Cancer prehabilitation in Scotland: 2025 survey findings report

8. Conclusion

This survey analysis reaffirms strong support for prehabilitation amongst staff, with a majority of respondents perceiving it as playing a crucial role in preparing patients for treatment. This maintained support was reflected in the high level of response to this survey, which gathered input from 302 staff, reporting on activities in all 14 territorial NHS Boards. These staff worked across a range of settings and roles, including in: Acute care, Community care, Local Authorities, and the Third Sector.

In the national adoption of prehabilitation, findings present a mixed view of progress. In 2025, there is a stronger sense that service delivery is underpinned by the eight Key Principles for Implementing Cancer Prehabilitation across Scotland compared to responses in 2022. This may reflect that staff are knowledgeable about prehabilitation and feel more confident in applying the key underpinning principles to their area of practice. Responses highlighted areas of service development and expansion: for example, reaching new cancer types, trialling screening tools, and developing leadership roles to embed prehabilitation in ways of working. The analysis also highlighted new or expanded services being provided and an increase in the proportion of respondents reporting permanent funding to support prehabilitation activities. These findings indicate positive developments towards embedding prehabilitation into pathways. Although the extent of progress may be limited when findings indicate ongoing challenges with timeliness in referrals, unequal access across cancers and treatment types, and continuing reliance on temporary funding for many activities, reflecting barriers reported in 2023.

Overall, the coverage of prehabilitation services locally reported was in line with 2022, which indicates modest change in the availability of local prehabilitation services. Similar issues around accessibility were also described. Many reported temporary funding coming to an end and were concerned about the impact this would have on the capacity to provide timely and equitable care. Funding and workforce capacity were recurring concerns with calls for sustainable investment and strategic workforce planning to address local gaps in particular modes of prehabilitation support. Key barriers to progress reported in 2023 around staffing and funding therefore continue to be reported in 2025, impacting the goal to ensure nationwide coverage of face-to-face universal prehabilitation across Scotland.

Recommendations from these findings for the second Cancer Action Plan include further awareness-raising activities amongst staff networks on online resources about prehabilitation to advance knowledge, skills and understanding of prehabilitation. In addition, facilitating opportunities to share learning from pilot projects around partnership and collaboration in delivery, and sharing guidance and/or developing communities of practice about co-designing activities for improved access, scaling of services, and measuring outcomes effectively. These enablers reflect recommendations in the 2023 report, including national guidance on outcome measurement, and minimum datasets for monitoring and evaluation. Follow-up conversations with prehabilitation staff are recommended for more conclusive insights on how to embed multi-modal prehabilitation in cancer pathways.