Summary of Progress against Actions
This report has provided an update on each action in the National Cancer Plan. In this section, the main milestones and activities are summarised to provide a summary overview, with information on significant delays or impacts on progress. Progress is summarised first for flagship actions and actions connected specifically with reducing inequalities. The remaining commitments are considered in relation to the six overarching sets of actions.
A skeleton framework for implementing a Single Point of Contact has been designed to inform pilot projects that are underway in Scotland (Action 3). Three early adopter Rapid Cancer Diagnostic Services (RCDS) have been established (formerly known as Early Cancer Diagnostic Centres) (Action 12). Interim service evaluation findings for RCDS have shown high patient satisfaction rates. For prehabilitation, a survey of services is underway and Maggie’s Centres are delivering pilot prehabilitation workshops and are in the process of evaluating their impact on patients (Action 24). Linked to this action, a digital resource for prehabilitation has been launched with information for patients and professionals (Action 25), including publication of the key principles of prehabilitation and psychological therapies and support framework (Actions 27). A nutrition framework for people affected by cancer is in the final stages of development (Action 26).
A new Scottish Cancer Network (SCN) has been commissioned, resourced and launched (Action 55). The Network is making progress to develop a national approach to producing Clinical Management Guidelines, and to host existing national clinical and service networks for cancer. All existing national networks have started transiting to the SCN, with some having already formally integrated.
Actions to tackle health inequalities in relation to cancer are showing progress. The success of these commitments must be viewed in the context of statistics that continue to report inequalities in screening uptake between the most and least deprived areas, and the continuing impact of lung cancer on mortality in Scotland. Progress includes investment in the Screening Inequalities Fund (Action 9) and pilot work on vaginal self-sampling to broaden the reach of cervical screening (Action 10). As part of a focus on lung cancer, two Detect Cancer Early lung cancer campaigns have been delivered with positive post-campaign evaluation (Action 28). A Clinical Trials Resilience group has been established, which has considered equity of access to trials and produced a report that outlines key barriers (Action 57).
Patient and Family Support
In addition to the Flagship Action to establish a Single Point of Contact (Action 3), progress is being made to transform cancer care, with investment in Macmillan’s ‘Improving the Cancer Journey’ service model that is being rolled out across Health and Social Care Partnerships in Scotland (Actions 1 and 2). Work is continuing to deliver the next iteration of the Scottish Cancer Patient Experience Survey (Action 4). Actions for guidance and information across a range of commitments related to patient and family support have been completed (Actions 5-8).
Detection and Diagnosis
Actions connected with Health Inequalities are summarised above (see Actions 9, 10). Guidance for the surveillance of at risk patients has been considered but no changes deemed to be required (Action 11) and progress with the Rapid Cancer Diagnostic Services (see Action 12) is described above under Flagship Actions. All committed mobile MRI and CT scanners are in place (Action 13) and work is ongoing to increase GP direct access to CT scans (Action 14). The Endoscopy Renewal Plan (Action 16) is delivering its planned activities and outputs. Slow but ongoing progress has been made in relation to national rollout of Cytosponge™ and Colon Capsule Endoscopy (CCE) procedures (Action 15). Preliminary data show an increase in procedures, and high levels of patient satisfaction among patients for CCE, although the adoption process is delayed. Similarly, the Gallium Scanner roll-out is progressing but with one of four planned scanners delayed (Action 17). The National Cancer Diagnosis Audit has been completed with feedback to participating GP practices (Action 18).
Actions associated with pre-treatment are ongoing with some delayed. This includes the audit of Scottish Referral Guidelines for Suspected Cancer (Action 19). Aimed at improving cancer waiting times, the refreshed Framework for Effective Cancer Management has been published (Action 20) and investment delivered on oversight of the most challenging pathways – urology and colorectal (Action 21). Work is progressing on the redesign of pancreatic and liver cancer pathways as less survivable cancers (Action 22) and the optimisation of urology pathways (Action 23).
To support pre-treatment approaches, Flagship Actions on prehabilitation highlighted above are progressing (see Actions 24, 25, 26, 27).
Campaigns to improve earlier detection of lung cancer to tackle Health Inequalities are noted above (see Action 28). Additional clinical guidance on the management of urgent suspicion of lung cancer referrals has been reviewed and archived (Action 29). Research into the feasibility of lung health checks is delayed but progressing (Action 30). Work to monitor the effectiveness of one-stop lung clinics has been superseded by development of the first national optimal diagnostic cancer pathway (Action 31).
A review of data on access to specialist surgery was paused due to service pressures (Action 32). Through work led by National Services Scotland, there are 15 Robotic Assisted Surgery (RAS) systems in Scotland, bringing Scotland in line with other developed nations, and investment has been made into RAS training for surgeons (Action 33). The Framework for Recovery of Cancer Surgery has now been published and reviewed (Action 34). Work is ongoing to monitor and explore new initiatives and service changes to improve recovery after surgery (Action 35). Awareness of weight management services (Action 36) is being supported through the nutrition framework being developed as part of prehabilitation (Action 26).
Work is ongoing to improve radiotherapy equipment as part of a rolling infrastructure replacement programme with continued investment in the Linear Accelerator (LINAC) Procurement Programme (Action 37). The National Radiotherapy Plan for Scotland has been published following a delay of six months (Action 38) and support for the expansion of radiotherapy peer review has been incorporated into the Plan (Action 39).
The Centre for Sustainable Delivery is taking forward exploratory work to scope out models and approaches that community-based phlebotomy services are using for wider community phlebotomy services (Action 40). An interim group was established to continue and expand the delivery of oral Systemic Anti-Cancer Therapies (SACT), which has been superseded by the National Cancer Medicines Advisory Group Programme, hosted by Health Improvement Scotland (Action 41). Work is ongoing but delayed to develop a national approach to non-medical SACT prescribing (Action 42). Work to utilise and enhance the delivery of SACT through community pharmacists is ongoing; changes to community pharmacy infrastructure are required before enhanced delivery of SACT through community pharmacists can be considered (Action 43). Work to review and update CEL 30 was paused due to service pressures but has now restarted (Action 44). The embedding of long-term rapid decision making for off-label medicines is underway and led by the National Medicines Advisory Group Programme, hosted by Health Improvement Scotland (Action 45).
Actions for acute oncology and precision medicine are progressing. A short life working group has developed a framework to consider the optimum model for a national approach to acute oncology (Action 46). The Scottish Strategic Network for Genomic Medicine has been established to optimise the provision of diagnosis, treatment, and prevention through precision medicine (Action 47). This network is providing strategic leadership to deliver on a genomics health service for Scotland (Action 48). The NHS National Services Division (NSD) put in place a Genomics Transformation Team that has conducted a gap analysis in response to the major service review completed by NSD in March 2022. Work is ongoing to ensure alignment between Scottish Medicine Consortium (SMC) approval for new medicines and laboratory capacity and infrastructure to make them available to patients.
Work is ongoing with the Scottish Cancer Lead Nurse / Nurse Consultant Group to support the enhancement of the Cancer Nurse Specialist role (Action 49). Health Boards now have robust policies on health and care workforce testing for COVID-19 that continue to be implemented (Action 50). There was a pause in the Healthcare Improvement Scotland staffing programme due to emerging workforce modelling and publication of the Scottish Government Health Workforce strategy (Action 51). Work is now ongoing to model cancer staffing demand by March 2023. Clinical leadership guidance has been published to support leadership development opportunities, and succession planning sessions for governance groups have been initiated in order to enhance clinical leadership skills (Action 52). The Action to support a ‘Flying Finish’ has been superseded by Workforce Short Life Working Groups, undertaking immediate and long-term modelling (Action 53).
Governance and Systems Support
Good progress has been made around various commitments to improve governance. This includes the review of the national cancer governance landscape (Action 54) and the flagship Scottish Cancer Network (Action 55) noted above. The Scottish Government is working with the Cancer Managers Forum on a range of issues to optimise services and a ‘Once for Scotland’ approach (Action 56). Activities to improve equity of access to clinical trials is progressing (Action 57). The Scottish Health Technologies Group has been promoted to organisations and individuals seeking support for new health technologies (Action 58). Activity is ongoing to introduce and deliver innovative solutions, like Near Me (Action 59), and to standardise patient consent for Systemic Anti-Cancer Therapies (SACT) (Action 60).
Actions to support improved data are progressing. This includes support for the ChemoCare Upgrade (Action 61) and integration of Systemic Anti-Cancer Treatment and radiotherapy data into the Scottish Cancer Registry Intelligence Service (Action 62). A notable milestone is the publicly available dashboard of weekly SACT Activity Early Warning data, with data incorporated into Public Health Scotland’s COVID-19 wider impacts dashboards. Work is progressing to map data and develop technical solutions for treatment summaries, with a minimal viable product now available (Action 63).
As part of work to assess the potential of Patient Reported Outcomes Measures (PROMs), national support is being provided including via the Scottish Cancer PROMs Advisory Group that has been established (Action 64). Work is also ongoing to better understand the effects of medicines on patients in the real world and to determine the feasibility of scaling up electronic data linkage, with Cancer Medicines Outcome Programme publications now available online (Action 65).
The Cancer Waiting Times data and definitions audit was completed by Public Health Scotland in May 2022 (Action 66). Quality Performance Indicators continue to be reviewed by practitioners and by Health Improvement Scotland to ensure they best reflect areas where quality and variations in practice can be improved (Action 67). Work to develop a Cancer Intelligence Platform, in order to provide a centralised space for data linkage and analysis, was paused due to the need to pivot to the COVID-19 response (Action 68). This work has now restarted with an adjusted timeline, and aims to be completed by March 2023.
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