Cancer strategy - monitoring and evaluation: participatory systems mapping

Background

For the monitoring and evaluation of Scotland’s 10-year Cancer Strategy 2023-2033 there was a need to build evidence on the impact of the Cancer Strategy in the health and care system. To do this, there was a need to understand the system itself which resulted in the commissioning of a system mapping exercise. This work was carried out with the support and guidance of the Cancer Strategy Monitoring and Evaluation Advisory Group.

The Cancer Strategy sets out 11 priority ambitions which are shared here, without hierarchy, for ease of reference:

• Preventing more cancers
• Earlier and faster diagnosis
• Best preparation for treatment
• Safe, realistic and effective treatment
• Excellent care and support after treatment
• Sustainable and skilled workforce
• Person centred care for all
• Tackling inequalities
• Mental health as part of basic care
• Flourishing research and innovation
• Cancer information and intelligence-led services

The main output of the system mapping exercise is a participatory system map portraying how NHS Scotland healthcare professionals perceive the interactions between the health and care system and people affected by cancer, and how the Cancer Strategy ambitions are expected to impact and be impacted by this system.

A system map of a complex system is inherently complex itself – this can make it hard to make sense of the output and continue to get value from the system mapping after the mapping process. In an attempt to counteract this difficulty, a system map visualisation tool was developed by analysts in the Department for Energy Security and Net Zero, UK Government, and the code shared for use among civil servants. A version of this visualisation tool has been deployed specifically for the Cancer Strategy systems map, providing a product that can be used for continuous learning and development.

The aspiration was that the system map would:

• Assist in the evaluation of the Cancer Strategy by providing focal points for potential future monitoring and evaluation – where to look in the system to understand if policy actions are working as anticipated.
• Assist with strategic planning by highlighting actions which appear to have high leverage.
• Guide data collection by considering indicators that could measure the impact of the Cancer Strategy – either reinforcing that current indicators are suitable or suggesting new indicators.

This report highlights some of the focal points in the system map and explores actions with high leverage, but does not cover indicator development. The Insights section explores in more detail how the system map was used to identify factors with high leverage, such as the tackling inequalities ambition of the Cancer Strategy.