Cancer action plan: progress report 1 - June 2023 to March 2024

2. Evidence and evaluation

2.1 Our monitoring and evaluation framework has two main purposes: accountability and learning. It set out how we will assess progress towards the strategic ambitions, including priorities for evaluation and using data to track the progress of change. As reflected by recent research, systematic progress tracking and evaluation are essential components of successful cancer policy and strategy implementation.

2.2 This first annual progress report acts as a starting point to assess any early indications of change and to highlight planned analysis that will provide evidence during the first action plan about early progress. Building on insights reported in the Progress Report for the National Cancer Plan published in August 2022, we report here on data, early evaluation of evidence and planned analysis to assess progress.

2.3 Tackling health inequalities is a cross-cutting ambition for all policy actions. We are commissioning work to evaluate how treatment is accessed and experienced by people in some of the groups targeted for early action in the strategy: people living in the most deprived areas of Scotland, and people living in remote areas of Scotland. Evidence from further evaluation activity is highlighted below to report on progress in relation to the other ambitions, including earlier and faster diagnosis.

2.4 Separately, to contribute evidence on tackling health inequalities for people in minority ethnic groups, an evidence review will be undertaken by Scottish Government social researchers to understand racialised health inequalities as they relate to cancer. Alongside the commissioned evaluation, this review will contribute evidence about how to reduce barriers and improve access for people who experience inequity of access and poorer outcomes. Findings from these projects will inform the development of the next three-year action plan to improve services for people in the target groups, and to adapt initiatives to better meet people’s needs. Any identified actions that could be taken to tackle health inequalities ahead of the next Action Plan will be considered as findings emerge from the evaluation.

2.5 As services recover following the COVID-19 pandemic, it is important to contextualise progress within the wider health and care system. A systems thinking approach has been used to examine the potential ways in which the system will impact, and be impacted by, the strategy. Perspectives of those working in the health and care system have been gathered using Rich Pictures and Participatory Systems Mapping methods. To date, three virtual workshops have taken place with 11 participants from six NHS Boards, including: consultants, clinical nurse specialists, project managers and occupational therapists.

2.6 Work is now being undertaken to update the system map to include the voices of people affected by cancer using existing data sources (consultation responses and focus group analysis). This system map will be used to support the monitoring and evaluation framework by outlining potential interactions between the different ambitions of the strategy and identifying key parts of the system from which positive change can be leveraged. The system map will also support analysts to identify potential causes and effects that may arise from the strategy and to provide recommendations for any further outcomes that we should consider measuring.

2.7 We will use emerging evidence from the system mapping analysis, the two projects that will contribute evidence about tackling inequalities and further evaluation activity to refine theories of change. This theory of change analysis will inform the next three-year action plan. Information about theory of change analysis and its role in assessing progress is set out in the monitoring and evaluation framework.

2.8 The monitoring and evaluation framework referenced an Advisory Group of experts who supported its development. This group continues to support our approach to monitoring and evaluation, including identifying effective methods for knowledge exchange and sharing good practice.

2.9 We also established headline indicators for assessing the extent of progress in the monitoring and evaluation framework and committed to report annually on these. It is too early to measure the impact of actions towards the end of Year 1 in relation to the intended high-level outcomes and vision for the ten-year strategy because: i) we do not yet expect to see measurable changes in national-level headline indicators, and ii) data development and time lags in published statistics mean that we are not yet able to access statistics that cover the timeline of Year 1 for most of the headline indicators. In Appendix A we include updates on early progress and data developments.