Cancer waiting times standards in Scotland: clinical review

3. Recommendations

3.1 Cancer Pathways

• Re – evaluate inclusion/ exclusion criteria of cancer types subject to CWT standards while taking into account the level of resource available for any additional data collection requests.
• Review evidence for making CWT standards timings variable according to tumour biology.
• Review evidence of patient benefit from submitting additional time intervals within the cancer pathway to CWT standards scrutiny e.g. time to subsequent treatment(s).
• Ensure that existing agreed cancer pathways are reactive to new techniques and treatments with well-established processes to enable change to be introduced.
• Minimise variance in agreed pathways by regular cross comparison and dialogue with local, regional and national specialty services.
• Refine the selection of USC patients in both primary and secondary care.

3.2 Primary Care

• Undertake a review of Scottish Referral Guidelines for Suspected Cancer.
• Reduce variance in availability of protocol led direct access to diagnostics.
• Ensure patients are provided with adequate information and support at the time of their USC referral.

3.3 Secondary Care

• Embed smarter vetting/triage processes to ensure USC referred patients are managed in order of apparent risk, in terms of access to diagnostics/clinics and avoid variation by considering the use of triaging protocols.
• Regularly review availability of slots for USC patients in clinics, and diagnostics waiting lists (radiology, endoscopy etc.) and make these flexible to best meet pressures in real time.
• Encourage greater use of virtual clinics and advice services learning from Health Boards where these have been successfully trialled.
• Regularly review turnaround times for diagnostic laboratory tests and communicate these to both clinical and tracking staff.
• Ensure that consideration is given to including other higher risk patient groups into any planning for USC referral patients.

3.4 Patient Support

• Ensure appropriate information on the USC referral process, tests throughout and purpose is available at the point of referral from primary care.
• Ensure an appropriate and consistent level of information is available throughout the whole pathway and dovetails, if needed, with treatment pathways and explanation of results.
• Provide a key contact for all patients requiring additional support, while ensuring they are clearly signposted for patients to utilise.
• Ensure locally relevant details and timescales are incorporated into any patient information materials/documents.
• Review and act on the outcomes of patient experience QPIs and other relevant patient evaluation processes (e.g PROMs) as and when available.

3.5 Data

• Embed proven good practice of close tracking of USC referral patients by fully supported tracking, audit and MDT staff.
• Review any current variance in data collection e.g. in application of exclusion criteria and other adjustments.
• Liaise with ISD Scotland colleagues to maximise available data usage for patient and service benefits.
• Ensure that all clinically relevant data e.g. from MDTs is assimilated into cancer tracking/pathway information.
• Integrate CWT data with any additional available outcome data such as recurrence rates and PROMs as well as survival/mortality.