Beating cancer: ambition and action

1. Beating Cancer: Ambition and Action

Shona Robison
Cabinet Secretary

This strategy sets out our ambitions on improving the prevention, detection, diagnosis, treatment and after care for people affected by cancer.

Through this strategy we will outline new actions we will take and also reflect and learn from the progress we have made in fighting cancer over the last 10 years.

Action to reduce health inequalities and to provide person-centred care are both central to delivery of this Strategy.

From initial tests through to diagnosis and treatment, having cancer can be a scary, difficult place. We need to support people who use services to have their voices heard and to support health and care services to listen, learn and improve to deliver more person-centred care.

We know that to reduce health inequalities we need to ensure people have sufficient knowledge, understanding, confidence and skills to cope with the complex demands of modern health care.

People are at the heart of this strategy, guided by the over-riding principle that everyone must have access to the services and to information they need to make the right choices for them and their families.

We have identified at least £100 million of additional investment over 5 years to help make this strategy a reality.

This strategy embeds our actions on detecting cancer early, not least through screening programmes. It sets out how we will invest in the provision of good quality, sustainable treatment and support for people to live well with, and beyond, cancer.

A key element to the strategy is on the measures in place, and the further plans being developed, to reduce the risk of people getting cancer in the first place.

All of this work is underpinned by measures to improve the quality and timeliness of data, and research and support to ensure we have a workforce with the right skills to tackle cancer in Scotland.

Our ambition is to shape the delivery of this strategy over the next decade by working together with people with cancer, their representatives, clinicians and service providers to reduce the impact of cancer and achieve world-class cancer outcomes for the people of Scotland.

The Challenge

Two out of five people will develop cancer in their lifetime.

32,000 people in Scotland were diagnosed with cancer in 2013 - an increase of around 12% in a decade. By 2027 this is expected to reach 40,000 a year - 110 people being diagnosed with cancer every day.

The number of people diagnosed will continue to rise. This is due, not least, to our ageing population and our success in increasing survival rates from other diseases.

With effective population-based screening programmes, earlier detection, better diagnostic methods and advances in treatments, more people in Scotland are surviving cancer than ever before. Cancer mortality rates in Scotland have reduced by 11% over the last 10 years.

We know that health inequalities are the result of fundamental inequity in the distribution of power, money and resources. This has an impact on the opportunities for good quality work, education and housing. In turn, these determinants shape individual experiences and health throughout life.

Cancer incidence is more common in the most deprived areas of Scotland - incidence rates have typically been 30% to 50% higher in the most deprived compared to the least deprived areas. Health inequalities can also be found in cancer mortality rates. Of people in the 45 to 74 year age group, those living in most deprived areas are more than twice as likely to die of cancer than those in the least deprived areas.

There are a number of reasons for this including lifestyle choices, variations in screening uptake and later diagnosis which ultimately have an impact on cancer survival. This situation is not inevitable and can be improved.

For people diagnosed with cancer between 1987 and 2011 the one-year survival rates have increased in men from 48% to 66%, and in women from 58 % to 69%. Five-year survival rates have increased from 29% to 48% in men, and from 40% to 54% in women.

This increase in the number of people surviving cancer will result in an increased use of specialist and primary care services, and due to the increasing age-profile, people using these services will most likely be presenting with multiple health conditions and complex health needs.

A key challenge will be for health, social care and third sector services to develop sustainable and innovative approaches to cancer care which meet the changing requirements of people with cancer to support them to live healthy lives at home.

But we can only rise to this challenge if we are willing to be ambitious in the change that can be realised.

Realising Our Ambitions

We will improve the experience of and outcomes for people affected by cancer across Scotland by improving service delivery and reducing health inequalities. We will do this by building on our extensive prevention programme already in place, in line with our 2020 vision for safe, effective, person-centred care and the National Clinical Strategy.

Fundamentally, the person-centred approach means asking not: "What's the matter with you?", but: "What matters to you?" and not assuming we know the answer in advance. It means finding out who is important to the person, and working with the individual and their loved ones to support their choices and their care. It means providing the information people need to be fully involved in decision making, ensuring that services and other support are as far as possible organised around their needs, and enabling them to be involved in decisions about their care at the level that makes sense to them.

We will place people with cancer at the centre of their care ensuring they are partners in their care able to make informed choices and know what is happening when and why. Feedback from individuals is vital for the continual evolution of cancer services and care, which is why we will ensure that the Scottish Cancer Patient Experience Survey is implemented and taken forward on a regular basis.

We will drive forward work to support early cancer diagnosis through uptake of national screening programmes and improved diagnostic capacity, with work focused on hard-to-reach groups. We are committed to continuing the Detect Cancer Early programme, including for breast, lung and bowel cancers. We will build on the programme to raise public awareness of potential risk factors for developing cancer, symptoms to be aware of, and of the availability and information on screening to increase uptake.

We will act on health inequalities in cancer outcomes by taking action to help more equitable access to screening, earlier diagnosis, support for health literacy and access to services to support people who are living with cancer that are aimed directly at hard-to-reach groups.

We will improve access to sustainable, high quality, effective cancer treatments across Scotland. Where someone has been diagnosed with cancer we want them to have access to the best professional and clinical support and services. Through workforce planning we want to ensure that everyone with cancer in Scotland who needs it has access to a specialist nurse during their care and treatment.

We will ensure people living with and beyond cancer have the support they need to live and, when the time comes, die well.

To make certain treatments and care is rooted in evidence we will work to improve the data we collect, analyse and publish, to better reflect the experiences of people with cancer. We want to embed research in the ethos of our healthcare services - allowing individuals access to and participation in clinical trials appropriate to their circumstances.

We will underpin and support this work by establishing a new cancer intelligence system to provide high quality, timely information for clinicians and individuals at all stages of their cancer journey, and by funding vital research.

What would success look like?

• More people surviving cancer for 1, 5 and 10 years
• Closing the gap in survival rates between Scotland and the best countries in Europe
• A reduction in cancer health inequalities
• People with cancer and their families feeling involved in decision making and able to make the right decisions for them on the basis of full information
• A radical improvement in experience and quality of life, including at the end of life
• A reduction in the growth in the number of people diagnosed with cancer
• More equitable access to services and treatment