Redesign of key cancer services

Key cancer services across Scotland are being redesigned in a targeted drive to reduce the time patients are waiting to be seen.

Urological and colorectal cancer services are being prioritised for improvement, to increase capacity and respond to the rising demand being seen by these services.

Health Secretary Shona Robison today confirmed a review of urology services is underway, with all three regional planning groups due to bring forward plans on how their services will be redesigned -  to improve patient care and waiting times.

In addition, efforts to reduce demand on colorectal cancer services are being prioritised, with a new primary care diagnostic test that can detect blood in stools being examined for national roll-out early next year. This follows a successful pilot in NHS Tayside that is estimated to reduce demand on colonoscopy services by 20%.

Health Secretary Shona Robison said:

“As our population lives longer, more and more people are being diagnosed with cancer. At the current rate, we expect to see a 25% increase in the number of people diagnosed with cancer by 2027.

“However, due to medical advances and improvements in our NHS, people are much more likely to survive cancer in 2016 than at any point in history. All of this together means our cancer services are facing unprecedented demand across Scotland.

“That is why I am today setting out a series of actions we’re taking forward over the next few months to make immediate improvements to capacity within these urological and colorectal services and reduce the time people wait to be seen.

“These service redesigns follow the direction we set out in our five-year, £100 million Cancer Strategy. The recently announced reform of the way outpatient services are delivered will also have a significant impact on streamlining access for patients to a cancer specialist, getting them that vital diagnosis or decision on treatment more quickly.

“This national service redesign, along with health boards local improvement plans, will help improve our cancer services for the future and deliver the improvements to waiting times that I am determined to see happen.”

Around 32,000 people in Scotland are diagnosed with cancer each year, with this expected to rise by a quarter to 40,000 in the next ten years.

The number of people diagnosed with urological cancers has increased significantly over the last decade. There has been a 49.3% increase in the number of people diagnosed with kidney cancer, a 16.1% increase in the number of people diagnosed with prostate cancer and a 2.8% increase in bladder cancer.

An extra 200 people a year are diagnosed with colorectal cancer than they were a decade ago. Demand for endoscopies has increased by nearly a quarter over the last two years.

Dr Craig Mowat, Consultant Gastroenterologist & Honorary Senior Lecturer, NHS Tayside, said:

“When a patient attends their GP because of concerns over a new bowel problem, unfortunately it is impossible to predict what's going on based on symptoms alone.

“Over the last year we have demonstrated that a qFIT stool test (for blood in the stool) taken in primary care - in addition to standard blood tests -  can identify those patients in whom the likelihood of significant bowel disease such as cancer or inflammatory bowel disease is extremely small. In these patients, invasive tests like colonoscopy could be avoided.

“We have also shown that patients with very high levels of blood are more likely to have serious disease and can therefore be fast-tracked to colonoscopy.

“We believe the availability of qFIT is transforming our approach to the investigation of bowel problems and ensures the right patients are brought to investigation quickly.”

Background

More detail on urology and colorectal cancer service redesign:

• The National Planning Forum (NPF) is working with regional planning groups to undertake a review of Adult Urological Surgery Services. An initial scoping exercise has been carried out to understand demand, capacity and workforce needs. It follows the introduction of three new robots across Scotland to assist with prostate cancer surgery. Next steps are to develop new service models to be agreed early next year.
• NHS Greater Glasgow & Clyde have already invested £1.2 million in urology improvements, with services being redesigned to create two new diagnostics hubs across the health board area. This will enable timely access to urological diagnostic procedures, resulting in a shorter wait between a patient having their biopsy to receiving their results.
• The qFIT diagnostic test, is designed to rule out the presence of blood in faeces – a key indicator of bowel disease – reducing the number of unnecessary colonoscopies being carried out in hospital. In Tayside, two thirds of all referrals from primary care now come in with qFIT test results included - this allows for appropriate triage of patients. To date there has been around 2,000 negative results - reducing the need for colonoscopy in these patients and allowing them to be managed appropriately in the community. This quarter, NHS Tayside met the 31-day Cancer Waiting Times target and improved their performance against the 62-day target, compared to the same quarter in 2015.  

The latest cancer waiting times statistics are available on the ISD Scotland website: http://www.isdscotland.org/