Cancer services action plan 2020 to 2023: final report

Actions completed since progress report

Work to address some of these actions will continue under the new 10-year cancer strategy and accompanying action plan.

Action 1: Rollout the Transforming Cancer Care (TCC) programme across Scotland

Action 2: Adapt the TCC programme to services changes

All bar one of the Health and Social Care Partnerships in Scotland to date have agreed to the ‘Improving the Cancer Journey’ (ICJ) model. It is anticipated that the remaining Health and Social Care Partnership will be confirmed in 2023. Scotland is now the first country in the UK where all cancer patients will have access to a key support worker to receive dedicated financial, practical and emotional support.

In terms of Holistic Needs Assessments (HNA), year on year growth can be seen across Scotland (Fig. 1). HNAs are conducted by the key support worker around a person’s physical, emotional, family, practical, lifestyle and spiritual needs.

Annual funding to continue the Scottish Government partnership with Macmillan Cancer Support has been agreed. This should ensure that a range of outcomes will be delivered across health and social care (HSC) in Scotland, including:

• better integration and co-ordination of services across HSC partners to meet the needs of people affected by cancer, aligned with national digital developments and placing the patient at the centre of communications
• efficient & effective cancer follow up pathways, ensuring patients are seen in the right place, at the right time and by the right person to meet their needs
• implementation of a process for the identification of holistic needs and planned care to respond to identified needs
• robust systems and processes to assist local planning and ensure continuous improvement in service delivery in future years.

Action 3: Work towards a single point of contact for cancer patients

All of the 12 pilot projects are now live. Progress to December 2022 was sought from all pilots which provided brief information on early learning and impact. Early indications are that the pilots are impacting positively on patient experience and clinical workload.

For example, in the NHS Western Isles project, two Healthcare Support Workers have been introduced into the Macmillan Cancer Nursing Team. The Macmillan Nursing Service is now available 7 days per week, ensuring improved local access to oncology/specialist palliative and end of life care support across the islands and across all care settings, including hospital. NHS Fife has created a Single Point of Contact Hub (SPoCH) for patients referred with urgent suspicion or diagnosed with cancer. The Hub enables patients to contact the service by telephone and/or email. So far, almost 90% of calls have been resolved by the Hub and do not need to be signposted to other services. NHS Forth Valley has introduced two oncology-based support workers to provide support throughout the cancer pathways to patients from seven tumour groups. Informal feedback has been positive from both staff, who have more time to concentrate on clinical work due to reduced admin and non-specialist calls, and patients, who have found the service helpful, with quick resolution of enquiries and welcoming the consistency of speaking to the same person each time they call.

Funding will be made available to continue the pilots under the new cancer strategy.

Action 7: Update information on cancer services with the Scottish Cancer Coalition

The Scottish Government continues to collaborate with the Scottish Cancer Coalition. The Coalition have been invited to sit on the recently established Scottish Cancer Strategic Board, with one of the Board’s key functions being oversight of the new cancer strategy and action plan delivery. This will ensure that the third sector will continue to provide live information sharing and input into national conversations around cancer services.

Action 9: Deliver the Screening Inequalities Fund

The National Screening Oversight (NSO), with the support of Scottish Government, has developed the Equity in Screening Strategy which, combined with an action plan, was published on 27th July 2023. The vision of the strategy is for access for all eligible individuals, across the full screening pathway.

The Strategy launched alongside the Equity in Screening Network which will support the strategy by capturing local and third sector research activity and allow individuals that work across screening to share evidence, best practice, and learning around screening inequalities.

This complements the ongoing work to address inequalities through the Screening Inequalities Fund. Annually, since 2018, £1 million has been provided, which is split into £650,000, allocated locally between each of the NHS Boards, and £350,000, which is used for national projects.

Several national projects are already being supported by the Inequalities Fund. This includes changes to national IT systems to improve engagement with participants (e.g., better use of text messaging). Research and learning from past projects have shown some ways to increase access to screening and uptake, including appointment reminders and targeted follow-up with non-responders.

Action 11: Develop guidance for surveillance of at risk patients

The Scottish Government continues to work with Health Boards and relevant stakeholders to identify if national guidance is needed on the delivery of services for high risk cancer surveillance and follow-up screening checks. To date there have been no areas of concern agreed so no national guidance has been developed. New Clinical Management Pathways developed by the Scottish Cancer Network include guidance on appropriate follow up.

Action 21: Increased oversight of cancer waiting times (CWT) to improve performance of both standards

Increased scrutiny continues through weekly cancer performance calls with all mainland Health Boards (monthly for island Boards) to identify challenges, explore solutions and ensure full adoption of the Framework for Effective Cancer Management. The most recent CWT report was published by Public Health Scotland in June 2023: Cancer waiting times - 1 January to 31 March 2023.

Action 22: Review new pathways to incorporate in the Framework for Effective Cancer Management

Work continues to embed 'Once for Scotland' pathways in the Framework for Effective Cancer Management. A National Effective Breach Analysis and Escalation Standard Operating Procedure (SOP) was officially launched on 3rd February 2023. This SOP will ensure robust processes are in place to mitigate breaches.

National referral regrading guidance is also under development; this guidance will help ensure that the right patients are put on the right pathway at the right time.

Action 24: Test and evaluate a programme of prehabilitation

The Maggie’s prehabilitation pilot Prehabilitation for cancer patients saw over 1522 people affected by cancer access this service by the end of March 2023. A final report on the projects was published in May 2023: Maggies Prehab pilot report.

Further funding has been made available to March 2024 for the extension and embedding of this prehabilitation programme. This funding should ensure that more people affected by cancer each year across Scotland will receive prehabilitation sessions, while demonstrating the value and effectiveness of prehabilitation for people with cancer and their families/carers, in terms of both immediate and longer-term impact. It will also build capacity to support individual needs throughout the whole patient pathway from prehabilitation to rehabilitation and will establish a sustainable programme that is well understood by clinicians and patients.

Action 25: Develop digital resource to raise awareness of prehabilitation

Work is ongoing to track the impact of the Prehabilitation for Scotland website launched in Summer 2022. Future work will focus on increasing usage through embedding the appropriate information and resources within pathways of care.

Action 26: Convene a nutritional cancer care advisory group

The advisory group was established and led on development of the framework for nutritional care. The Nutrition Framework for People Affected by Cancer was published and made available online in November 2022. Implementation of this framework will be carried forward into the new cancer strategy and action plan.

Action 27: Identify ‘best learnings’ from the West of Scotland’s Psychological Therapies and Support Framework

The national Psychological therapies and support framework for people affected by cancer was published in April 2022. Implementation of this framework will be carried forward into the new cancer strategy and action plan. Investment in clinical leads and project co-ordinator will ensure that further work is fully embedded, supports benchmarking, and establishes capacity and demand.

Action 36: Support awareness of weight management services

This action will continue to progress in tandem with Prehabilitation / Pre-treatment actions, specifically Action 26.

The importance of body weight and nutrition information is highlighted in the Nutrition Framework for People Affected by Cancer and referral pathway embedded within.

Action 39: Support expansion of RT peer review

This action has been incorporated into the National Radiotherapy Plan for Scotland published in March 2022.

Action 41: Continue and expand the delivery of oral SACT

This action is progressing via the work of National Cancer Medicines Advisory Group (NCMAG) Programme (see action 45). Twenty treatments were approved under the COVID-19 NCMAG framework and 4 have now been approved on the new business-as-usual NCMAG framework.

A public facing webpage has been created which details the remit of NCMAG and hosts published and upcoming advice. NCMAG advice documents (healthcareimprovementscotland.org)

Action 44: Review and update CEL 30

CEL 30 (2012) (Revised 2023) - Guidance for the safe delivery of systemic anti-cancer therapy - has been completed. It has come into force on 5th June 2023 and is published on Scotland’s Health on the Web (SHOW).

Action 49: Enhance the Clinical Nurse Specialist (CNS) role

Following publication of the Review of Clinical Nurse Specialist and Nurse Practitioner roles within Scotland report, work continues to identify the role and reallocation of tasks for CNSs working in the cancer specialty. Actions 1, Transforming Cancer Care, and 3, Single Point of Contact, are part of various workstreams supporting delivery of this action.

Action 56: Continue support of NHS Scotland Cancer Managers Forum

The Cancer Managers Forum continues to meet once every quarter to ensure key learnings and best practice are shared. The Forum has recently announced a new Chair, NHS Grampian’s Cancer Manager.

Action 58: Promote the use of the Scottish Health Technologies Group (SHTG)

We will continue to promote the Scottish Health Technologies Group where relevant.

Action 59: Introduce and deliver innovative solutions, like Near Me

A number of innovations were delivered through this action plan. Examples include the Scottish Capsule Programme (SCOTCAP) enabling upscaling of Colon Capsule Endoscopy (CCE), and increased use of Near Me, a video consulting service; Non-Medical Prescribing (NMP) and Connect Me, offering various services for patients to communicate with healthcare professionals.

Action 63: Map data and develop technical solutions for treatment summaries

A minimum viable product - Cancer Treatment Summaries (TSUM) Application - was completed and piloted in gynaecological services in the West of Scotland. The work will continue to be developed and scaled up over the next cancer strategy.

Action 64: Assess the potential of Patient Reported Outcome Measures (PROMs)

Scottish Cancer PROMs Advisory Group and Forum continue to meet on a six-monthly basis. Key learning and recommendations from the second meeting of the Forum were published in November 2022. Core principles for the collection of cancer PROMs will be developed under the new cancer action plan.

Action 67: Consider how the Cancer Quality Performance Indicators (QPIs) can best drive forward recovery

The National Cancer Quality Programme continues, with QPIs under regular review to ensure ongoing improvement and better outcomes for patients. The National Cancer Quality Steering Group will transition to a National Cancer Quality and Improvement Board during 2023-24. This transition will support a refreshed approach to measuring and improving quality in cancer services and encompasses a significant role for Healthcare Improvement Scotland (HIS).

Since the 2022 progress report, HIS has updated the following QPIs following formal review:

• Breast cancer
• HepatoPancreatoBiliary Cancer
• Mesothelioma
• Oesophago-Gastric Cancer
• Prostate Cancer
• Sarcoma
• Testicular cancer