National cancer plan: progress report - August 2022

Scotland's national cancer plan comes to completion in March 2023. This report uses insights from the available evidence to update on progress against all 68 actions in the plan as at 31 August 2022.

Cancer Plan Progress Updates: Governance and System Support

Actions for Governance

Action 54 – Review the national cancer governance landscape

Commitment: We will conduct a rapid review of overall national cancer governance to ensure it is optimised for the recovery and redesign phases.

Progress: An independent review was conducted in December 2020 by NHS National Services Scotland. This outlined several options and provided recommendations that were consulted on with key members of the cancer landscape. The recommendations have been implemented.

Flagship Action

Action 55 – Create a national resource to deliver 'Once for Scotland' approach

Commitment: We will identify and invest up to £2.78 million into a dedicated national resource for supporting a ‘Once for Scotland’ approach to cancer. This will help ensure everyone in Scotland has equitable access to treatment, no matter where they live in Scotland.

The work will initially focus on developing clinical management guidelines and improvement in patient pathways, including surgery, for less common cancers. Throughout, it aims to promote clinical consensus, collaboration and continuous improvement.

Progress: A new Scottish Cancer Network (SCN) was commissioned, resourced and launched in Summer 2021. The network has two key functions: 1) to develop a national approach to producing Clinical Management Guidelines, and 2) to host existing national clinical and service networks for cancer. Over the duration of the plan, the Network will receive over £2.2 million. This funding has been used to directly fund the Scottish Cancer Network and the networks which now fall within its remit and their project (e.g. PHCC-PIP).

Under the SCN, three National Clinical Management Pathways are in development (for breast, lung and brain cancer), and expected to be published by March 2023. The Network is assisting with the workforce review of the Children and Young People’s Network, and have discussed with relevant networks the structure and resourcing required. All existing national networks have started transiting to the SCN, with some having already formally integrated. The network continues to monitor progress, and have held six-weekly progress meetings, and a mid-way review in May 2022.

Action 56 – Continue support of NHS Scotland Cancer Managers Forum

Commitment: The Cancer Managers Forum is made up of operational and clinical Cancer Service Managers to discuss, share and support best practice within NHS Scotland. We will continue to support the Forum to share learning, challenges and best practice across Scotland to improve cancer care and services, as well as patient experience, encouraging a ‘Once for Scotland’ approach.

Progress: The Cancer Managers Forum has continued to meet on a regular basis. The Forum is working with Scottish Government on a range of issues to optimise services for patients, including data collection, pathway development and agreeing common guidelines.

Action 57 – Establish the Cancer Clinical Trials Subgroup

Commitment: We will establish a National Cancer Trials Resilience subgroup to oversee the safe resumption of clinical research trials impacted by the pandemic.

Progress: A Clinical Trials Resilience group has been established with a subgroup looking specifically at equity of access to trials. The group has produced a report which outlines key barriers to accessing trials and sets out a number of recommendations for the Scottish Government to consider.

Action 58 – Promote the use of the Scottish Health Technologies Group

Commitment: We will promote the use of the Scottish Health Technologies Group to analyse health technologies related to cancer, prior to their implementation.

Progress: Where appropriate, the Scottish Health Technologies Group has been promoted to organisations and individuals seeking support for new health technologies. This is an ongoing action, and we will continue to promote the Scottish Health Technologies Group where relevant.

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

Commitment: We will remain alert to potential service innovations benefitting patients, such as those that emerged during our COVID-19 response, which could be introduced quickly with national support and governance.

Progress: Many activities and outcomes attached to this action are encompassed through other updates in this report. National NHS Near Me data is being used to evaluate outcomes, and a review of NHS Near Me usage within cancer services to understand best practice and opportunities for further improvement is under consideration.

Action 60 – Standardise patient consent for Systemic Anti-Cancer Therapies across Scotland

Commitment: We will ensure a consistent approach to patient consent, including electronic consent, for Systemic Anti-Cancer Treatment is used across Scotland.

Progress: Standardised paper forms have been introduced and there is good utilisation of these. For example, there was a marked increase in downloads after Healthcare Improvement Scotland guidance was published at the end of 2020, and a steady increase thereafter. An electronic consent (e-consent) feasibility study, led by National Services Scotland, has commenced. This will help identify the feasibility of introducing national e-consent and the preferred national model.

Actions for Data Needs

Action 61 – ChemoCare upgrade support

Commitment: All five instances of ChemoCare (the electronic prescribing system) will be upgraded to Version 6 by the Chemotherapy Electronic Prescribing and Administration Systems (CEPAS) User Group to achieve a uniform approach across the country.

Progress: South East Cancer Area Network (SCAN) and West of Scotland Cancer Area Network (WoSCAN) have launched their updated ChemoCare and are testing their current updates. The North Cancer Alliance (NCA) is amalgamating three instances of ChemoCare across 3 cancer centres so not yet complete. There will be learning from the other networks as part of ongoing work.

Action 62 – Integrate Systemic Anti-Cancer Treatment and radiotherapy data into the Scottish Cancer Registry Intelligence Service

Commitment: Continue to develop and prioritise the integration of Systemic Anti-Cancer Treatment (SACT) and radiotherapy data into the Scottish Cancer Registry Intelligence Service.

Progress: Public Health Scotland (PHS) have successfully connected to all 5 instances of ChemoCare in Scotland using Data Virtualisation and have developed national mapping and validations methods to standardise across them. A publicly available dashboard of weekly SACT Activity Early Warning data is now available, and data are incorporated into PHS’s COVID-19 wider impacts dashboards. The focus is now to ensure consistent validation of data and to reach agreement on consistency of local recording for key national variables (e.g. Treatment Intent) to increase sustainability and to support fully functional reporting by March 2023.

To raise awareness of developments, a poster was presented at the NHS Scotland Annual Conference in June 2022 and over 250 people now subscribe to the Scottish Cancer Registry and Intelligence Service mailing list.

Radiotherapy data is being collected across all Health Boards and submitted to NHS Digital for presenting on a UK benchmarking tool CancerStats2. PHS is exploring the potential of the data to enhance the Scottish Cancer Registry and further bespoke analysis.

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

Commitment: We will work in partnership (with Digital Service, Public Health Scotland, Health Boards, patients and clinicians) to map data needs and develop technical solutions for treatment summaries, delivering a national prototype product by June 2021.

Progress: Development of the technical solution for treatment summaries continues in the West of Scotland with launch of a clinically available product planned for October 2022. Local development has included ongoing engagement with clinical teams and patient groups in NHS GG&C alongside engagement with external eHealth teams to ensure that the technical solution can be deployed across health boards in Scotland.

Action 64 – Assess the potential of Patient Reported Outcome Measures

Commitment: Patient Reported Outcome Measures (PROM) have the potential to provide vital information in how we configure our services. We will provide national support to assessing the potential and value of these, linking with other digital strategies, and guiding pan-Scotland approaches to adoption.

Progress: A Scottish Cancer PROMs Advisory Group has been established and has met several times. In March 2022, the Scottish Cancer PROMs Forum held its first online event, with 133 attendees; key learnings and recommendations have been published and future events are being planned. The Forum will support the Advisory Group in developing a set of key principles for the collection and use of cancer PROMs in clinical practice. Additional PROMs funding totalling £167,000 has been dispersed across the Regional Cancer Networks for local projects.

Action 65 – Support Phase 2 of the Cancer Medicines Outcomes Programme

Commitment: We will support Phase 2 of the Cancer Medicines Outcomes Programme (CMOP) with up to £822,000 in funding to better understand the effects of medicines on patients in the real world and determine the feasibility of scaling up electronic data linkage.

Progress: Phase 2 of the Cancer Medicines Outcome Programme (CMOP) continues to be funded and progress is continuing. The Programme Board (including patient representation) meets biannually to track key milestones and deliverables. There are now two delivery groups which focus on (i) maximising existing data, and (ii) improving and transforming care. The group are upscaling their programme to see if data linkages will work across other boards and networks, including provisioning of national Systemic Anti-Cancer Therapy (SACT) data from Public Health Scotland. To share learning, a number of CMOP publications are available online.

Action 66 – Retrospective audit of Cancer Waiting Time data undertaken

Commitment: Public Health Scotland will conduct an audit of the application of Cancer Waiting Times data and definitions to ensure consistency of data capture and adherence to exclusion criteria across Scotland.

Progress: The PHS Cancer Waiting Times data and definitions audit was completed in May 2022. Final individual Health Board and National reports have subsequently been drafted and are in the process of being finalised. Publication of these reports is planned for Autumn 2022.

Action 67 – Consider how the Cancer Quality Performance Indicators can best drive forward recovery

Commitment: We will consider how Quality Performance Indicators can continue to be best used to further inform and drive cancer recovery.

Progress: The Scottish Cancer Quality Steering Group has oversight of the cancer Quality Performance Indicators (QPIs). This is an ongoing action and QPIs continue to be reviewed by practitioners and by Health Improvement Scotland to ensure they best reflect those areas where quality and variations in practice can be improved.

Action 68 – Complete phases 3-5 of the Cancer Intelligence Platform

Commitment: Implement a phased approach to developing a Cancer Intelligence Platform, in order to provide a centralised space for data linkage and analysis.

Progress: Following the completion of Phase 1 and 2, Phases 3-5 were initially delayed due to the IT resource in National Service Scotland DaS (Digital and Security) pivoting towards COVID-19. A workshop was held in May 2022 to agree a new work stream plan and adjusted timeline for 2022/23. The Cancer Intelligence Platform work has now been prioritised by PHS and DaS resource has been assigned. This development has restarted using Agile methodology and aims to complete by March 2023.



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