Cancer Action Plan: annual progress report 2024-2025

Appendix B - Evidence & Evaluation

Introduction

This section presents findings from published reports to contribute evidence about progress during the second year of the Cancer Action Plan 2023 - 2026. We report on data, analysis and evaluation conducted between April 2024 and July 2025. Some reports are noted as they have published at time of writing this report rather than within the reporting period.

To meet our strategic intent of improved cancer survival and to provide excellent, equitably accessible care, the Cancer Strategy sets out 11 ambitions addressing cross-cutting and pathway priorities. Analysis is presented below that draws together learning about progress towards the vision for those ambitions where relevant evidence has been published since April 2024. The cross-cutting ambition to tackle inequalities is considered through each of the other ambitions.

Preventing More Cancers

Earlier and Faster Diagnosis - Harnessing Data

Cancer incidence reflects risk factors for developing cancer, efforts to detect cancer (e.g. public awareness, screening programmes), and the at-risk population which is increasing due to an ageing and expanding population (see blog by Public Health Scotland (PHS) which discusses the increasing prevalence of cancer and burden of disease). The latest releases by PHS of cancer mortality and cancer incidence and its relationship with socio-economic circumstances (i.e. deprivation status) includes data up to December 2022. These data provide a baseline ahead of the launch of the Cancer Strategy for Scotland in 2023. Data reflect a long-term trend of an increasing number of diagnoses over time. However, rates of both cervical cancer and pre-cancerous cervical changes (cancer in situ of cervix uteri) have greatly reduced in females aged 20-24 because of the human papilloma virus (HPV) vaccination programme for secondary school age males and females. This began in 2008, although rates of immunisation have experienced a gradual decline in the last decade, a trend which has continued in the rates reported for 2023/24.

The most common cancers in Scotland in 2022 were lung, breast, prostate and bowel, accounting for over half (55%) of all new diagnoses (incidence, excluding non-melanoma skin cancers, which by convention are excluded from ‘all cancer’ figures). These four cancers together account for 46% of all cancer deaths in Scotland. In 2022, the European Standardised Rate (EASR), or the risk of dying from cancer in Scotland, decreased by 11.1% compared to 2013 (from 333.7 to 296.8 per 100,000 population respectively). Despite this decline in risk, the number of deaths due to cancer has increased by 3.2% (to 16,265 from 15,764 in 2013). This increase largely reflects the increase in the proportion of older age groups within the population, and the fact that cancer is more common among older people.

While overall cancer death rates have declined in both men and women, certain cancer types have shown notable increases since 2012. In men, liver cancer deaths have risen by 15%. Among women, liver cancer deaths have increased by 20%, and uterine cancer deaths have gone up by 21% over the same period. Nearly half (49%) of liver cancer cases are preventable through lifestyle changes such as reducing obesity, smoking, alcohol consumption, and preventing viral liver infections. The risk of cancer has been increasing in females aged under 50 years old. The rate in males under 50 remains fairly constant. However, risks of colorectal cancer have increased significantly in both females and males under 50 years. For both males and females, registrations of melanoma skin cancers increased in 2022. For all cancers combined (excluding non-melanoma skin cancer), rates were 24% higher in the most deprived areas compared with the least deprived (736 per 100,000 vs. 594 per 100,000). Large socio-economic differences are evident for lung, head and neck, prostate and cervical cancer. As indicated by PHS, there is potential to reduce socio-economic inequalities in cancer risk and later-stage diagnoses through improving uptake of HPV vaccination and cervical screening, and reducing rates of smoking and alcohol consumption, particularly in more deprived areas.

Emergency presentation data on brain cancer and leukaemias were included in this latest incidence analysis. Since brain cancers are not assigned a stage like other cancers, this evidence is helpful to serve as a proxy for ‘late stage’ detection, i.e. the grade of the cancer has advanced and is causing symptoms, making the patient present at A&E. Patients with brain cancer are the most likely of all cancer patients to be diagnosed during an emergency admission to a hospital. Data in 2020, 2021 and 2022, suggest that there was not an increase in the proportion of ‘late stage’ brain cancer diagnoses during the pandemic, e.g. due to potential delays to diagnosis caused by disruption to cancer services. Conversely, the proportion of patients diagnosed with leukaemia following an emergency admission has been increasing. Nearly half of all leukaemias (46.1%) were diagnosed following an emergency admission in 2022, compared with 36.2% in 2017. It is possible that the pandemic exacerbated an increase in emergency admissions due to the stresses placed on all aspects of the health service, meaning patients were less likely to see a GP with ‘early’ symptoms. There has not been a ‘recovery’ in non-emergency diagnoses in 2022, with only 0.5% increase in these.

The distribution of emergency and non-emergency routes to diagnosis has been analysed in a new publication on Routes to Cancer Diagnosis, Cancer Stage and Curative Treatment for Cancer Information to Support Visions from the Cancer Strategy released by PHS. The data from this ‘official statistics in development’ release can be treated as a baseline from which to measure progress over the course of the Cancer Strategy. After the COVID-19 pandemic caused significant disruptions to routine pathways in 2020, the proportion of cancers diagnosed through emergency routes (an emergency admission to hospital) – for 18 cancers combined – reduced between 2021 (24.8%) to 2022 (22.8%), although variation by cancer type was observed. The largest reduction was for cancers of the kidney (-5.5%), and the largest increase was for cancer of the oesophagus (+4%). There was a reduction in emergency routes to diagnosis in all deprivation quintiles (SIMD) between 2021 and 2022. The reduction was similar for those in the least deprived quintile (-3%) and the most deprived quintile (-2.5%). The proportion of emergency diagnoses within each stage – for 16 common cancer types combined that can be staged – reduced slightly for every stage between 2021 and 2022. In terms of reducing late-stage cancer diagnosis, the proportion of late-stage registrations – for 16 cancer types combined –remained similar between 2021 (41.5%) and 2022 (41.1%). No consistent patterns were observed by deprivation quintile between 2021 and 2022 due to differences in the numbers of patients with unknown stage.

This report also included data reporting against the aim of more people receiving curative treatment, by measuring the proportion of patients treated curatively between 2021 and 2022. See Headline Indicator E for further commentary on this.

Earlier and Faster Diagnosis – Improved Public Education and Empowerment

Three independent evaluations of the Detect Cancer Earlier behaviour change campaign – ‘Be the Early Bird’ – reported on four phases of the campaign in March 2023, September - October 2023, August - September 2024, and March 2025. The campaign is aimed at people living in areas of deprivation, given the overall risk of developing cancer being higher in the most deprived compared with the least deprived areas of Scotland. Impact was established in findings that showed high levels of awareness of the campaign, and action being taken as a result: the majority of people who recognised elements of the campaign reported improved symptom awareness for those symptoms included in the campaigns so far. Progress is thus being made in addressing a key barrier to early cancer detection among higher-risk populations, supporting the broader strategy to improve cancer outcomes and reduce health inequalities. The campaign narrowly missed its target to reduce family impact concerns as a barrier to seeking help, reflecting the need for future campaign phases to focus on addressing these deep-seated fears.

Earlier and Faster Diagnosis – Supporting Primary Care

The strategic vision is being supported by a wider programme of work within primary care to increase resources for general practices in disadvantaged areas targeted at activities to address health inequalities. Learning produced by the independent evaluation of the Inclusion Health Action in General Practice (IHAGP) programme will inform approaches to supporting care for people who experience multiple inequalities and who are at high risk of or have cancer, supporting the cross-cutting ambition to tackle health inequalities in cancer. Early evaluation findings from interviews with General Practice staff indicate the positive impact of proactive outreach and extended consultations with patients at high risk of physical or mental ill health due to poverty and inequality. Enhancing workforce knowledge and skills via training related to health inequalities and developing community connections by building on existing networks were additional areas of activity viewed as positive enablers. Additionally, the use of data and digital tools were important facilitators to enable new ways of communicating with patients, improved record keeping, and identifying patients to target. While positive impacts were identified by staff, time-limited funding was viewed as limiting the scale of activity, and a barrier to resourcing and embedding longer-term interventions. While the target population for this intervention was wider than people affected by cancer, the barriers and enablers highlighted here provide useful learning for tackling inequalities in cancer linked to living in areas of socio-economic deprivation.

Earlier and Faster Diagnosis – Invest in Innovation and Diagnose Faster

Cancer Research UK’s Test, Evidence, Transition Programme aims to accelerate the effective spread and adoption of innovative pathways. The first phase projects in Scotland have evaluated access to breast cancer assessment clinics without a GP appointment (NHS Forth Valley) and rapid access referrals for prostate cancer via a nurse-led model (NHS Fife). Analysis of the new breast cancer pathway demonstrated that it was acceptable to patients and staff. Streamlining the referral pathway was considered beneficial as it reduced the need for GP appointments and the majority of people who received a referral directly from a receptionist reported a positive experience, although a small minority reported that they would have preferred to have seen their GP first. Analysis indicated that health outcomes were comparable to the previous pathway, with cancer diagnosis and staging being broadly similar. No issues with inappropriate referrals were identified. The new referral pathway was less expensive, associated with lower costs per patient due to the elimination of a GP appointment for most patients.

The report reflects on the potential for fast-track pathways to reduce barriers to care among those who find it harder to attend appointments (e.g., due to inflexible work, caring responsibilities, or unreliable or expensive transport) and suggests further investigation of this may be beneficial. Analysis of the new prostate cancer pathway suggests that rapid access diagnostic clinics led by specialist nurses can reduce the number of people involved in patient care and cost less than the traditional consultant-led approach, although the new diagnostic pathway did not appear to reduce time to diagnosis. While most patients were satisfied with the quality of the service, staff noted challenges. These included increased administration and inconsistency in how referrals were allocated to clinics, in addition to potential bottlenecks further down the diagnostic pathway (e.g., imaging and biopsy). The report concludes there is value in involving nurse specialists in direct patient care from the start of the diagnostic journey, particularly in relation to communication and patient experience. Concerns about role clarity and the potential for over-investigation indicate the need for further consideration of the design and integration of nurse-led pathways within existing healthcare systems.

With the aim to improve pathways of less survivable cancers, particularly hepatocellular carcinoma and pancreatic cancer, with a view to shortening the time to staging and agreeing treatment plans, the Scottish Cancer Network evaluated a pilot national co-ordination delivery model as a test of change. The pilot aimed to reduce delays in patient pathways and improve communication for patients and healthcare professionals, leading to a standardised, patient-centred experience and treatment in line with a Realistic Medicine approach. The evaluation identified a decrease in the duration of time on the pathway from diagnosis to starting definitive treatment for both outpatients and inpatients and demonstrated improved communication and information-sharing for patients. However, due to information governance and IT infrastructure constraints, the data available for analysis were more limited than originally anticipated (sample size and timeline for data gathering). This pilot was extended for a further year to consider this additional support layer further, as noted earlier on in this report. 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.

Best Preparation for Treatment - Prehabilitation

As a core component of preparation for treatment, a survey was commissioned in 2025 to understand progress since 2022 towards embedding the eight Key Principles for Implementing Cancer Prehabilitation across Scotland in practice. Comparisons have been made with analysis reported in 2023. Findings show continued strong support for prehabilitation amongst staff delivering services, with a majority perceiving it as playing a crucial role in preparing patients for treatment.

Progress has been made in terms of respondents indicating a stronger sense of service delivery being underpinned by the Key Principles compared to responses in 2022. This finding may reflect that staff are knowledgeable about prehabilitation and feel more confident in applying the key underpinning principles to their area of practice. While the offer of local prehabilitation activities was similar in 2022 and 2025, respondents reported examples of local service improvements, such as reaching patients with a wider variety of cancer types, trialling screening tools, and developing leadership roles to embed prehabilitation in ways of working. These findings indicate positive developments towards embedding prehabilitation into pathways.

The report highlights that progress may be impacted by continuing challenges with timeliness in referrals, unequal access across cancers and treatment types, and continuing reliance on temporary funding for many activities. Respondents were concerned about sustainable staffing for prehabilitation activities and the time-limited nature of funding, much of which was coming to an end.

The report provides recommendations around awareness-raising among staff, including awareness of online national resources on prehabilitation. It also recommends sharing learning from pilot projects around good practice in partnership working that may be beneficial for expanding coverage and increasing routine measurement of outcomes and experiences to demonstrate impact.

Person-Centred Care for All

Funded by Scottish Government and Macmillan Cancer Support, and delivered in partnership with Public Health Scotland, results of the most recent Scottish Cancer Patient Experience Survey (SCPES) were published in 2024. The survey was issued to a sample of people aged 16 or over with an inpatient or day case record with any mention of cancer and a discharge date between October 2022 and June 2023, and with a diagnosis of cancer between April and December 2022 validated using the Scottish Cancer Registry. Where results are comparable, analysis of responses in 2024 was compared with analysis in 2018 and 2015 (see the technical report and supplementary data tables for further detail about the survey and its analysis).

The survey established that most people’s experience of cancer care and treatment is positive: 95% of people were positive about the overall care received, the same as in 2018 and slightly higher than in 2015 (94%). There was variation in overall levels of satisfaction for some groups compared with figures at national level: people with gynaecological cancer were less likely to rate their overall care positively, and people with haematological cancer were more likely to rate it positively. Although most people (96%) reported they were treated with dignity and respect, satisfaction in this area was slightly lower than in 2018 (97%). There was also a reduction in the number of people reporting they were told that they had cancer ‘sensitively’ (84% compared with 86% in 2018 and 2015), reflecting the need for more progress in these areas.

Most people (88%) agreed that different people treating and caring for them (i.e. General Practice, hospital staff, specialist nurses, community nurses) worked well together to give the best possible care always or most of the time, although this represented a reduction since 2018 (91%). For cancer clinical nurse specialists (CNS) who deliver services and support people who require specialist care across hospital and community settings, 93% of people reported being given the name of a CNS or another named contact who would support them through their treatment. Notably, higher proportions of people with urological (20%) and skin cancer (15%) were not given a CNS or other named contact, compared to all patients (7%). Most people (88%) found it easy to contact their CNS or named contact and most (89%) got answers they could understand to important questions they asked. The percentage of people who found it quite difficult or very difficult to contact their CNS or other named contact is higher among people with breast cancer (9%), compared with all patients (6%).

While most (68%) people found it quite easy or very easy to travel to appointments relating to cancer care, 18% found it very difficult or quite difficult, similar to 2018. Compared to the national level, this was higher among people living in the NHS Boards of Orkney, Shetland and Western Isles (38%), and among people with head and neck cancer (25%). Compared to the national level, people living in the NHS Boards of Orkney, Shetland and Western Isles (47%), Dumfries & Galloway (46%), Highland (38%), and Borders (38%) were more likely to experience ‘length of travel time’ as a difficulty when travelling to cancer care appointments. Except for NHS Borders, people living in these NHS Boards were also more likely to identify the ‘cost of accommodation’ as a difficulty related to travelling for care, compared to 2% at the national level. People living in more deprived areas were more likely to report ‘access to suitable transport’ as a difficulty when travelling to receive care (11% among people living in the most deprived areas, compared to 7% nationally). Progress on addressing these barriers could improve patient satisfaction among the groups experiencing them.

For information on wider support, 24% of people said they were not given timely information about charity, voluntary or community groups that could support them during treatment, while 39% said they were not given timely information on wider support available after treatment. Scores for these questions relating to wider support are lower than ratings for overall care. Compared with all patients (24%), the percentage of people who were not given information on wider support before treatment was higher among: people aged 75 years or older (33%); and people with skin (44%), urological (37%) and colorectal/ lower gastrointestinal cancer (32%). Compared with all patients (39%), the percentage of people who were not given information on wider support once treatment ended was higher among people with skin cancer (58%). For information on care needed when returning home, 18% of people said healthcare professionals did not give their family, or someone close, all the information needed to help care for them at home. People with gynaecological cancer (27%) were the least likely to receive all the information needed to help care for them at home. These findings indicate that the provision of timely information about wider support during and after treatment could be enhanced for all patients, and with particular attention to the groups noted here.

An independent evaluation commissioned by Macmillan reported in 2024 on the nationwide rollout of Macmillan’s Improving the Cancer Journey (ICJ) services in partnership with the Scottish Government under the Transforming Cancer Care Programme. This programme aims to provide holistic support and comprehensive care along the full pathway. Evidence of positive outcomes was established for individuals via support with the non-medical impact of cancer. Impact in the broader healthcare system was also demonstrated, with Health Needs Assessments leading to appropriate support along the pathway, and care being person-centred and coordinated. The locally embedded nature of ICJ services was highlighted as beneficial for connecting individuals with community networks and supports.

Enabling a community-orientated approach is a key principle of the Health and Social Care Service Renewal Framework and so this finding is relevant for further development for cancer services more broadly. Key recommendations to support continued progress include supporting teams to sustainability, and routine and systematic recording of service uptake, outcomes and experiences. Analysis of uptake by Scottish Index of Multiple Deprivation (SIMD) showed that, in most ICJ programme areas, people resident in the most deprived national SIMD quintile were proportionately or even over-represented among service users. This indicates that services were reaching the people likely to be in the greatest need.

The report recommends that the principles underpinning the ICJ programme are transferred to future initiatives targeted to reducing inequalities, reflecting transferable learning for this wider ambition in the strategy. The value of building a learning culture and reflective practices in ICJ partnerships is highlighted to identify and share good practice and generalisable learning. These findings align with the ambition of the Service Renewal Framework to deliver change via a culture of collaboration, learning, and delivering measurable impact on health outcomes.

Healthcare Improvement Scotland’s scalability assessment of Single Point of Contact (SPoC) pilots was published in 2025. Twelve SPoC project sites have been piloted in 10 NHS Boards and one Regional Cancer Network to support tests of change in relation to SPoC through the cancer pathway. The sites have tested a variety of models, supporting patients with varying cancer types, and along different points in the pathway. Navigators provide administrative, logistical, social and emotional, and informational support. The broad aims of this role are to improve patient experience, and to release clinical time to provide more proactive and complex care. The assessment found significant impact in both these areas. SPoC acts as a bridge to link the dual needs and requirements of patients and clinical staff. This results in improved experience and wellbeing of both staff and patients, as well as having wider system benefits. Key enablers included: i) clinical engagement from medical and nursing colleagues, ii) leadership support, iii) a skilled and confident workforce, iv) clear communication of role to patients and relevant NHS staff, v) commitment to longer term support and funding, vi) limiting cancer types and ensuring sufficient training.

While SPoC is effective in supporting NHS Boards to maximise the efficiency of services by enhancing pathways for patients and improving efficiencies of working in teams, SPoC is not cost-neutral. Non-recurring funding and fixed-term contracts were noted as key barriers to implementation. The assessment concludes that, with the provision of ongoing funding to create and appoint to new roles, SPoC should be scaled up across Scotland.

The report recommends that pathway data be reviewed to determine where support can be focused on cancer types and pathways with greatest demand, and to consider the role of SPoC in reaching and supporting access amongst underserved groups. It is noted that local adaptation is key to success, therefore scaling using a set of principles rather than a rigid model would enable wider implementation. Strengthened engagement with ICJ and prehabilitation is recommended to promote whole system working that can help to provide a holistic pathway for patients experiencing multiple inputs from those providing care. For navigator roles, the report recommends a national skills and competency framework. Ongoing development of learning systems to support peer networks and share good practice is highlighted. When preparing for scaling, the report recommends that the aims of SPoC should be refined to ensure that they are distinct and measurable.

Interaction with the wider Healthcare System

Participatory systems mapping has been used to collate and structure perspectives from NHS Scotland healthcare professionals to develop a system map of the current healthcare system as experienced by those affected by cancer, and how the Cancer Strategy impacts and is impacted by this wider system. The analysis has helped build evidence about those factors that influence positive change in the system from the perspective of those who participated in the systems mapping. The interaction between the Cancer Strategy and aspects of the system identify three factors of high leverage or influence across the system. Firstly, a synergy was identified between the two Cancer Strategy ambitions of tackling inequalities and person-centred care, meaning that these ambitions support each other to influence positive change in the system. The synergy between these two policy ambitions relies on the participants’ perspective that the person-centred care ambition would improve the availability of SPoC. Participants generally held the view that SPoC initiatives were a core component of person-centred care. This in turn translated into the view that widespread, consistent availability of SPoC initiatives would reduce inequalities. Further, coordinated care was identified as having high leverage in the system to effect positive change. This factor is closely linked to multiple Cancer Strategy ambitions, suggesting that participants believe that achieving coordinated cancer care would be necessary for Cancer Strategy success. Participants thought that coordinated care would: i) directly improve access to care, treatment and diagnosis, ii) enable staff to deliver the right care in the right place, and iii) make it easier to share clear information on the patient journey because the journey itself is clearer.

Important limitations of this methodology are highlighted in the report, most significantly that the system map represents only a snapshot of the system being studied, at a particular time, and from the specific perspectives of those who participated. The map does not demonstrate causality. Instead, it provides a resource to support ongoing analysis, policy development and evaluation. As such, the insights present useful learning for consideration in the second Cancer Action Plan. Most notably, that the synergy identified between the tackling inequalities and person-centred care ambitions suggests that these have high leverage to influence positive change.

Theory of Change Analysis and Evaluation

The resulting system map complements ongoing theory of change analysis, which was outlined in the Monitoring and Evaluation Framework to support the Cancer Strategy. A review and update to the theories of change are planned, using data, analysis and evaluation conducted between 2023 and 2025. This work will support development and implementation of the second Cancer Action Plan. A further report in 2026 will bring together evidence to assess progress towards the strategic vision and ambitions, and to consider evaluation priorities going forwards.

Headline Indicators

We established headline indicators to assess the extent of progress towards the intended high-level outcomes and vision for the Cancer Strategy and committed to report annually on these. At the start of Year 3, there continued to be delays in the publication of statistics needed to report on some of the indicators, related to delays involved in producing updated population estimates following the 2022 Census. In Appendix A we include updates on the available statistics and report on headline indicators which are in development.

Key Insights and Learning from Evidence

Beyond learning applicable to the specific pathway and cross-cutting ambitions considered above, much of the evidence gathered to date reflects common opportunities and issues that are relevant to national policy to support cancer care and treatment more broadly. Person-centred, coordinated and collaborative care are central themes that have emerged as enablers for good care, supported by local adaptation of national principles and community-oriented approaches. Strengthening connections between initiatives such as prehabilitation, ICJ and SPoC are likely to support progress to provide a holistic pathway of care. The need for consistent data recording, sustainable funding models, and learning systems to scale up good practice are further themes that have emerged from across the evaluations and analysis reported here. With most people’s overall experience of cancer care and treatment remaining generally very positive, specific areas for progress to improve experience relate to communicating a diagnosis sensitively and ensuring consistent access to a Clinical Nurse Specialist or named contact to support people through their treatment. Consideration should be given to how information on wider support can be provided more consistently and equitably, especially for groups reporting lower levels of satisfaction, and applying transferable learning from those reporting higher levels of satisfaction. Addressing difficulties associated with travel to receive care would support progress to improve experiences, with attention to inequalities relating to geography and deprivation.

Analysis from published reports highlights that better data on outcomes are necessary to provide evidence to understand impact for patients individually, as well as to demonstrate impact, value and cost effectiveness from services. Utilising the National SACT Dataset, including linkage with other nationally held databases, CMOP-PHS have provided 15 RWE reports to date on the use and impact of cancer medicines on patients in Scotland. Most of the reports have supported decision-making in both SMC’s and NCMAG’s HTA processes, yet other clinical reports have provided valuable information to support health and care services. The Scottish Cancer Patient Reported Outcome Measures (PROMs) Toolkit, developed by the Scottish Cancer PROMs Advisory Group (SC PROMs AG), will be a helpful resource to support the meaningful gathering of information about the impact of care on people’s quality of life and drive improvements in their care, healthcare services and the generation and utilisation of cancer intelligence. As identified in relation to ICJ services, which are central to the ambition to provide person-centred care for all, improved recording and assessment of outcome data would support the case for local sustainability through integration of activities into ‘core business’ and help close the ‘feedback loop’ for staff about the benefits of activities.

A key recommendation from evaluating the national rollout of ICJ services involves supporting services to transition from non-recurring funding to ‘core business’ via permanently committed funding. Understanding how services have managed to achieve core/ recurring funding, including the data and methods used to achieve this, is highlighted as important learning to obtain and share across services. Similarly, scaling up, sustainability and funding are highlighted as issues relevant to widening coverage of prehabilitation activities to support the ambition of best preparation for treatment, and in the findings of the scalability assessment of the SPoC initiative. Progress would be enabled by sustainable, long-term funding.

Most evaluation evidence to date relies predominantly on staff perspectives, including staff views on patient outcomes and experiences. Gathering data on outcomes and experiences directly from people receiving support or services would be beneficial, with consideration given to data linkage and comparison. This will require appropriate data access and sharing arrangements, which relies on information governance, as reflected in the evaluation of the pilot to improve pathways of less survivable cancers reported above, and IT infrastructure and data recording platforms or mechanisms, as reported in the ICJ evaluation report. How best to strengthen data gathering and reporting of patient outcomes and experiences will rely to a large extent on national ambitions connected with the Health and Social Care Data Strategy. The Health and Social Care Service Renewal Framework builds on this strategy and emphases the importance of access to data that measures outcomes, quality and impact. Aligning with further strategic work to deliver this ambition will be important to support improved data access, recording and measurement to enable progress with evidencing impact.

Knowledge exchange and learning from evaluation is articulated as a key purpose of the Monitoring and Evaluation Framework. Findings from the scalability assessment of SPoC and the evaluation of ICJ services highlight the value of transferable, scalable and well-evidenced learning that is available from the local level. Similarly, analysis of prehabilitation services emphasises the value of sharing good practice in partnership working to expand coverage. These findings have broader application for other projects or programmes seeking to scale up and sustain innovative support and services. Understanding what variation tells us about the system, and what is or is not working in different areas, would support the spread of good practice across the system. Such learning is pertinent where programmes face common barriers and enablers around funding, sustainability and scaling up. A national coordinated approach to support learning systems and the sharing of good practice across programmes would be helpful to enable progress.