radiotherapy - clinical trials of adjuvant and palliative radiotherapy

  • Research into individualising treatment on the basis of tumour/patient parameters

High quality chemotherapy

  • Research into the appropriate use of chemotherapy - clinical trials of adjuvant and palliative chemotherapy

  • Development of new chemotherapeutic agents

  • Development of novel therapies

  • Research into individualising treatment on the basis of tumour/patient parameters

  • Establishment of Scottish Cancer Research Network (SCRN)

  • Links with National Cancer Research Network (NCRN) and National Cancer Research Institute (NCRI)

  • The NCRN Process

See section on prevention

  • Role of the developing Scottish Cancer Research Network in building portfolio of trials and doubling patient participation in trials

  • National Translational Research Centres (NTRAC) established in Scotland (one Dundee/Glasgow virtual centre and one in Edinburgh)

  • Co-ordination of SCRN/NTRAC activities