Cancer Action Plan: annual progress report 2024-2025

3. Progress against ambitions

Ambition 1 – Preventing more cancers

Our 10-year vision is that Scotland is a place where the new generation of young people do not want to smoke. It is a place where everyone eats well and has a healthy weight, underpinned by a population that is more physically active. Alcohol is no longer a major cause of cancer. The incidence of preventable cancers, such as cervical cancer, is reduced.

3.1. This ambition relates to actions 1-9 in the Cancer Action Plan 2023-2026.

3.2. The Tobacco and Vaping Framework : roadmap to 2034 was published in November 2023. This sets out the roadmap and decisive actions to reach a tobacco free Scotland by 2034, tackling the biggest preventable risk factor for cancer. During the first two-year implementation period, the Scottish Government committed to working with the UK Government and Devolved Governments and Administrations on 4-Nation approaches. This led to the 4 Nations joint public consultation Creating a smokefree generation and tackling youth vaping - GOV.UK.

3.3. The UK wide Tobacco and Vapes Bill (the Bill) was reintroduced to the UK parliament on 5 November 2024. The Bill aims to create a smoke-free UK and will gradually end the sale of tobacco products across the country, which is intended to break the cycle of addiction and disadvantage. The Bill, if passed, will enable regulation to strengthen the existing ban on smoking in public places to reduce the harms of passive smoking. It will ban vapes and nicotine products from being deliberately promoted and advertised to children to stop the next generation becoming addicted to nicotine. The Bill will strengthen enforcement activity to support the implementation of the measures within it as well as broaden our pre-existing tobacco and vapes register by including nicotine products and herbal smoking products. The Scottish Parliament provided unanimous legislative consent to the UK wide Tobacco and Vapes Bill on 29 May 2025. The Scottish Parliament’s consent to this landmark legislation will ensure that children born after 1 January 2009 can never be legally sold tobacco.

3.4. As part of our Tobacco and Vaping Framework an assessment of the effectiveness of existing smoke free spaces in Scotland’s hospital grounds, as well as review of further options, is being led by ASH Scotland. The Tobacco and Vapes retail register has been an asset to enforcement authorities in Scotland for over 15 years. A refreshed Tobacco and Vapes retail register was launched in January 2025, which supports enforcement as well as for engagement with retailers on compliance.

3.5. Smoking Cessation Services are essential to ensuring people have access to the right support, at the right time, to quit smoking. The Scottish Government are continuing to implement the recommendations from the PHS Review of smoking cessation services in Scotland and to consider how these important services can continue to develop in the future. This includes the Public Health Action Team on Smoking Cessation, a collaboration between PHS, Scottish Government and NHS Boards, which is supporting the continuous improvement of local smoking cessation services. The NHS stop smoking service Quit Your Way Scotland offers expert advice and directs users to local services where they can access a range of support, medications and products.

3.6. In the first year of the action plan, a Public Health Scotland evaluation, estimated that our world-leading Minimum Unit Pricing (MUP) policy for alcohol has likely averted hundreds of alcohol-attributable hospital admissions and deaths, and contributed to tackling health inequalities. The estimated reductions in deaths and hospital admissions wholly attributable to alcohol were largest among men and among those living in the 40% most deprived areas in Scotland, indicating that MUP contributed to addressing alcohol-related health inequalities. Since then, the Scottish Parliament agreed to continue MUP and to set the price per unit at 65 pence, aiming to further increase its public health benefits. Engagement with key business associations and retail groups ensured maximum awareness of the price increase and implementation date as it came in to force in September 2024.

3.7. Additionally, the Scottish Government remains committed to progressing work on protecting children and young people from exposure to alcohol advertising, and commissioned PHS to carry out a review of the evidence for the range of options that are available to the Scottish Government under devolved powers. Although outside of the reporting period, Scottish Government, at the time of writing this report, notes the publication of this on 2 September 2025 (Rapid review of evidence about alcohol marketing and advertising). Scottish Government will consider PHS’ findings and consider where the evidence might support further action or consultation on alcohol marketing restrictions.

3.8. We continue to work with Scottish Health Action on Alcohol Problems (SHAAP) to raise awareness amongst health professionals about the links between alcohol consumption and cancers to support intervention, and so that they can use opportunities in their work to intervene to reduce the risks.

3.9. The Scottish Government continued to further embed learning from the 2022 SHAAP published report ‘Alcohol and Cancer Risks: A Guide for Health Professionals’ (Alcohol and Cancer Guidance 2025) by developing a national service specification for alcohol and drug services. This will be included in a new Alcohol and Drugs Strategic Plan, which is due to be published in 2026.

3.10. The Scottish Government continues to work alongside other UK Nations to deliver key actions and support the UK Government’s commitment to expand on the existing voluntary guidelines for alcohol labelling by introducing a mandatory requirement for alcoholic drinks to display consistent nutritional information and health warning messages, as part of their 10-year Health Plan published in June 2025.

3.11. We remain encouraged that there are no cases of Cervical Cancer to date in fully vaccinated women who received their HPV vaccination at aged 12 and 13 years old since the HPV programme was first introduced in 2008.

3.12. We continue to deliver the one dose HPV vaccine schedule, introduced in January 2023, to every S1 pupil in Scotland. Although the vaccine coverage for the HPV vaccination programme in Scotland remains high, with 88.7% of females having received the vaccine by the end of S4, we recognise that the number of young people receiving their teenage immunisations has declined, with females in the most deprived areas least likely to take it up. This decline in immunisation uptake rates has been observed across the UK and globally.

3.13. The Cervical Cancer Elimination Expert Group was formed in the first quarter of Year 2 to consider how to achieve Cervical Cancer Elimination in Scotland. Sub-groups were agreed for Vaccines, Screening and Treatment and have been identifying options to progress further in these areas.

Ambition 2 – Earlier and faster diagnosis

Our 10-year vision is that later stage disease (stages III and IV) has reduced by 18 percentage points. A focus will remain on reducing the health inequality gap, particularly those from areas of deprivation.

This ambition relates to actions 10 to 46 in the Cancer Action Plan 2023-2026.

Improving public education and empowerment

3.14. We re-ran our high impact Detect Cancer Earlier (DCE) Programme ‘Be the Early Bird’ behaviour change campaign across Scotland in August 2024 and March 2025, using mixed media including TV, digital and ‘out of home’ i.e. outdoor advertising. A new bird – ‘Bonnie the seagull’ – was introduced to the campaign creative in March 2025 to highlight head and neck cancer symptoms.

3.15. The ‘Be the Early Bird’ campaign uses available data and insight to target areas of deprivation. A multi-channel approach is adopted to reach and empower individuals with unusual persistent symptoms to take action.

3.16. Paid-for media advertising was used to ensure widespread reach and frequency of message with the target audience, building belief and empowering changes in behaviour. Public Relations further helped create visibility of the campaign in the media and counteract fatalistic attitudes through the telling of living well stories and clinical advice, helping to shift attitudes. Community roadshows have allowed deeper engagement with members of the public in their communities. Partnerships have helped extend the reach of the campaign through the channels of trusted brands/stakeholders. The getcheckedearly.org website continues to enable change, being a place to find information, view case studies of people living well after treatment, and offers a symptom checker tool for those concerned about possible symptoms.

3.17. We published a full campaign Evaluation Report in June 2025. The ‘Be the Early Bird’ campaign has demonstrated a strong performance across both of its 2024-25 phases, meeting or exceeding 9 out of 10 SMART objectives. The campaign’s impact is evident in the high levels of recognition, engagement and reported action, and increased visits to the getcheckedearly.org website. While the objective ‘to maintain the proportion of the target audience who disagree that they wouldn’t want to find out if they had cancer because they would be worried about the impact on their family’ was narrowly missed, there was some positive movement. Changing entrenched attitudes and beliefs such as fear around cancer will take time and repeated exposure to positive messaging. This indicates a need to continue efforts to shift these long-held attitudes.

Supporting primary care

3.18. Clinical review of the Scottish Referral Guidelines (SRGs) for Suspected Cancer was completed to help ensure the right person is on the right pathway at the right time (Scottish Referral Guidelines for Suspected Cancer 2025). Healthcare Improvement Scotland and Cancer Research UK presented comprehensive evidence with over 200 pieces of evidence analysed and considered by representatives from across NHS Scotland. Although not part of this reporting period, at time of report writing the SRGs have been published. This included for the first time guidance for referring people presenting with non-specific symptoms suspicious of cancer.

3.19. A new primary care cancer education platform – Gateway C – was launched on 30 April 2024 across NHS Scotland, supported by NHS Education for Scotland (NES). Gateway C provides innovative and tailored information to support earlier cancer diagnosis efforts and enable effective decision-making. This free online platform is accessible to all primary care clinicians including pharmacists, dentists, and optometrists.

3.20. We continue to drive our Inclusion Health Action in General Practice (IHAGP) programme to address health inequalities in Primary Care. Longer consultations for patients with high or complex needs are required as well as an improvement in patient experience and engagement, with a need to target resources in areas of deprivation. We published an Early Evaluation Report in July 2024. Clear successes were captured relating to patient care and support, changes in working culture and improved connection with, and health outcomes for, patients. We have invested a further £1 million in 2025/26 and continue to identify ways to engage with those not already engaged with services. We have commissioned an evaluation of extended consultations and outreach to understand the most impactful interventions for those from the most deprived areas, who are less likely to engage.

Optimising screening

3.21. Modernisation of and improved access and availability to the breast screening programme is ongoing. In Year 1 of our Action Plan, self-referral for breast screening was recommenced for those aged 75 and over and screening centres continued to offer 2% of their capacity to support appointments for people over-70 with the option to increase where capacity arises.

3.22. The Breast Screening Modernisation Board, which was formed to take forward the recommendations in the Major Review of the Scottish Breast Screening Programme report published in May 2022, met for the last time in 2025 and provided a final report to the Scottish Government. Following this, we have commissioned Screening Oversight and Assurance Scotland to take these recommendations forward. This will begin exploring a nationally managed breast screening service, which was a key recommendation within the Board’s report. This will then allow for a more effective and consistent implementation of other recommendations within the report across Scotland’s six breast screening centres.

3.23. The Scottish Expert Advisory Group for lung screening, which was tasked with providing advice on the scoping, implementation, establishment and delivery of a targeted lung cancer screening programme, has concluded their work and provided a costing model to the Scottish Government. This has provided valuable insight into the anticipated requirements for a national lung screening programme, however, it has also highlighted significant constraints, such as the availability of equipment, recruitment of staff and development of the necessary infrastructure. Therefore, the group estimated that it would take 7-10 years for a full lung screening programme to be implemented due to the complexities, also recognised by the UK NSC, of rolling out a targeted lung screening programme.

3.24. The Scottish Government have therefore committed to a targeted lung screening pilot in the Population Health Framework 2025-2035, which will support the phased roll out of a national lung screening programme. This pilot, currently expected to launch in 2027, will allow us to invite eligible individuals from more deprived areas ahead of a full national rollout, enabling earlier screening for those at significantly higher risk of developing lung cancer and experiencing disproportionately high mortality rates.

3.25. In Year 2 of the Action Plan, the Scottish Government has welcomed the recommendation from the UK National Screening Committee, which recognises HPV self-sampling could improve accessibility and increase uptake of cervical screening. Work is ongoing in Scotland to deliver self-sampling to those who are eligible in a phased manner, with plans being finalised for the start of the roll-out. To introduce self-sampling as quickly as possible, we will begin by offering it to women living in some of our most deprived areas, which evidence shows have lower levels of uptake, in the spring of 2026. This will provide valuable insight and evidence to support the wider roll-out of self-sampling.

3.26. The Equity in Screening Implementation Group (ESIG) continues to oversee implementation of the 41 actions in the Equity in Screening Strategy. The three-year plan is in the final year, and therefore Screening Oversight and Assurance Scotland have begun work on the next Strategy, to be published in 2026. They will engage and consult with health boards and other organisations with responsibility for screening as part of this process.

3.27. All NHS Boards have implemented their Equity Strategies for Screening. We have made available £1 million in 2025/26 to support them to deliver local initiatives, and to PHS and Screening Oversight and Assurance Scotland for national initiatives to tackle inequalities.

Enhancing diagnostics

3.28. We expanded our Rapid Cancer Diagnostic Services (RCDS), with NHS Forth Valley opening their new service in May 2025, bringing the national total to six. The RCDS implementation guide was published and will support NHS Boards to consider how best to deliver a RCDS to meet local needs. We continue to work with NHS Boards to consider patient pathways for those with non-specific symptoms suspicious of cancer to ensure cancer is diagnosed or ruled out as quickly as possible. The newly published SRG for non-specific symptoms of cancer further enhances this.

3.29. Delivery and implementation of the Endoscopy and Urology Diagnostic Plan continues, including the expansion of Urology Diagnostic Hubs and adoption of alternatives to traditional endoscopy. New Quantitative Faecal Immunochemical Test (qFIT) guidance has been published, with NHS Boards validating existing waiting lists using the new guidance. The Endoscopy Reporting System (ERS) is now live in two NHS Boards and the eNHS Scotland Academy confirmed that they will take the next cohort for the Endoscopy Assistant Practitioner Programme, starting October 2025.

3.30. We continue to support NHS Boards to implement the Optimal Lung Cancer Diagnostic Pathway, and the Head and Neck Cancer Diagnostic Pathway, with further funding and toolkits. The Centre for Sustainable Delivery (CfSD) began development of the Optimal Colorectal Cancer Diagnostic Pathway, and it is expected to publish in 2025. The adoption of Once for Scotland clinical diagnostic pathways developed by CfSD’s specialty delivery groups (SDGs) continue to ensure patients are on the correct pathway at the correct time.

3.31. The Scottish Strategic Network for Diagnostics (SSND) was fully established in Year 1 of the Action Plan and reports to the NHS Scotland Strategic Planning Board. SSND workplans align with the plans of the five national diagnostic networks. In year 2 of the Action Plan there was engagement with the diagnostics wider delivery environment. Scottish Government has developed a diagnostics transformation plan and is working to develop a Target Operating Model for diagnostic disciplines.

Investing in innovation

3.32. The Scottish Government has commissioned the Accelerated National Innovation Adoption (ANIA) pathway to deliver a once for Scotland approach to the identification, assessment and accelerated national adoption of medical technologies that could have a transformative impact on patient outcomes. The first programme to come through ANIA is targeted at improving the referral pathway for suspected skin cancer. Rollout began in November 2024. The new app which allows GPs to use their own mobile device to attach an image to a dermatology referral is now available to all GP practices across Scotland. This has the potential to significantly reduce the dermatology waiting list by diverting around 50% of patients each year either back to their GP with advice or direct to treatment through the creation of a digital tirage process in secondary care.

3.33. Scottish Government are working collaboratively with the third sector to drive service redesign efforts including CRUK’s Test, Evidence, Transition (TET) Programme. It aims to accelerate the effective adoption of innovative pathways, whilst working to reduce inequality in access to proven interventions. The University of Stirling published evaluations of the NHS Fife and NHS Forth Valley projects aiming to reduce waiting times and supporting earlier diagnosis efforts, in the prostate and breast cancer pathways respectively. Colorectal projects associated with endoscopy and qFIT are underway in NHS Borders and NHS Greater Glasgow and Clyde.

Harnessing data

3.34. PHS continued to deliver against the data roadmap that was developed in Year 1 of the Action Plan that outlines key timelines for delivery within the Cancer Strategy. We are working with PHS to publish more timely staging data for additional cancer types, starting with head and neck cancers and other common cancers. In 2024, updates to statistics were postponed due to delays to the production of the National Records of Scotland Mid-Year Population Estimates following the 2022 Census. However, PHS subsequently obtained data that allowed them to publish in 2025 the cancer incidence and mortality deprivation reports for 2022, and they will publish 2023 incidence (again, minus deprivation initially) in September 2025.

3.35. Validation of urgent suspicion of cancer (USC) referral data has continued between NHS Boards and PHS, with the intention to include this data in future cancer waiting times (CWT) publications. The quality and comparability of Cancer Quality Performance Indicators and Cancer Registry staging data has been reviewed, initially finding that the definitions are often different. Further work will follow to harmonise definitions and metadata. PHS can now view QPI data directly via the new BOXI reporting system. The Cancer Incidence in Scotland report was published in November 2024, which included staging data from 2022 (2022 Cancer Staging Data).

3.36. Scottish Government continues to focus on the availability and quality of Primary Care cancer data to enable service improvement. NSS is leading on a Primary Care Data Intelligence Platform to improve access to primary care data. PHS is also exploring primary care data as part of a pilot with an NHS Board. This will be used to familiarise PHS with primary care patient level data and assess the potential uses to fill several data gaps that would be vital in improving understanding of the cancer journey for patients in Scotland. It will also be assessed for its capacity to report early signs and symptoms of cancer.

3.37. We continue to improve the availability of cancer diagnostic datasets. PHS has begun to collect regular RCDS data quarterly, which will inform the future direction of RCDSs and non-specific cancer pathways in NHS Scotland. PHS now have a full year of data and are planning to publish high level outputs in 2025.

3.38. The Scottish Government continues to consider additional measurements for monitoring improvements in blood and neurological cancer pathways. Working with experts in this area, and wider UK nations, further work is required to define ‘avoidable’ emergency presentation diagnoses. PHS are exploring the potential proxy measures that may be used as an alternative to staging where appropriate, following engagement with the third sector.

3.39. PHS now publishes rates of emergency and non-emergency diagnoses for 18 cancers, with the first annual report published in August 2025. Routes to Cancer Diagnosis, Cancer Stage and Curative Treatment for Cancer Information to Support Visions from the Cancer Strategy

Diagnosing faster

3.40. Scottish Government commissioned a clinically led review of the latest data and evidence to determine whether there is merit in specific additional or alternative cancer waiting times standards for different types of cancer and cancer treatment. Any amendments to standards must enhance patient experience and outcomes. A range of stakeholders are expected to be engaged when the review begins.

3.41. CfSD has continued to review the Framework for Effective Cancer Management (FECM), relaunching a refreshed version in February 2025. Onsite visits have been ongoing to support implementation. A FECM toolkit was developed, including best practice examples. In-depth demand, capacity, activity, queue (DCAQ) analysis has been undertaken for prostate cancer pathways. This work will form an understanding of national capacity and highlight areas for future improvement.

3.42. The Scottish Government continues to support NHS Boards to progress improvement plans, providing an additional £11.3 million to NHS Boards in 2024/25. Most funding was directed to urology, colorectal and breast – the three most challenged tumour types. In addition, in 2024/25, an initial investment of £30 million was provided to target reductions to the national backlogs that built up throughout the pandemic with over £1.7m of this funding directed towards diagnostics and treatment for patients referred with an urgent suspicion of cancer to reduce waiting lists.

3.43. Each Territorial Health Board has provided updated 62-day performance improvement plans for 2025/26, detailing what is being done at local levels to drive improvements. £14.23 million of the £110 million planned care funding available in 2025/26 across NHS Scotland is being directed towards Cancer Waiting Times.

3.44. Originally due to end in March 2024, the pathway improvement project for hepatocellular carcinoma and pancreatic (HPB) cancers, renamed the Scottish Care and Co-ordination Service for HPB Cancer (SCOT-HPB), was extended for a further year to consider lessons learned so far and potential ways that the pilot model could be implemented sustainably. This pathway improvement initiative was the first of its kind across the UK. It aimed to explore the potential benefit of an additional co-ordination support layer to existing HPB cancer pathways and had not replaced them.

3.45. Findings noted that the goals of the pilot service to improve scan to treatment time and communication were valid and worthwhile, but there was a clear need to do more for this group of patients to materially change their outcomes. There was a need for consistent nationally agreed diagnostic and treatment pathways, rather than an additional co-ordination layer to existing highly variable pathways.

3.46. To that end, the Scottish Government commissioned the Scottish Hepato-Pancreato-Biliary Network (SHPBN) to use the learning from the SCOT-HPB pilot in addition to existing clinical evidence to develop full standardised pathways. These will address sustainable and equitable access to care and treatment to improve outcomes for people with HPB cancers. Working with CfSD, the SHPBN will deliver these within the lifetime of this first Action Plan.

Ambition 3 – Best preparation for treatment

Our 10-year vision is every person diagnosed with cancer in Scotland is provided with timely, effective, and individualised care to best prepare them for treatment. This begins with prehabilitation and holistic needs assessment and continues throughout the individual’s pathway of care, including appropriate follow up. A comprehensive range of cancer genomic tests is available to all those who could benefit.

3.47. This ambition relates to actions 47-55 in the Cancer Action Plan 2023-2026.

Prehabilitation

3.48. Scottish Government is developing a partnership with CfSD that will explore the potential for digital innovation in supporting the delivery of prehabilitation and strengthening partnerships with existing stakeholders. The Macmillan National Improvement Advisor-Prehabilitation post established in Year 1 of the Action Plan continued to lead on feasibility testing with clinical teams to embed the prehabilitation website and screening into pathways of care and supported development of digital technology for use within cancer pathways. The Scottish Health Technologies Group assessed the role of digital in cancer prehabilitation.

3.49. Following successful piloting of a National Cancer Prehabilitation Screening Toolkit, the agreed screening tools will be added to the Right Decision Service (RDS). Digitisation will ease the screening process and support triaging and assessment to support the right person getting the right service at the right time.

3.50. Scotland’s cancer prehabilitation website also continues to be developed and embedded within pathways of care. This supports the implementation of universal level prehabilitation and ensures evidence-based information and advice is readily available to people affected by cancer across Scotland. It also hosts guidance and frameworks, providing staff working with people affected by cancer with up-to-date evidence-based information that supports service development and delivery.

3.51. Following investment by Scottish Government in 2021-2024, Maggie’s have continued to deliver a universal prehabilitation programme through each of their eight Scottish centres. Their cancer prehabilitation workshops supported 1,468 people affected by cancer from April 2024 – end June 2025.

3.52. Following the development of a universal prehabilitation workshop toolkit by NHS Education for Scotland in Year 1, Ayrshire Cancer Support also began to offer cancer prehabilitation workshops in late 2024. Their workshops supported 28 people affected by cancer to end June 2025.

3.53. During 2024-25, the national Nutrition in Cancer (Prehabilitation) Group have worked collectively to develop tools that aid implementation of the Nutrition Framework for People Affected by Cancer and adequately assess the nutritional needs of people affected by cancer. This has been achieved by supporting the national screening pilot (see 3.34) and by undertaking local work that extends nutrition screening into outpatient settings. In addition, prehabilitation advocates in NHS Greater Glasgow and Clyde have worked with the World Cancer Research Fund Nutrition Helpline to test how this could enhance nutritional care and cancer pathways. When available, the National Nutrition in Cancer Group will learn from the outcomes of this work and make appropriate recommendations.

3.54. Questions related to the Nutrition Framework, nutrition screening, and the prehabilitation website were incorporated into the 2025 prehabilitation survey. Although not part of this reporting period, at time of writing survey results have been published.

Genomics

3.55. The genomic medicine strategy and one-year implementation plan has been published.

3.56. The development of the Scottish Strategic Network for Genomic Medicine (SSNGM) is an integral action acting as a front door for genomic healthcare in Scotland and a means of linking together expertise across the NHS, academia and industry. Scottish test directories for cancer and rare and inherited conditions (including testing for inherited cancer syndromes) are available on the SSNGM website. Following the funding and national implementation of six of the eleven priority cancer testing pathways in Year 1 of the Action Plan, exploratory work is underway for the further expansion of genomics testing as part of the NHS National Services Division (NSD)’s laboratory transformation plan, which is looking at service delivery models.

3.57. NHS Greater Glasgow and Clyde (NHSGGC) is involved in preliminary work for molecular tumour board (MTB) models, which integrate genomic data to guide personalized cancer treatment. They have supported the development of scalable, digital tools like the MDT Cancer Referral App to facilitate these discussions.

3.58. SSNGM held regular webinars in collaboration with the Thyroid Cancer Network on genomic testing pathways for thyroid cancer. Further webinars were held on other areas of the cancer test directory, in collaboration with SPAN.

Ambition 4 – Safe, realistic, and effective treatment

Our 10-year vision is that all people with cancer have equitable access to treatments, with minimal variation in care. Where someone’s cancer can potentially be cured, they have access to the best available treatment to achieve this. Pathways benefit from new technologies and tests allowing earlier treatment and leading to better outcomes. The Scottish Cancer Network is at the centre of this work, developing national clinical management pathways for all people with cancer.

3.59. This ambition relates to actions 56-69 with references to actions 77, 78 and 88 in the Cancer Action Plan 2023-2026.

3.60. The Scottish Government has continued to provide funding for the Scottish Cancer Network (SCN), who continue to host the five National Managed Clinical Cancer Networks (MCNs) and the Clinical Management Pathways Programme (CMP).

3.61. Following extensive consultation, the SCN published Clinical Management Pathways for Prostate Cancer in 2025 and Head and Neck Cancers in 2024. These are available on RDS. Systemic Anti-Cancer Therapies only CMPs for Renal Cancer and Melanoma are underway. All MCNs continued to deliver on core actions, such as holding education events and helping to monitor quality through cancer quality performance indicators.

Robotic Assisted Surgery

3.62. Scottish Government has commissioned PHS to develop and implement the Robotic Assisted Surgery (RAS) Audit. This will ensure robust data collection is in place, allowing for the monitoring of performance and identification of inequity so that improvements can be driven forward. This will actively inform plans to increase the delivery of RAS across Scotland in a sustainable and effective way.

Radiotherapy

3.63. Oversight and support for the implementation of the National Radiotherapy Plan for Scotland as part of the wider Cancer Strategy continued. The Scottish Oligometastatic Stereotactic Ablative Radiotherapy (SABR) Network continued, supporting the continued roll out of SABR across Scotland.

3.64. The Chief Scientist Office (CSO) is assessing the current evidence on the use of photons vs proton beam therapies to develop a long-term view of patient access in Scotland.

3.65. Further to this, fifty-three radiographer trainees completed training in June 2023. Capital replacement continued to be managed by the Technical Specification and Evaluation subgroup (TSE) with successful delivery of equipment on a rolling basis.

Systemic anti-cancer therapy services

3.66. All regions and related NHS Boards received additional funding for Systemic Anti-Cancer Therapy (SACT) services, with £4.6 million released in 2024/25 to support boards to meet recognised pressures. The Scottish Government has continued to meet the commitment to increasing national resourcing for SACT and Acute Oncology Services up to £10 million per annum by 2027, by increasing this figure to £6.6 million in 2025/26.

3.67. The Oncology Transformation Programme has continued and in the last period undertaken extensive engagement to develop a target operating model (TOM) for oncology. The TOM will provide a proposed nationally agreed blueprint for the future direction of oncology services in NHS Scotland. We continued to support the transition to a single national way of working regarding the electronic chemotherapy prescribing system, recognising that this will be a step change process in coming years.

3.68. Scottish Government supported Scottish Medicines Consortium (SMC) and National Cancer Medicines Advisory Group (NCMAG) advice to be consistently implemented in Scotland. This included integrating NCMAG’s approval process into the medicines landscape and the formalising the relationship with the SMC and the Cancer Medicines Outcomes Programme- Public Health Scotland (CMOP-PHS).

3.69. CMOP-PHS is generating real world evidence (RWE) that is supporting the decision-making process for the approval of new medicines using real world data (RWD). CMOP-PHS provided evidence for new cancer medicines undergoing initial assessment by the SMC’s New Drugs Committee (NDC) and for those undergoing re-assessment after an interim acceptance. To date, CMOP-PHS has provided NCMAG with RWE on SACT for advanced colorectal cancer, multiple myeloma and ovarian cancer. The programme has supported the SCN’s tumour specific systemic anti-cancer therapy groups to address CMP development, with work to describe the tolerability of SACT for early breast cancer. The programme has also published evidence regarding immunotherapy use in skin, renal, urothelial and lung cancers, as well as Chimeric Antigen Receptors (CAR-T) use, which has added to the growing evidence based regarding CAR-T use in Scotland.

3.70. The SMC continued to review its decision processes and criteria to ensure they are fit for purpose. The SMC continues to support NHS Boards to better understand the decision-making process and they have implemented changes to streamline the initial assessment process for ultra orphan medicines. The expectation remains that NHS Boards will consider whether to make SMC-recommended medicines (or an equivalent) available on their formularies within 90 days. Notably, the requirement is for NHS Boards to make public their decision on SMC advice within a 90-day period, not that the advice itself is implemented.

3.71. Scottish Government is working to improve alignment between SMC approval and available capacity and infrastructure within NHS Scotland to ensure that new medicines are available to people with cancer. The Scottish Government has established the Access to New Medicines Horizon Scanning Advisory Board (HSAB) to identify and analyse new disruptive medicines currently in licensing and Health Technology Appraisal (HTA) pathways/pipelines that are due to be considered by the SMC for routine access in the following six to eighteen months (if a submission to the SMC is made). This will facilitate the necessary forward planning required should these medicines be accepted for use within the NHS in Scotland.

Strengthening models of care

3.72. Scottish Government are strengthening quality improvement through the Cancer Quality Programme, focussing actions relating to agreed priority QPIs in line with strategic aims and national clinical agreement of quality in cancer services. Scottish Government has commissioned the National Cancer Quality Improvement Board (NCQIB) following a review of national cancer governance as committed to within Recovery and Redesign: An Action Plan for Cancer Services (2021-2023).

3.73. The transition to a new Improvement Board aligns with the overall aim of the Cancer Strategy for Scotland (2023 – 2033) to improve cancer survival and provide excellent, equitably accessible care. The overall purpose of the NCQIB is to provide strategic direction and have oversight of the delivery of the National Cancer Quality Programme.

3.74. The Cancer Quality Programme has continued to deliver over 2024/25, with a review of Ovarian Cancer, Acute Leukaemia, Cervical Cancer and Endometrial Cancer QPIs taking place. A change of approach to the NCQIB’s formal QPI review process was agreed following a consultation and engagement process. Various QPI sets were reviewed and published Cancer QPIs – Healthcare Improvement Scotland.

Ambition 5 – Excellent care and support after treatment

Our 10-year vision is that personalised support and care post-treatment are core considerations in cancer management pathways: this includes rehabilitation, early detection of recurrence, and supportive and palliative care. People affected by cancer are informed and supported to adequately manage side effects of treatment with the appropriate tools, including an electronic treatment summary. All individuals requiring rehabilitation have access to meaningful, person-centred rehabilitation that will support them to live well and support a good quality of life, regardless of their stage on the cancer pathway. Follow-up is standardised in the SCN’s clinical management pathways, is evidence-based for each cancer type and individual (including secondary cancers) and covers patient-initiated requests for review. Every person with cancer in Scotland requiring palliative care receives well-coordinated, timely and high-quality care, including care around death. Bereavement support is provided for families and carers based on their needs and preferences.

3.75. This ambition relates to actions 70-76 with reference to action 92 in the Cancer Action Plan 2023-2026.

Rehabilitation

3.76. A network of local rehabilitation leads across all 14 territorial Health Boards have continued to meet and developed a greater understanding of the delivery of the Six Principles of Good Rehabilitation in NHS Boards.

3.77. In addition to work within the National Rehabilitation Network on the implementation of the Six Principles, Scottish Government has directly engaged with each NHS Board to discuss areas of challenge and to share learning and best practice.

3.78. The Six Principles have been recognised through the Health and Social Care Services Renewal Framework (SRF) as we reform services.

3.79. Major Change 4 as set out in the SRF (improving access to services and treatment in the community) and Major Change 5 (redesigning hospitals) both prioritise rehabilitation as a lever for shifting care into the community and reducing hospital dependency, with Allied Health Professionals (AHPs) leading delivery across settings. The SRF also commits to implementing the Once for Scotland Rehabilitation Approach as part of population-level planning.

Palliative and end of life care

3.80. In Year 2 of the action plan, a consultation was undertaken to inform a new strategy and delivery plan, with responses analysed. At the time of writing although outside of reporting period, we have published the Palliative Care Matters for All strategy that aims to achieve the very highest standards of care right up to the end of life and to ensure high quality palliative care wherever and whenever it is needed.

3.81. Building on the publication of Discovering Meaning, Purpose And Hope Through Person Centred Well-being And Spiritual Care - A National Framework, the Scottish Professional Leadership Group (Spiritual Care) considered developing a national service specification which would highlight the importance of bereavement care. It was confirmed that all NHS Boards offer bereavement support for staff on either a formal or informal basis. This group are currently piloting a new dataset to record the number of staff undertaking training nationally and are considering how best to use Patient Reported Outcome Measures to evaluate the impact of interventions. National Guidance for Care for spiritual distress (existential crisis) | Right Decisions has been published by Healthcare Improvement Scotland.

3.82. A programme of work was implemented to redraft the palliative care and spiritual care NHS Inform pages to help ensure that they are up to date and signpost to the correct external sites. Pages recently updated and developed include ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR), benefits advice, NHS 24 and NHS Board palliative care team advice. Work is also being undertaken to refresh the workplan for the Palliative Care guidelines to ensure accessible information.

3.83. The Palliative Care Workforce Training, Education and Resources Working Group began working with NES in 2024/25 to carry out scoping work around the development of a palliative care training micro-site that would act as a one-stop-shop for training and resources on palliative care. Further to this, funding was awarded to NHS NES and Faith in Older People (FiOP) to develop education resources for the health and social care workforce.

3.84. Further to this, the Scottish Palliative Care Guidelines were updated, providing practical, evidence-based guidance to support safe and consistent prescribing and clinical decision making by staff providing general palliative care. These guidelines are managed and delivered by Healthcare Improvement Scotland (HIS), and are now available on the Right Decision Service website and mobile app. A key action within the Palliative Care Strategy is to ensure the sustainable management, updating and expansion of the guidelines. Since their launch, the Scottish Palliative Care Guidelines have been viewed nearly one million times by over 150,000 users.

Ambition 6 – Sustainable and skilled workforce

Our 10-year vision is for a sustainable, skilled workforce with attractive career choices and fair work, where all are respected, supported, and valued, whether they work wholly or partly in cancer services.

3.85. This ambition relates to actions 79-91 in the Cancer Action Plan 2023-2026.

3.86. Following the completion of the Allied Health Professional (AHP) Education and Workforce Policy Review in 2023, an advisory group has been established to oversee the effective implementation of the recommendations. The advisory board continued to meet quarterly with one of the four key themes of delivery focusing on workforce enhancement for AHPs.

3.87. Scottish Government funded NES to provide the non-medical endoscopy training programme. 53 places in total have been made available for non-medical endoscopy training. 36 of these places have now qualified, 9 months ahead of schedule. The remaining 17 non-medical endoscopists continue to train across Scotland.

3.88. Following the annual review of medical training establishments Scottish Government Ministers have approved the creation of 47 additional specialty training places for 2025. This review process has considered the need for additional training places in all specialties, although following the conclusion of the process (including data analysis), no additional training places were recommended in either medical or clinical oncology this year. A revised annual review process for 2026 is continuing to be co-developed with stakeholders including NHS Education for Scotland, and the Scottish Shape of Training Transition Group, which usually leads the review process. Twenty clinical oncology posts were advertised throughout 2024 with ten (50%) filled. Four posts were advertised in medical oncology and two (50%) filled. This is an increase from the previous year where just six posts (33%) out of eighteen advertised in clinical oncology were accepted, and just one post (33%) accepted out of three advertised in medical oncology. There is more to be done on improving fill rates in both specialties.

3.89. Improving Wellbeing and Working Cultures (IWWC) sets out the Scottish Government’s vision to improve wellbeing, leadership and equality across our health, social care and social work workforce. Following a delay, Scottish Government published IWWC, setting out our ambition to enhance working cultures across our health, social care and social work workforce through programmes of work at a national level that focus on the pillars of wellbeing, leadership and equality. This has been cascaded to key stakeholders across the sectors.

3.90. An abridged Action Plan illustrating current priority actions was issued to stakeholders alongside IWWC to demonstrate interventions which are currently funded and underway across the system.

3.91. Further engagement is underway with key stakeholders to explore existing and emerging priorities across the sectors. This has supported the development of IWWC case studies. The purpose of these case studies is to connect, support and inspire individuals, teams and organisations by sharing examples of initiatives which are already making a difference and improving working cultures across social care, social work and health.

3.92. Three NHS Scotland workforce policies have been live since November 2023 to increase employee flexibility and retention. The Flexible Work Location and Flexible Work Pattern Policy provide employees with a range of flexible working options to help them to balance their lifestyle whilst maintaining and promoting the best possible service to our patients and service users. The retirement policy includes a ‘Retire and Return’ arrangement that supports retiring employees who wish to continue in employment with the health board that is suitable to them and the service.

Ambition 7 – Person-centred care for all

Our 10-year vision is that people with cancer are at the heart of all decisions and actions involving them. They are given the opportunity to co-design their own care plan, and information including a treatment summary is readily available. A single point of contact (SPOC) is at the centre of this. Where possible, diagnostic tests and treatment are situated close to home and travel to specialist care is fully supported, making use of the continued advancement in new technologies.

3.93. This ambition relates to actions 94 to 105 in the Cancer Action Plan 2023-2026.

Improving the cancer journey

3.94. The roll-out of Improving the Cancer Journey (ICJ) services, as part of the £27 million Scottish Government partnership with Macmillan Cancer Care, continues across Scotland. These will ensure that everyone affected by cancer is aware of the support services available and how to access them, helped by ongoing roll-out of the ICJ service. Over 2023/24, 5,360 individuals were supported via ICJ and completed a Holistic Needs Assessment (HNA).

3.95. In Year 2, the final agreement to establish an ICJ service was signed with Forth Valley, and new services went live in Borders and Shetland. Work continues to improve referrals and data quality with ICJ teams.

Single point of contact

3.96. In Year 1, all 12 Single Point of Contact (SPoC) pilots were funded, with the scope and scale of the programme increasing as the final pilots commenced. A scalability assessment of the programme was initiated, led by Healthcare Improvement Scotland (HIS) to outline the impact of each project and the conditions within which they have been established. Consideration to the expansion of the SPoC approach is underway ahead of the next Cancer Action Plan.

3.97. In Year 2, the scalability assessment was completed by HIS. The assessment found that over a 12-month period SPoC services have had over 30,000 interactions with people affected by cancer, providing information, advice, support and enabling self-management. It found that SPoC improved cancer care experience by ‘taking the stress out of the time around diagnosis’. SPoC further improved cancer care delivery by ‘freeing up clinical nurse specialists (averaging 13.4 weeks per year of CNS time per site) to focus on the more complex needs of patients and enabling proactive care’. SPoC staff were found to be effective in triaging calls from people affected by cancer, managing on average 82% of calls that would previously have been directed to CNS.

3.98. The assessment found that many of the access issues faced by people with protected characteristics can be lessened by single point of contact navigators. There were also examples where the SPoC team positively impacted consultant time by managing intervention lists, and service provision was increased from a 5-day to a 7-day service.

3.99. One unique project carried out as part of the SPoC programme is West of Scotland Cancer Network (WoSCAN’s) prostate cancer project, which introduced a digital approach to prostate cancer follow-up. This utilises the national Connect Me system to provide prostate-specific antigen (PSA) test results directly to patients and signpost to first line advice and information. Impact was positively associated with the length of time the system is in place and the number of patients enrolled.

3.100. In one area for example, the waiting time for results reduced by 20 days (from 22 to 2 days on average). Approximately 500 specialist nurse hours per annum were found to be released, enabling a focus on new patients with diagnosis up to 18 weeks earlier (from 239 days down to 111 days), and on unwell or more complex patient cases.

3.101. Earlier intervention for unsatisfactory results (within 2 days) was noted, with significantly fewer unplanned telephone contacts seeking advice or results occurring. It was also found to reduce paper, printing and postage, and reduce travel required for patients.

Patient experience

3.102. Scottish Government carried out the latest iteration of the Scottish Cancer Patient Experience Survey (SCPES), distributed to 8,800 people. Findings were published in September 2024. The survey found that experience of cancer care in Scotland is largely positive, with 95% of people reporting a positive experience and an overall rating of experience of care reported to be 9.1 on a scale from 0 to 10.

3.103. Secondary analyses were carried out in 2025, with findings reported in May. This report explores differences in the patients’ overall experience of cancer care, appointments, information received on cancer and treatments, and wider support, based on cancer type, individual characteristics (age group, employment status, whether they have long-term conditions or not) and characteristics of where they live (level of deprivation and how urban or rural such place is). Following publication, new actions are being considered to improve the experience of people diagnosed with cancer and how best to measure this going forward. The Scottish Cancer Strategic Board wrote to all NHS Boards to make clear that these results should be considered and improvements actioned where required.

3.104. The development of a person-centred measurement framework has begun, with a quantitative instrument prototype nearing completion in June 2025.

3.105. A separate pilot to consider scale up of the Cancer Treatment Summaries pilot has not progressed as the Scottish Government has committed to major programmes, as outlined in the delivery plan, including the Digital Front Door (DFD) and the Integrated Social Care and Health Record (ISCHR) that support person-centred care. Over time the underpinning infrastructure required to support these two programmes will provide an integral foundation for the future of digital health and social care and Cancer Treatment Summaries.

3.106. A review of cancer content, and its governance, on NHS Inform has been carried out. This includes links to general and tumour site-specific third sector organisations. Focus remains on how best to manage this content, particularly in relation to keeping it up-to-date and relevant to care, treatment and support available in Scotland.

3.107. The use of Care Opinion continues to be promoted across the NHS in Scotland. An increasing number of stories related to cancer are received each month. In Year 2 of the action plan, the number of stories published increased to an average of 61 per month.

Realistic Medicine

3.108. Shared decision making (SDM) is a key principle of Realistic Medicine, which ensures people are at the centre of decision making regarding their care. We are committed to increasing the awareness of Realistic Medicine with both the public and healthcare professionals, with conditions placed on NHS Boards from 2023/24 to provide information on the delivery of Value Based Health & Care (VBH&C) in their Annual Delivery Plans and to promote the use of BRAN questions (benefits, risks, alternatives, nothing) as a framework to focus healthcare discussions with the public.

3.109. Scottish Government is promoting SDM training to health and care colleagues, including those involved in delivering cancer services, to help them deliver care based on what matters most to the people they care for. In addition, working with NHS Education for Scotland (NES), Scottish Government launched the Shared Decision Making (SDM) Realistic Conversations eLearning module. It was filmed with NES and Realistic Medicine (RM) clinical leads to demonstrate SDM conversation in practice using a care home patient/relative scenario.

3.110. Collaborative work has continued with NHS24 on the re-run of the ‘It’s OK To Ask’ campaign through the recently established Realistic Medicine Community of Practice (CoP). The aim is to raise awareness of the BRAN questions and encourage the public to engage more meaningfully in their conversations with health and care professionals. Through the RM Network and the CoP, NHS Boards were encouraged to ensure the re-run of the national campaign was complemented by local messaging and support to maximise the impact of the campaign.

3.111. Additional work to support promotion and implementation of RM and VBH&C included promotion of the Realistic Medicine Casebook, which was published outlining case studies across Scotland where VBH&C and RM principles are being implemented with positive outcomes.

3.112. The 14^th Citizens Panel survey (CP14) survey was successfully developed and delivered by Healthcare Improvement Scotland, then circulated to all key stakeholders. A summary report is now available. CP14 messages have been incorporated into key RM materials. Findings were presented to the RM Network to understand Network delivery of the messages and explore additional support needs.

3.113. A Webinar session with Queen Margaret University (QMU) interprofessional students was held with c.300 health students in attendance and was positively received. There was ongoing promotion of all new learning resources via various forums including the RM Network to actively encourage uptake within individual NHS Boards.

3.114. The Realistic Medicine Team also supported the Scottish Cancer PROMs Advisory Group to develop and launch the Scottish Cancer Patient Reported Outcome Measures (PROMs) Toolkit in October 2024. This will help to improve understanding of patient outcomes. Developed with the contribution of participants at the Scottish Cancer PROMs Forum event(s), the Toolkit is supported by NHS Education for Scotland, who have hosted the Toolkit on Turas. The Toolkit has been platformed via several outlets including social media; the Scottish Cancer PROMs Forum; internal and external newsletters; and various conferences and meetings. As of 30^th June 2025, the Toolkit has 1,055 page views and 208 downloads.

3.115. A new eLearning resource on Finance and Value-Based Health and Care (VBH&C) was also launched, and the need to develop an eLearning module through NES on health inequalities was agreed.

3.116. The Right Decision Service was commissioned to develop two Realistic Medicine apps and web-based toolkits, which have now been successfully co-designed and developed with patient and public groups. One is focused on supporting professionals, whereas the other is focused on supporting citizens (Being a Partner in My Care: Realistic Medicine Together). Both are now live and being promoted for use.

Ambition 9 - Mental health as part of basic care

Dependent on need, proactive and comprehensive psychological and mental health interventions and support are available and accessible, from those trained at informed to specialist practice types, to all people affected by cancer and their families.

3.117. This ambition relates to actions 106 -110 in the Cancer Action Plan 2023-2026.

3.118. In Year 1 of the Action Plan, we made significant headway with these actions, publishing the Mental Health and Wellbeing Strategy in June 2023, Scotland's Mental Health and Wellbeing: Strategy. It sets out the vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. The accompanying delivery plan 2023-25 (Mental Health and Wellbeing - Delivery Plan 2023-2025) and workforce action plan 2023-25 (Mental Health and Wellbeing - Workforce Action Plan 2023-2025), describe the work that we will undertake to improve mental health and care provision for everyone in Scotland.

3.119. We also published the Core Mental Health Standards (Core Mental Health Quality Standards) and the National Specification for Psychological Therapies (PT) and Interventions in the same year (Psychological therapies and interventions specification). These set out the standards to which we expect PT and mental health services to be delivered. PHS published the Specification along with updated waiting times guidance for PT, and the updated PT Matrix by NES, which describes recommended evidence-based therapies.

3.120. We have undertaken significant work with NHS Boards to support implementation of the Specification. We have published two national Once for Scotland guides following development with NHS Board psychology teams, NES, PHS and other stakeholders. In August 2024, the first guide (National Implementation Guide 1: Digital Evidence Based Psychological Treatments) was published to support the delivery and recording of digital evidence-based PT. Although outside of the reporting period, at time of writing the second guide (National Specification for the Delivery of Psychological Therapies and Intervention in Scotland: National Implementation Guide 2), to encourage the use of improvement tools and approaches to enhance the delivery of psychological services and treatments, was published on 3 September 2025. Scottish Government funded a ‘PT national co-ordination function’ to support NHS Boards with the implementation of the specification, which included two new posts. The national co-ordination function ‘PT Implementation Support Team’ will continues to support local and national improvements in psychological services delivery. Led by the Scottish Government Psychology Advisor and Policy team, the work covers three key areas: 1) operational delivery and leadership and governance; 2) quality improvement via implementation of the PT National Specification with all NHS Boards; 3) training and capacity building initiatives to improve workforce capacity and a trauma-informed approach.

3.121. Following a trial period, NHS Board psychology teams assessed their delivery of PT Specification outcomes by completing the first PT Self-Assessment tool. We are reviewing the key themes and recommendations from these assessments.

3.122. We continue to provide tailored support to those NHS Boards not on track to meet the PT waiting times standard, including providing access to professional advice, ensuring they have robust improvement plans in place and monitoring their implementation.

3.123. The national trauma training programme led by NES and funded by the Scottish Government continued to support the workforce to be trauma informed and trauma trained. Access has been given to evidence-based training, tools and guidance to support trauma-informed and responsive systems, organisations and workforces in Scotland. It aims to support everyone, in all sectors of the workforce, to know how to adapt the way we work to make a positive difference to anyone who has been impacted by psychological trauma and adversity.

3.124. The Psychological Therapies and Support Framework for People Affected by Cancer remains a priority within health boards’ annual delivery plan guidance. Each of the three Regional Cancer Networks have supported the annual benchmarking process with their respective Boards and wider local organisations providing psychological care and support. Analyses and action planning are ongoing with Regional Steering Groups managing the process. A 2025 prehabilitation survey was carried out in early 2025, as referenced earlier in this report. This will help to determine the impact of the Framework within the early/prehabilitation phase of the cancer pathway.

Ambition 10 – Flourishing research and innovation

Our 10-year vision is that equitable access to clinical trials has become integral to the management of treatment options. Where relevant, health professionals have allocated research time, adequate laboratory support and are working in partnership across academia, industry and the third sector. Qualitative and non-RCT research are providing relevant high-quality evidence to inform best care. Routine cancer data are available to support this. More complex molecular tests ensure people with cancer have access to a portfolio of precision oncology and clinical research. Laboratories have capacity to support research, including clinical trials. New technologies are being used to strengthen the full cancer patient pathway, with alternative methods for consultations and information-sharing leading to greater choice and convenience for people with cancer. The application of artificial intelligence (AI) has grown. Multidisciplinary networks are making the best use of scientific and clinical expertise to translate innovation into clinical practice. Health Boards make robust, evidence-based decisions based on Scottish Health Technologies Group (SHTG) advice, leading to improved outcomes and more efficient use of resources.

3.125. This ambition relates to actions 111 – 119 in the Cancer Action Plan 2023-2026.

3.126. Consideration has been given to the viability and prioritisation of all recommendations of the Improving Equity of Access to Cancer Clinical Trials in Scotland report. A greater understanding of the quality of equity of access to clinical trials data has been developed in collaboration with the NRS Cancer Network. This identified stratification of trial participation by SIMD postcode and barriers around use of data to stratify by ethnicity and cancer type.

3.127. Funding for the Edinburgh and Glasgow Experimental Cancer Medicine Centres (ECMC) continued, matched with funding from CRUK. There was a continuing programme of engagement with CRUK and the ECMC Leads in Edinburgh and Glasgow throughout the reporting period.

3.128. There has been expansion of the National Institute for Health and Care Research (NIHR) programmes available to researchers based in Scotland. In Year 1 of the Action Plan, a total of 9 programmes were available, including the Invention for Innovation (i4i) programme; the Programme Grants for Applied Research (PGfAR) programme; and the Research Programme for Social Care (RPSC). Memorandums of Understanding (MoUs) have now been put in place with National Institute for Health and Care Research (NIHR) and Department of Health and Social Care (DHSC). Webinars were supported to make researchers aware of new opportunities. Feedback shows that there have been successful Scotland-led applications across several of the newly accessible programmes. The CSO is actively promoting these opportunities to the research community.

3.129. Funding has continued for the NHS Research Scotland Cancer Network. The number of studies and number of patients recruited via NRS data intelligence capabilities was continuously monitored. The network has been fully engaged in work to bring commercially funded cancer vaccine studies to Scotland. It is anticipated from discussions around the Voluntary Scheme for Branded Medicines Pricing (VPAG) UK-wide investment to develop commercial clinical trials that 40-50% of supported trials will be in Cancer.

3.130. Scottish Genomics Test Advisory Groups (SG-TAG) for cancer, rare and inherited conditions, and pharmacogenomics were established in Year 1 of the Action Plan. These have subsequently been replaced by a revised process to capture new tests or changes in indication in testing as part of horizon scanning.

3.131. Discussions were had with colleagues in NHS England to access genomic educational materials and 1.5 days FTE post secured at NES to support genomics education and training. Work was undertaken to map training resources available and support workforce planning.

3.132. Demand optimisation work has been ongoing to examine what tests are used across Scotland. Funding remains pressured and a review of the funding and commissioning model underpinning genomic service provision is underway.

3.133. Discussions with Celtic nations continued regarding an interim model and with all UK nations as part of the Genome UK Shared Commitments and National Genomics Board regarding longer-term considerations in relation to cancer genomic datasets. The cancer test directory began to be mapped to Systematised Nomenclature of Medicine (SNOMEDCT) ontologies. A standard genomics glossary was developed, and data analyst and data architect support are being sought. A survey is underway to consider existing consent models for genetic testing.

3.134. The Scottish Health Technologies Group (SHTG) published recommendations and advice on a multitude of areas such as a review of the evidence for the effectiveness of digital delivery of cancer prehabilitation and the stability of prostate specific antigen (PSA) in blood samples to support the update of the Scottish referral guidelines for suspected cancer on prostate cancer. SHTG also published an artificial intelligence supported clinician review of chest x-rays from patients with suspected lung cancer to consider clinical and cost effectiveness and an Innovative Medical Techology Overview (IMTO) on the topic of artificial intelligence assisted lower gastrointestinal endoscopy.

3.135. SHTG ran a webinar to promote and raise awareness of the evaluation framework developed in Year 1 of the Action Plan. This intends to help evaluators, technology developers and decision makers better understand what information is required to identify technologies of value to service users and the health and care system. Over 200 people attended the webinar and feedback was positive.

3.136. As recognised in the first Cancer Action Plan Progress Report, the timescales for the first iteration of Digital Front Door (DFD) have changed since the publication of the cancer action plan. The first phase of the DFD will now be delivered by the end of the current Parliamentary term in 2026.

3.137. Scottish Government is committed to launching the first version of a personalised digital health and care service, which will provide digital notifications, access to personal health information and options for patients to interact directly with health and social care services as part of a five-year plan. The new service will draw together three major programmes – the Digital Front Door, the National Digital Platform, and the Integrated Social Care and Health Record, that are set out in Scotland’s Digital Health and Care Strategy Enabling, Connecting and Empowering: Care in the Digital Age and its supporting Delivery Plan 2024-25 Care in the Digital Age: Delivery Plan 2024-25. The new service, implemented as a national capability, will deliver empowerment and choice for people, as well as supporting productivity in the NHS, through online appointment booking, digital communication rather than physical letters, and the ability to deliver targeted public health interventions. We anticipate it will offer real benefits of flexibility and control for people, so that they can interact more effectively with the system, while achieving cost savings and efficiency for our health and social care services.

Ambition 11 – Cancer information and intelligence-led services

Our 10-year vision is of a more integrated cancer intelligence platform along the full cancer pathway. This creates a responsive system that efficiently supports data collection, retrieval and use for clinical management, surveillance, evidence generation and policy development, which is aligned to the move towards a single electronic health record. Quality Performance Indicators will be a key driver of an overall cancer services improvement agenda, aligning with national clinical management and optimal pathways. Data collection and analysis of measures including PROMs (patient-reported outcome measures) and PREMs (patient reported experience measures) are integrated into service provision to facilitate person-centred care and shared decision making.

3.138. This ambition relates to actions 120 -136 in the Cancer Action Plan 2023-2026.

Data

3.139. Scottish Government provided PHS with over £1 million of funding in 2024/25 and again in 2025/26 to continue to improve the Scottish Cancer Registry, analyses of Cancer Audit Data and the Cancer Intelligence Platform (CIP) and to support continued provision of radiotherapy datasets. Further funding was released to support regional intelligence and reporting.

3.140. CIP testing has been completed allowing additional datasets to be migrated to production, such as cancer registrations, mortality data, acute hospital data, cancer staging and pathology data. Work is underway to add Outpatients and Prescribing data, as well as data from the three national cancer screening programmes via the Screening Intelligence Platform being developed in parallel to CIP with NHS NSS. The Cancer Analysts & Peers Support Group (CAPs) has begun developing a matrix to capture data sources, software and analytical skills and capacity across NHS Boards to help understand the analytical landscape.

3.141. SACT activity data continues to be published on a weekly basis. An overall 30-day mortality publication was published and the PHS website was updated to provide public facing information, signposting and for the publishing of documentation around SACT. PHS began the development of a national SACT platform with NHS NSS.

3.142. PHS continued building on the work of the Cancer Medicines Outcome Programme-Public Health Scotland (CMOP-PHS) integration with national data to better understand the benefits from SACT to support clinical decision making.

To date, 15 reports have been published via PHS to ensure transparency to all stakeholders, with 10 specifically for Health Technology Assessment (HTA) purposes (7 for SMC and 3 for NCMAG). Additionally, CMOP-PHS outputs have published 5 other clinical reports detailing immunotherapy use for skin, renal, urothelial and lung cancers and CAR-T use across Scotland. Whilst producing reports is a key metric for progress, the CMOP-PHS team worked to ensure compliance with PHS templates; refine the report(s) structure; ensure processes are sustainable; and provide education regarding the use of RWE in Scotland. An Initial education session was held with SMC and other report users to raise awareness of the National SACT Dataset, and the existing data quality and caveats which accompany its use.

3.143. CMOP-PHS have also been instrumental in supporting data development in PROMs. CMOP-PHS have been engaged in close dialogue with those responsible for the national PROMs work to help inform and shape the routine collection of outcomes data from patients, which is intended to become part of the suite of real-world data with which CMOP-PHS can report on wider patient outcomes in the future.

3.144. Furthermore, the Scottish Cancer Patient Reported Outcome Measures (SG PROMs) Advisory Group ran the 4th Scottish Cancer PROMs Forum event in March 2025, which welcomed 53 attendees, including clinicians, service managers, academia, pharmaceutical and digital companies, as well as patients and members of the public. The discussions from previous Forum events have been instrumental in the development of the SC PROMs Toolkit as well as understanding the needs and concerns around PROMs of all stakeholders

3.145. Work to implement a genomics module within the national Laboratory Information Management System (LIMS) has been ongoing, with funding secured and staff released to support development.

3.146. Scottish Government continued to fund the International Cancer Benchmarking Partnership in association with CRUK, which has continued to provide valuable international comparisons and learning.

3.147. As a member of the European Network of Cancer Registries (ENCR), PHS is considering guidance on collecting recurrence data by cancer registries and will consider the feasibility of implementing these recommendations, together with other approaches to gathering cancer recurrence data, by 2026.

3.148. Novel analytical work has been undertaken to support a better understanding of cancer survival, outcomes, demographics and inequalities. For example, new analyses of Cancers of Unknown Primary and more detailed analyses of liver cancer incidence and outcomes have been produced and presented at the European Network of Cancer Registries 2025 scientific conference.

3.149. In addition, new methodologies for producing cancer incidence projections are underway. Methodologies for assigning ethnicity to individuals was presented to the PHS SAAG group (Statistics and Analytical Advisory Group), who endorsed the chosen methodology. Guidance has been developed on the appropriate use of the race and ethnicity index as well as wider guidance on collection, analysis and publication of race and ethnicity data.

Governance

3.150. Continued streamlining to reduce the complexity of the cancer governance landscape has reduced duplication of clinical effort and time and clarified the mechanisms for change across NHS Scotland. It’s anticipated further work in this area will continue over the remainder of the plan.