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

3. Progress against ambitions

Ambition 1 – preventing more cancers

Our 10-year vision is that Scotland is a place where the new generation of young people do not want to smoke. It is a place where everyone eats well and has a healthy weight, underpinned by a population that is more physically active. Alcohol is no longer a major cause of cancer. The incidence of preventable cancers, such as cervical cancer, is reduced.

3.1 This ambition relates to actions 1-9 in the Cancer Action Plan 2023-2026.

3.2 The Tobacco and vaping framework: roadmap to 2034 was published in November 2023, which sets out the roadmap and decisive actions to hit our goal of 5% by 2034. A four nations public consultation was completed with the government response - Publication of 4-nation consultation response on Smoke Free Generation - laid in Parliament in January 2024. Following this the UK wide Tobacco and Vapes Bill was published in March 2024 and The Bill will increase the age of sale for tobacco products and provide powers to legislate on vape flavours, displays, packaging, and other measures. In addition, commencement statutory instruments have also been laid to enable provisions within the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 to be enacted. A Review of smoking cessation services in Scotland was published in September 2023 with a short-life working group established to take forward its recommendations.

3.3 Public Health Scotland (PHS) published the Evaluating the impact of minimum unit pricing for alcohol in Scotland: Final report in June 2023. This was laid in Parliament in September 2023 Minimum Unit Pricing Evaluation and Consultation followed by a public consultation. The Consultation on Restricting Alcohol Advertising and Promotion: Analysis of responses was published in November 2023. The Scottish Parliament has voted to approve the continuation of MUP and to raise the level to 65p, aiming to increase its public health effects. This new level will come into effect 30 September 2024.

3.4 The Scottish Government has also been working with Scottish Health Action on Alcohol Problems (SHAAP) to raise awareness amongst health professionals about the links between alcohol consumption and cancers so that they can use opportunities in their work to intervene to reduce the risks.

3.5 In 2022 SHAAP published ‘Alcohol and Cancer Risks: A Guide for Health Professionals’ and Scottish Government ensured that this was shared with all clinicians across Primary Care in Scotland. The Scottish Government is working to further embed this learning by developing a national service specification alongside guidance, informed by the UK-wide clinical guidelines. These will aim to provide clarity on the types of treatment and recovery services available.

3.6 Initial engagement has begun with representative groups covering service commissioners, service providers and people who use, have used or could use the services. We plan full public consultation on a draft specification with an aim to publish the final version in 2025.

3.7 HPV immunisation statistics Scotland - School year 2022/23 were published in November 2023. The number of young people receiving their teenage immunisations has shown a decline this year, when compared with last year, however uptake rates for the HPV vaccination programme in Scotland remain high with 87.7% of females having received the vaccine by the end of S3 and 90.1% of females by the end of S4. Females from the most deprived areas were less likely to receive their HPV vaccination. This follows on from the one dose schedule that was introduced on 1 January 2023 for all those eligible in the programme up to their 25th birthday. We envisage that as this programme change embeds, it will increase the amount of people completing their vaccination schedule, as it will remove the requirement to be recalled to receive a second dose.

3.8 Work to interrogate data on cervical cancer for those in high-risk populations has started. An Expert Group was formed in March 2024 to take forward scoping work and provide recommendations on how to achieve Cervical Cancer Elimination in Scotland. A study published in January 2024 showed no cervical cancer cases have been detected in fully HPV-vaccinated women in Scotland who entered the programme when it commenced in 2008 and were given their first dose at age 12-13 years.

Ambition 2 – Earlier and faster diagnosis

Our 10-year vision is that later stage disease (stages III and IV) has reduced by 18 percentage points. A focus will remain on reducing the health inequality gap, particularly those from areas of deprivation.

This ambition relates to actions 10 to 46 in the Cancer Action Plan 2023-2026.

Improving public education and empowerment

3.9 The most recent Detect Cancer Earlier (DCE) campaign – Be the Early Bird – was re-run during September and October 2023. Field activity targeted to take place in the most deprived areas was held over 11 days in March 2024. Feedback was largely positive with good campaign recognition, including from members of the public who had been prompted to see their GP following the initial campaign run in Spring 2023.

3.10 Independent evaluation of DCE campaigns continues to be undertaken, with recent results demonstrating high impact. In addition to tackling some of the barriers to DCE actions and raising awareness of the benefits of taking these actions, the campaign has also successfully increased awareness of three of the cancer symptoms that are featured in the campaign adverts. There were significant increases seen between pre and post campaign evaluation results for three DCE behaviours, including an increase in those saying that they have checked themselves for signs of cancer. The Detect Cancer Earlier marketing campaign: evaluation report 2022/23 and Detect Cancer Earlier Marketing Campaign - 2023\/2024 Evaluation Report have been published.

3.11 In order to improve symptom awareness for all cancer types, additional case studies have been sourced and shared on DCE channels to prompt wider health-seeking behaviour, such as a recent bladder cancer case study: Glen Long | Get Checked Early. Promoting symptom awareness is ongoing through field activity - face to face, symptom leaflet, and promotion and use of the symptom checker: Common signs and symptoms | Get Checked Early. Work on the Get Checked Early website continues, including regular review of content, and engagement remains high, with the symptom checker webpage attracting most attention after the homepage.

3.12 The DCE programme is also supportive of the Scottish Cancer Coalition’s awareness-raising efforts, having highlighted several cancer awareness months through DCE social channels. Additionally, new testicular cancer content was created in partnership with STV and shared across STV and DCE social channels.

Supporting primary care

3.13 Work has started to conduct a clinically led review of emerging and existing data to update the Scottish Referral Guidelines for Suspected Cancer. A national steering group was established in November 2023 and continue to meet on a 6-weekly basis. Healthcare Improvement Scotland and Cancer Research UK have been commissioned to undertake evidence reviews to support the project. Peer review sessions started in April and will run through to October 2024. Once the review has progressed further, draft updated guidelines will be widely circulated for consultation and final updated guidelines are expected to publish early 2025.

3.14 A primary care cancer education platform for NHS Scotland, Gateway C , has been procured and launched in April 2024. This is a free online earlier cancer diagnosis resource for primary care professionals, with interactive courses, webinars, podcasts, documentary-style videos and emerging news. Twenty-two courses are now live including courses on our Earlier Diagnosis (ED) national priorities of head and neck, lung, and colorectal cancers.

3.15 The North Cancer Alliance completed a project exploring the role of community pharmacists in earlier diagnosis efforts and shared the findings and several recommendations with the Scottish Government for consideration.

Optimising screening

3.16 The Inclusion Health Action in General Practice (IHAGP) programme is in place to ensure increased resources are targeted in areas of deprivation. The IHAGP Steering Group met four times between August – March 2023 and tranche one of IHAGP funding for 2023/24 was released in September 2023, allocated directly to practices in areas of deprivation. Targeted actions include outreach with patients who had not taken up the offer of cervical screening.

3.17 Modernisation of and improved access and availability to the breast screening programme is ongoing. Self-referral for breast screening recommenced for those aged 75 and over on 1 December 2023. Screening centres are continuing to offer 2% of their capacity to support appointments for those over-70 but can increase where capacity is available. Detailed proposals for work across 2024/25 by the Breast Modernisation Board are moving forward.

3.18 A Lung Scottish Expert Advisory Group (SEAG) was established and met for the first time in August 2023, to consider the UK National Screening Committee recommendation on targeted screening for adults aged 55–74 identified as being at high-risk of lung cancer. Several key workstreams have been identified to allow work to be carried forward to address a range of issues and questions surrounding establishment and implementation of a lung cancer screening programme in Scotland. The LungScot study, led by the University of Edinburgh, expanded successfully to the areas of Greater Glasgow and Clyde, Highlands and Grampian in 2023. This study will help inform work undertaken by the SEAG.

3.19 The Scottish Government continues to work with NHS National Services Division (NSD) and National Screening Oversight (NSO) in monitoring any developments and progress in validating a self-sampling device for clinical use for cervical screening. We continue to wait for a recommendation from the UK National Screening Committee. A screening prioritisation event hosted by NSO in November 2023 concluded that there may be other ways in which uptake of cervical screening can be improved, such as moving to digital communications to target younger participants who are less likely to take up their invitation.

3.20 The Equity in Screening Implementation Group (ESIG) has been established to oversee implementation of the 41 actions in the Equity in Screening Strategy and will report to the National Screening Oversight Board (NSOB). The Equity in Screening Network has also been fully established, and the first learning event of the Network was held in November 2023, with a focus on individuals eligible for cervical screening who have experienced sexual trauma. Health Boards have been tasked with the creation of board specific equity plans in line with national outcomes.

Enhancing diagnostics

3.21 The University of Strathclyde evaluation report of Rapid Cancer Diagnostic Services (RCDS) was published in February 2024: Final Report of the Evaluation of Rapid Cancer Diagnostic Services. The evaluation showed that the RCDS model delivers a quality service at speed, is cost effective, and is highly valued by patients and staff. The Scottish Government will now work with Boards across Scotland to reflect on the evaluation report, embed learning and work towards population coverage as reflected in PfG and Cancer Strategy commitments.

3.22 Delivery and implementation of the Endoscopy and Urology Diagnostic Plan is ongoing, with tailored support being provided by the Centre for Sustainable Delivery (CfSD). CytoSCOT and colon capsule endoscopy (CCE), as alternatives to traditional endoscopy, have now been adopted as business-as-usual. A surveillance database to identify high-risk / long waiting patients went live in October 2023 and is now available to health boards.

3.23 Funding was released to health boards to support implementation of Scotland’s new optimal lung cancer diagnostic pathway. The UK Lung Cancer Coalition report was published in November 2023 to help clarify current service provision gaps: Scottish Pathways Matter | UKLCC. A revised design of the pathway was published on the CfSD website in February 2024: Lung Cancer Diagnostic Pathway. The first bi-annual review of the pathway and toolkit will take place in late 2024.

3.24 The head and neck cancer optimal diagnostic pathway was published on 11 January 2024: Head and Neck Cancer Diagnostic Pathway. Funding to support delivery and implementation was issued to Boards in December 2023. Scoping and planning for development of the colorectal cancer diagnostic pathway is underway.

3.25 The Scottish Strategic Network for Diagnostics (SSND) has been fully established, and reports to the NHS Scotland Strategic Planning Board. The development of SSND’s workplans for 2024/25 is being planned, which will be aligned to the plans of the five national diagnostic networks.

3.26 In relation to ensuring equitable direct access to imaging for primary care, the University of Strathclyde RCDS evaluation report showed that RCDSs can work in parallel with direct access to CT to meet different primary care needs in health boards where both are available. For example, in NHS Ayrshire and Arran, where direct access to CT and an RCDS were operational, both picked up cancers above the Scottish Referral Guidelines for Suspected Cancer threshold of 3% (11% and 6% respectively) suggesting that an effective model may be to have both running in parallel.

3.27 The Scottish Pathology Network (SPaN) set up a digital pathology subgroup that led to the development of a national digital pathology strategy being adopted, as a key priority of the SSND steering group. SPaN is currently scoping the immediate steps required to safeguard existing local digital pathology services and a route to evaluate implementation options for a national solution.

Investing in innovation

3.28 Cancer Research UK produced an innovation horizon-scanning document outlining the innovation pipeline for Scotland's three earlier diagnosis priority areas – head and neck, lung, and colorectal cancers. The output of this commission was presented to the Scottish Government in late 2023 and disseminated widely amongst stakeholders. With the Scottish Cancer Innovation Consortium now concluded, new ways of engaging, sharing good practice and learning in the innovation workspace will be found.

3.29 The ANIA project to evaluate the use of Artificial Intelligence (AI) in reading chest x-rays (CXR) for earlier diagnosis of lung cancer continues, with the CXR AI Steering Group meeting every six weeks. Two test projects are ongoing in NHS Greater Glasgow and Clyde and NHS Grampian. The Scottish Health Technologies Group (SHTG) developed the Initial Medical Technology Overview (IMTO) which supported the strategic case that went to the Innovation Design Authority (IDA) on 2 April 2024. A more detailed value case will now be developed (returning to IDA in December 2024) and discussions ongoing for wider roll out of CXR-AI projects to other Health Boards.

3.30 NHS Fife and NHS Forth Valley are currently running projects aimed at shortening waiting times and supporting earlier diagnosis efforts (in prostate and breast pathways respectively), under Cancer Research UK’s Test, Evidence, Transition Programme. The University of Stirling has conducted evaluations of these projects and intends to publish the findings in due course.

Harnessing data

3.31 2022 staging data was published by PHS for breast, bowel, and lung cancers in November 2023. The frequency of reporting and data points relating to emergency presentation data is currently under consideration. Updates to statistics have been delayed due to delays to the production by National Records of Scotland (NRS) of the Mid-Year Population Estimates following the 2022 Census. This process requires additional and more complex work immediately following a Census compared with the annual estimates released between Census years. Validation of urgent suspicion of cancer (USC) referral data is continuing between PHS and health boards.

3.32 Clarification is yet to be made around additional measurements for monitoring improvements in blood and neurological cancer pathways. Representatives from CfSD attended a round table hosted by the Brain Tumour Charity in February 2024 and will consider this further.

3.33 With an aim to improve the availability and quality of Primary Care cancer data, a short life working group has been established. Meetings have been held with primary care, PHS, and Cancer Research UK to better understand potential solutions to improving access to quality primary care data. Wider PHS discussions are underway to develop a Primary Care Intelligence Platform. Key findings from CRUK’s National Cancer Diagnosis Audit were presented to the Earlier Cancer Diagnosis Programme Board in March 2024.

3.34 Cancer Quality Performance Indicators for head and neck cancers are being reviewed in line with the new optimal cancer diagnostic pathways to ensure alignment and improve data availability. RCDS, endoscopy and Cytosponge datasets are expected in 2024 with diagnostic activity (endoscopy and pathology) expected towards 2026.

3.35 PHS have developed a data roadmap which outlines key timings for delivery within the life of the cancer strategy. More information is available under Ambition 11.

Diagnosing faster

3.36 The adoption of Once for Scotland clinical pathways developed by CfSD’s specialty delivery groups continues. Health boards have shared their cancer improvement plans for 2024/25, which include detail of adoption of pathways.

3.37 Outputs from a Urology peer review to spread best practice and promote CfSD pathways was circulated and new guidance on breast changes was disseminated.

3.38 Tailored support to health boards to embed the Framework for Effective Cancer Management (FECM) continues, with quarterly progress reports provided by boards detailing how action plans are being implemented. The reports are closely monitored by CfSD Clinical Leads and officials with feedback provided to board Cancer Management Teams. A programme of onsite support visits to boards was implemented with resulting recommendations produced. The framework will be reviewed and refreshed in 2024.

3.39 £11.3 million of non-recurring Cancer Waiting Times funding was released to health boards in August 2023. Most funding is being directed to urology, colorectal and breast – the three most challenged tumour types. Health board updates on this funding, including demonstrating its impact, were submitted in early 2024, followed by their cancer improvement plans for 2024/25.

3.40 The pathway improvement project for hepatocellular carcinoma and pancreatic (HPB) cancers, renamed the Scottish Care and Co-ordination Service for HPB Cancer, has been extended for a further year and we are exploring options for sustained delivery of positive outcomes after March 2025. Results have already demonstrated potential learning that can be used to support improvements to earlier diagnosis, referral and management decisions, not just for pancreatic and liver cancer pathways, but also for other rare cancers.

Ambition 3 – Best preparation for treatment

Our 10-year vision is every person diagnosed with cancer in Scotland is provided with timely, effective, and individualised care to best prepare them for treatment. This begins with prehabilitation and holistic needs assessment and continues throughout the individual’s pathway of care, including appropriate follow up. A comprehensive range of cancer genomic tests is available to all those who could benefit.

3.41 This ambition relates to actions 47-55 in the Cancer Action Plan 2023-2026.

Prehabilitation

3.42 Prehabilitation is specifically referenced in the Lung Clinical Management Pathway and Head & Neck Optimal Cancer Diagnostic Pathway Toolkit. A Macmillan National Improvement Advisor-Prehab started post in November 2023, hosted by the Centre for Sustainable Delivery, leading on feasibility testing with clinical teams to embed the prehabilitation website and screening into pathways of care. The Scottish Health Technologies Group assessed the role of digital in prehabilitation: Digital Cancer Prehabilitation. A survey of prehabilitation services in Scotland is planned in 2025 to evaluate progress since the first survey of prehabilitation services published in 2023.

3.43 Maggie’s continue to deliver universal prehab workshops through each of their 8 centres with 1,273 people accessing them in 2023/24. The Maggie’s team also worked with National Education Scotland (NES) and with stakeholders to support wider roll out of workshops. A draft toolkit and training plan have been developed with potential to test them with pilot sites.

3.44 A Nutritional Care in Cancer (Prehabilitation) group has been established, working to explore the uptake of the Nutrition Framework for People Affected by Cancer across Scotland. Wider nutritional work is ongoing with UK organisations that will also influence implementation of the Nutrition Framework in Scotland.

Genomics

3.45 Although after the March 2024 reporting timeframe, at the time of writing this report the genomic medicine strategy and one-year implementation plan has been published and is included for ease.

3.46 The Scottish Strategic Network for Genomics Medicine (SSNGM) is active, meets regularly with stakeholders across Scotland and distributes newsletters to the genomics community on a quarterly basis. Scottish test directories for cancer and rare and inherited conditions (including testing for inherited cancer) are available on the SSNGM website alongside information on the Scottish Genomic Test Advisory Group review process for the review of new tests and targets. Six of eleven priority cancer testing pathways funded in 2023/24 were implemented nationally. Exploratory work is underway for the further expansion of genomics testing and a molecular tumour board model is being piloted as part of a research project at NHS Greater Glasgow and Clyde.

Ambition 4 – Safe, realistic, and effective treatment

Our 10-year vision is that all people with cancer have equitable access to treatments, with minimal variation in care. Where someone’s cancer can potentially be cured, they have access to the best available treatment to achieve this. Pathways benefit from new technologies and tests allowing earlier treatment and leading to better outcomes. The Scottish Cancer Network is at the centre of this work, developing national clinical management pathways for all people with cancer.

3.47 This ambition relates to actions 56-69 with links to actions 77,78 and 88 in the Cancer Action Plan 2023-2026.

3.48 The Scottish Government has continued to provide funding to the Scottish Cancer Network, National Managed Clinical Networks and the Managed Service Network for Children and Young Adults during fiscal year 2023/24.

3.49 The Scottish Cancer Network (SCN) published the first three CMPs – Breast, Lung and Neuro-oncology in September 2023. By March 2024, there had been 600 registrants for access. A specific website has been developed for patient-facing tumour-specific information and went live in March 2024. Scoping and preparations have been made for the two next planned CMPs – Head & Neck and Prostate.

3.50 Five national networks – SANON (adult neuro-oncology); SHPBN (hepato-pancreato-biliary); SSN (sarcoma); SMN (mesothelioma); STCN (thyroid) – were active, supported by SCN to meet regularly, address service challenges, support education events and help monitor quality through QPIs.

Robotic assisted surgery

3.51 Seventeen robots are now active across health boards for robotic-assisted surgery (RAS) following previous Scottish Government financial investment. An estimated 110 clinicians have undergone training to ensure robots are used to maximum capacity and this will continue to increase.

3.52 A RAS data audit led by PHS will be implemented in 2024 to ensure robust data collection is in place. This will allow for the monitoring of performance and identification of inequity so that improvements can be driven forward. The Clinical Reference Group has worked with PHS and National Planning to consider further use of RAS where there would be clinical benefit, and this is actively informing plans to increase the delivery of RAS.

Radiotherapy

3.53 Oversight and support for the implementation of the National Radiotherapy Plan for Scotland continues. Fifty three radiographer trainees completed in June 2023. The national group for Stereotactic Ablative Body Radiotherapy met regularly and there has been continued recruitment into clinical trials. Paediatric molecular radiotherapy saw increasing demand and expanded quicker than expected. National radiotherapy data is now received monthly and will be analysed as part of business-as-usual processes. Capital replacement is managed by the Technical Specification and Evaluation subgroup (TSE) which has met regularly with successful delivery of equipment on a rolling basis.

Systemic anti-cancer therapy services

3.54 All regions and related Health Boards received additional funding for Systemic Anti-Cancer Therapy (SACT) services with a total of £3 million disbursed in 2023. A further £4.6 million will be released in 2024/25 to support boards to meet these pressures. The Scottish Government has continued to meet the commitment to increasing national resourcing for SACT and Acute Oncology Services up to £10 million per annum by 2027.

3.55 The mobilisation phase of the new Oncology Transformation Programme (OTP) that intends to address service and workforce pressures was completed in November 2023. The recommendations were prioritised and agreed in March 2024 with the expectation that the OTP will commence in the first quarter of 2024/25. The priority is to develop the sustainable operating model for a new nationally supported population-based NHS Scotland oncology service.

3.56 Further to this, two-year contract extensions were signed with the same end date for all instances of the electronic chemotherapy prescribing system across Scotland for the first time to allow procurement of a new system by 2026.

3.57 A business case was developed with plans and priorities for the next 3 years agreed for the Cancer Medicines Outcomes Programme (CMOP) in collaboration with PHS, subject to annual funding. CMOP is generating real world evidence for the Scottish Medicines Consortium (SMC) and National Cancer Medicines Advisory Group (NCMAG). This will support the process of approving new medicines with real world data on their use. In 2023/24, CMOP provided support to SMC’s reassessment process for Cemiplimab for cutaneious squamous cell carcinoma, which received an interim acceptance in 2020. Evidence was also provided to NCMAG to support the decision-making process for second line use of tyrosine kinase inhibitors in renal cell carcinoma. Work to support and enhance clinical management pathways is also underway.

3.58 We continue to work with the SMC to ensure that its decision-making processes and criteria continue to be fit for purpose.

3.59 The East Region Formulary (ERF) team (covering NHS Fife, NHS Lothian, and NHS Borders) has now included cancer medicines in its regional formulary.

3.60 The Chief Pharmaceutical Officer (CPO) held initial discussions with colleagues from Healthcare Improvement Scotland (HIS) regarding how it could work with the Scottish Cancer Network (SCN) to develop a process to allow a once-for-Scotland approach to the formulary approval process, which will complement SCN’s role in the development of any associated protocols for cancer medicines that are accepted by the SMC.

3.61 Membership for the Access to New Medicines Horizon Scanning Advisory Board (HSAB) has been agreed and the draft terms of reference will be finalised at the Board’s inaugural meeting due to be held in early summer 2024. This will help identify new medicines – such as chimeric antigen receptors (CAR-T) – which may have significant implications for service delivery to support advance planning on how to prepare for their introduction.

Strengthening models of care

3.62 The National Cancer Quality Steering Group (NCQSG) met regularly until agreement was reached on transitioning to a new National Cancer Quality and Improvement Programme Board (NCQIPB): the NCQSG stood down in March 2024 and the new board will stand up imminently. The Colorectal Cancer National QPI Report was published in June 2023. Reviews and consultations were held on brain/CNS, and thyroid quality performance indicators (QPIs).

Ambition 5 – Excellent care and support after treatment

Our 10-year vision is that personalised support and care post-treatment are core considerations in cancer management pathways: this includes rehabilitation, early detection of recurrence, and supportive and palliative care. People affected by cancer are informed and supported to adequately manage side effects of treatment with the appropriate tools, including an electronic treatment summary.

All individuals requiring rehabilitation have access to meaningful, person-centred rehabilitation that will support them to live well and support a good quality of life, regardless of their stage on the cancer pathway. Follow-up is standardised in the SCN’s clinical management pathways, is evidence-based for each cancer type and individual (including secondary cancers) and covers patient-initiated requests for review. Every person with cancer in Scotland requiring palliative care receives well-coordinated, timely and high-quality care, including care around death. Bereavement support is provided for families and carers based on their needs and preferences.

3.63 This ambition relates to actions 70-76 with links to action 92 in the Cancer Action Plan 2023-2026.

Rehabilitation

3.64 A network of local rehabilitation leads has been established to champion rehabilitation in their health boards and regular meetings have been held. Subgroups were formed to look at research & data; workforce; and strategic implementation. A self-assessment tool for services and teams is being developed to support the ability for services to benchmark themselves against the Six Principles of Good Rehabilitation as outlined in the Once for Scotland Approach.

3.65 Consensus has proven to be challenging on national follow up guidance for individual cancers. Limited follow up guidance has been published as part of the now complete breast cancer management pathway. Follow up will be considered as part of the process of the development of the next two CMPs – head & neck and prostate.

Palliative and end of life care

3.66 Drafting of a new Palliative Care Strategy, which aims to achieve the very highest standards of care right up to the end of life and to ensure high quality palliative care wherever and whenever it is needed, is well underway. An evidence-based, project management approach has been taken to the development of the Strategy, with a range of data on current and future palliative care needs and experiences collected ahead of drafting. A number of expert working groups were also established to support the development of actions to be included in the strategy, and these groups will continue to support the delivery of these actions. We aim to publish the draft Strategy for public consultation in summer 2024.

3.67 Discovering meaning, purpose and hope through person centred wellbeing and spiritual care: framework was published in June 2023. Services within health boards were reviewed, including bereavement support services for staff. Out of the fourteen territorial NHS Boards and the Golden Jubilee: seven Boards provide a 24/7 Service and two have local arrangements in place for patients. The provision of bereavement support for staff is mixed; some Boards offer a more formal model of staff support while all Spiritual Care Teams offer bereavement support on an informal basis, as part of core service delivery.

3.68 ‘Spiritual Care’ pages within NHS Inform were reviewed and updated. A National Service Specification for spiritual care services has been drafted and spiritual care is embedded in the draft Ageing and frailty standards – Healthcare Improvement Scotland currently out for consultation.

3.69 One of the key actions within the Palliative Care Strategy is the development of a single online portal for palliative care training and education resources. This work, which is being led by NES, is already underway and will help to ensure that learning resources are well-coordinated and easily accessible, and that staff are aware of the availability of these resources.

3.70 NES have also appointed Educators for Spiritual Care, with the aim to explore how spiritual care can be embedded into workforce education, training, and practice standards. This will ensure that people can access holistic care and support to help them with any physical, psychological, social, and spiritual needs that they may have.

3.71 Further to this, work is also underway to update the Scottish Palliative Care Guidelines, which provide practical, evidence-based guidance to support safe and consistent prescribing and clinical decision making by staff providing general palliative care. These guidelines are managed and delivered by Healthcare Improvement Scotland (HIS), and are now available on the Right Decision Service website and mobile app. A key action within the Palliative Care Strategy will be to ensure the sustainable management, updating and expansion of the guidelines.

Ambition 6 – Sustainable and skilled workforce

Our 10-year vision is for a sustainable, skilled workforce with attractive career choices and fair work, where all are respected, supported, and valued, whether they work wholly or partly in cancer services.

3.72 This ambition relates to actions 79-91 in the Cancer Action Plan 2023-2026. Key actions regarding planning and attracting a sustainable workforce are covered in Ambition 4 in relation to the SCN.

3.73 Following the completion of the Allied Health Professional (AHP) Education and Workforce Policy Review in 2023, an advisory group has been established to oversee the effective implementation of the recommendations. The advisory board has met twice so far in October 2023 and March 2024.

3.74 We are on track to meet the 2025 endoscopy trained practitioner target (currently 91%), with projections of reaching added endoscopy capacity target also on track.

3.75 The ongoing expansion of medical undergraduate places continued with an increase of 100 in 2023/24 and the number of widening access places increased from 60 to 110. A further 3 clinical oncology training posts were created in 2023, and 2 additional posts were created in medical oncology. These uplifts were funded in line with recommendations submitted by the Scottish Shape of Training Transition Group. No uplifts were recommended in clinical or medical oncology for 2024.

3.76 Eighteen clinical oncology posts were advertised throughout 2023 and 6 (33%) filled. Three posts were advertised in medical oncology and 1 (33%) filled. Going forward, there will be an immediate focus on improving fill rates in both clinical and medical oncology.

3.77 Improving Wellbeing and Working Cultures (IWWC) sets out the Scottish Government’s vision to improve wellbeing, leadership and equality across our health, social care and social work workforce. Finalisation of IWWC, and the accompanying Action Plan, has been delayed. However, IWWC is expected to be published in Summer 2024. The Workforce Specialist Service, psychological therapies delivered through local boards and the national wellbeing helpline delivered by NHS 24 remain available for staff.

3.78 Three NHS Scotland policies have been live since November 2023 to increase flexibility and retention. The Flexible Work Location and Flexible Work Pattern Policy provide staff with a range of flexible working options to help them to balance their lifestyle whilst maintaining and promoting the best possible service to our patients and service users. The Retirement policy includes a ‘Retire and Return’ arrangement that supports retiring employees who wish to continue in employment with the health board that is suitable to them and the service.

Ambition 7 – Person-centred care for all

Our 10-year vision is that people with cancer are at the heart of all decisions and actions involving them. They are given the opportunity to co-design their own care plan, and information including a treatment summary is readily available. A single point of contact (SPOC) is at the centre of this. Where possible, diagnostic tests and treatment are situated close to home and travel to specialist care is fully supported, making use of the continued advancement in new technologies.

3.79 This ambition relates to actions 94 to 105 in the Cancer Action Plan 2023-2026.

Improving the cancer journey

3.80 The roll-out of Improving the Cancer Journey (ICJ) services, as part of the £27 million partnership with Macmillan Cancer Care, continues across Scotland. ICJ is now in place in Angus, Highland (inc. Argyll and Bute), Dumfries and Galloway, Dundee City, East Dunbartonshire, East Renfrewshire, East Lothian, Edinburgh City, Fife, Glasgow City, Inverclyde, Midlothian, Perth and Kinross, Renfrewshire, North Lanarkshire, South Lanarkshire, West Dunbartonshire, and West Lothian. Scoping work is in its final stages in East Ayrshire, North Ayrshire, South Ayrshire, Borders, Orkney, Shetland, and the Western Isles with services expected to launch shortly.

3.81 Work continues to ensure that everyone affected by cancer is aware of the support services available and how to access them, helped by ongoing roll-out of the ICJ service. Over 2023/24, 5,360 individuals were supported via ICJ and completed a Holistic Needs Assessment (HNA).

Single point of contact

3.82 All 12 Single Point of Contact (SPoC) pilots are now live, with the scope and scale of the programme increasing as the final pilots commenced. The impact of the programme is now being demonstrated by individual projects. A scalability assessment of the programme was initiated in early 2024, led by Healthcare Improvement Scotland (HIS). This will outline the impact of each project and the conditions within which they have been established. Outputs will be shared by the end of March 2025 and will include recommendations on at-scale implementation including approaches and associated costs. This work will also consider parallels and emerging learning from navigator posts embedded in Optimal Diagnostic Pathways and Rapid Cancer Diagnostic Services (RCDS).

Patient experience

3.83 Approval to carry out the latest iteration of the Scottish Cancer Patient Experience Survey (SCPES) was received in December 2023. Fieldwork began in February 2024 with the survey distributed to 8,800 people. Survey findings are expected to be published in September 2024. Following publication, we will consider any new actions required to improve the experience of people diagnosed with cancer and how best to measure.

3.84 The development of a person-centred measurement framework continues with a draft framework completed and service user focus groups and engagement testing the Framework in Spring 2024.

3.85 A pilot to consider scale up of the Cancer Treatment Summaries pilot has not progressed. This is due to financial pressures and a result of re-prioritising of wider Digital work. Digital Health & Care priorities for 2024/25 are set out in the recently published Digital Health Care delivery plan. Whilst the pilot is unable to progress at this time, we have committed to major programmes, as outlined in the delivery plan, including the Digital Front Door (DFD) and the Integrated Social Care and Health Record (ISCHR) that support person-centred care. Over time the underpinning infrastructure required to support these two programmes will provide an integral foundation for the future of digital health and social care and Cancer Treatment Summaries.

3.86 A review of cancer content, and its governance, on NHS Inform has been carried out. This includes links to general and tumour site-specific third sector organisations. Discussions continue on how best to manage this content, particularly in relation to keeping it up-to-date and relevant to care, treatment and support available in Scotland.

3.87 The use of Care Opinion continues to be promoted both internally within the Scottish Government and externally to a variety of partners and stakeholders. An increasing number of stories related to cancer are received each month and regular reports are submitted to the Scottish Cancer Strategic Board for information.

Realistic medicine

3.88 The Scottish Government worked with NES to develop new education tools and resources for all health and social care colleagues throughout the reporting period to enhance the practice of Realistic Medicine (RM) and the delivery of person-centred care. Resources on Shared Decision Making (SDM) and Value Based Health and Care (VBH&C) were launched in December 2023, and actively promoted to encourage uptake. Realistic Conversation Training, delivered by NHS Greater Glasgow & Clyde (GG&C), has been successful in providing the communication skills required to implement shared decision making in health and care. The Chief Medical Officer’s (CMO) Realistic Medicine Annual Conference was in the process of being organised for 22 April 2024, bringing together medical and social care practitioners to hear about latest practice and innovations.

3.89 We are committed to increasing the awareness of Realistic Medicine, with conditions placed on Health Boards in FY 2023/24 to provide information on the delivery of VBH&C in their Annual Delivery Plans and to promote the use of BRAN questions in respect of the delivery of all healthcare services. The Realistic Medicine Network progressed this within all board areas. Examples of this include:

• NHS Lanarkshire – BRAN questions advertised within the Near Me waiting room, ensuring that any remote consultations also include guidance to encourage patients in asking questions.
• NHS Ayrshire & Arran/GG&C/Lanarkshire – have integrated the BRAN questions on outpatient information and appointment letters.

3.90 The promotion of SDM training continued through the reporting period, with Realistic Medicine funding conditions for FY 2023/24 contingent on local clinical leads ensuring staff complete SDM training modules. The delivery of this training was assessed on a six-monthly basis, alongside regular meetings with the RM Network. Meetings and drop-in sessions were also organised to assess overall annual progress with local actions plans. The impact of SDM has been clearly demonstrated. For example, NHS Lanarkshire established a shared decision-making clinic in University Hospital, Hairmyres, to develop primary care guidance for high-risk patients, to include frailty scoring as part of the referral pathway. With 40-50% patients opting out of surgery, this clinic has had impact in enhancing theatre and intensive care bed utilisation.

Ambition 9 - Mental health as part of basic care

Dependent on need, proactive and comprehensive psychological and mental health interventions and support are available and accessible, from those trained at informed to specialist practice types, to all people affected by cancer and their families.

3.91 This ambition relates to actions 106 -110 in the Cancer Action Plan 2023-2026.

3.92 The Mental Health and Wellbeing Strategy was published in June 2023. It sets out the vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. The accompanying delivery plan 2023-25 and workforce action plan 2023-25, both published in November 2023, describe the work that we will undertake to improve mental health and care provision for everyone in Scotland. Both the strategy and the delivery plan address the need for better mental health outcomes for people with long-term physical conditions and prioritise tackling inequalities.

3.93 The National Specification for the Delivery of Psychological Therapies and Interventions in Scotland was published in September 2023. The Specification aim is to improve the experiences and outcomes for people who access psychological therapies (PT) and interventions across Scotland. The specification will:

• let individuals, their families and carers know what they can expect when accessing PT and interventions – from preventing poor psychological health through self-help to care provided by professionals and psychological care services.
• ensure a consistent, high-quality range of therapies, interventions, and psychological services are provided to everyone who needs them.
• support the measurement of the quality of services to support improvement.

3.94 The Specification was published along with new updated waiting times guidance for PT (by PHS), and the updated psychological therapies matrix (by NES) which describes recommended evidence-based therapies.

3.95 This suite of documents will help to ensure that services deliver and measure Psychological Therapies in a more standardised way across Scotland.

3.96 In preparation for full implementation of the specification from May 2024, work continued with the PT expert advisory group, Heads of Psychology Services Scotland (HOPS), to develop a self-assessment tool that health boards can use to measure their performance against the specification outcomes. The self-assessment tool then moved to a testing period with three NHS health boards to provide feedback and allow refinement prior to full roll out across all boards.

3.97 Core Mental Health Quality Standards were also published in September 2023. These standards, informed by the principles set out in the Mental Health and Wellbeing Strategy, clarify what support should look like for people accessing mental health services.

3.98 All these publications recommend that a trauma informed approach is embedded in the delivery of care and practice of mental health services.

3.99 In terms of the Psychological Therapies and Support Framework, a national steering group, the Cancer Prehabilitation Oversight Group, was established in October 2023 to oversee prehabilitation work as part of this framework’s implementation. Annual Delivery Plans (ADPs) produced by all territorial NHS Boards are also scrutinised to ensure local implementation.

3.100 To help understand the demand and capacity for psychological care and support, a national scoping exercise was conducted as part of the Macmillan Psychology Project, with benchmarking underway. A final report will be disseminated in due course.

Ambition 10 – Flourishing research and innovation

Our 10-year vision is that equitable access to clinical trials has become integral to the management of treatment options. Where relevant, health professionals have allocated research time, adequate laboratory support and are working in partnership across academia, industry and the third sector. Qualitative and non-RCT research are providing relevant high-quality evidence to inform best care. Routine cancer data are available to support this.

More complex molecular tests ensure people with cancer have access to a portfolio of precision oncology and clinical research. Laboratories have capacity to support research, including clinical trials. New technologies are being used to strengthen the full cancer patient pathway, with alternative methods for consultations and information-sharing leading to greater choice and convenience for people with cancer. The application of artificial intelligence (AI) has grown. Multidisciplinary networks are making the best use of scientific and clinical expertise to translate innovation into clinical practice.

Health Boards make robust, evidence-based decisions based on Scottish Health Technologies Group (SHTG) advice, leading to improved outcomes and more efficient use of resources.

3.101 This ambition relates to actions 111 – 119 in the Cancer Action Plan 2023-2026.

3.102 A delivery group to consider the viability and prioritisation of all recommendations and agree actions of the Improving Equity of Access to Cancer Clinical Trials in Scotland report has been established. The initial 51 recommendations have been consolidated and the initial categorisation of these recommendations has been undertaken to divide the recommendations into short, medium and long-term recommendations.

3.103 Funding for the Edinburgh and Glasgow Experimental Cancer Medicine Centres (ECMC) is in place for 2023-2028, matched with funding from Cancer Research UK (CRUK). Work with CRUK on the evolution of the pan-UK ECMC network continues.

3.104 There has been expansion of the National Institute for Health and Care Research (NIHR) programmes available to researchers based in Scotland. A total of 9 programmes are now available, including Invention for Innovation (i4i) programme; Programme Grants for Applied Research (PGfAR) programme; and Research Programme for Social Care (RPSC). Chief Scientist Office have been working to maximise awareness of these schemes to the research community, for example through hosting webinars.

3.105 Funding for 2023/24 was confirmed to support the NHS Research Scotland Cancer Network. The number of studies and number of patients recruited via NRS data intelligence capabilities continues to be monitored.

3.106 Scottish Genomics Test Advisory Groups (SG-TAG) for cancer, rare and inherited conditions, and pharmacogenomics were established in late 2023. Demand optimisation work is ongoing to examine what tests are being ordered across Scotland. Discussions with colleagues in NHS England to access genomic educational materials took place and NES are planning how best to signpost such materials for NHS Scotland staff.

3.107 Data standardisation work is ongoing in relation to cancer genomic datasets. Discussions with Celtic Nations continue regarding an interim model and with all UK nations as part of the Genome UK Shared Commitments and National Genomics Board regarding longer-term considerations.

3.108 Following referral from SCN, SHTG published recommendations in October 2023 on tumour profiling tests to guide adjuvant chemotherapy decisions for patients with early breast cancer.

3.109 In December 2023, SHTG provided advice on the use of capsule sponge devices to detect Barrett’s oesophagus and early-stage oesophageal cancer, considering clinical effectiveness, cost effectiveness, safety, and patient experience. This advice was used by the ANIA collaborative to inform national decision making. SHTG has also published two Innovative Medical Technology Overviews (IMTOs) to support decision making in the ANIA pathway:

• Artificial intelligence supported clinician review of chest x-rays from patients with suspected lung cancer.
• Colon capsule endoscopy (CCE) for the detection of colorectal polyps and cancer.

3.110 In early 2024, SHTG published an assessment of local anaesthetic biopsies (compared with inpatient biopsy) of suspicious laryngeal and pharyngeal lesions. The assessment included an environmental impact assessment of reusable versus disposable scopes.

3.111 SHTG continues to engage with a number of patient with cancer organisations to facilitate their involvement in current and upcoming work. SHTG has published an evidence framework intended to help evaluators, technology developers and decision makers better understand what information is required to identify technologies of value to service users and the health and care system.

3.112 Timescales for the first iteration of Digital Front Door (DFD) have changed since the publication of the cancer action plan. The first phase of the DFD will now be delivered by the end of the current Parliamentary term in 2026. Data on the use of Near Me up to September 2023 has been collected and analysed and results are being considered by the Scottish Government.

Ambition 11 – Cancer information and intelligence-led services

Our 10-year vision is of a more integrated cancer intelligence platform along the full cancer pathway. This creates a responsive system that efficiently supports data collection, retrieval and use for clinical management, surveillance, evidence generation and policy development, which is aligned to the move towards a single electronic health record. Quality Performance Indicators will be a key driver of an overall cancer services improvement agenda, aligning with national clinical management and optimal pathways. Data collection and analysis of measures including PROMs (patient-reported outcome measures) and PREMs (patient reported experience measures) are integrated into service provision to facilitate person-centred care and shared decision making.

3.113 This ambition relates to actions 120 -136 in the Cancer Action Plan 2023-2026.

Data

3.114 PHS received over £1 million of funding for 2023/24 to improve the Scottish Cancer Registry and Cancer Intelligence Platform and support continued provision of radiotherapy datasets. PHS is collaborating with NHS Lothian’s Cancer Intelligence Team to plan and provide extracts of national radiotherapy data, perform quality assurance, and develop standard reporting that will be of use to PHS, Lothian and other Scottish cancer centres.

3.115 Further funding totalling over £260,000 was released in July 2023 to support regional intelligence and reporting.

• Data on SACT has been validated and collaborative work between PHS and the South East Scotland Cancer Network is in progress around data validation and methodologies.
• National SACT data is also being used to develop methodology for national derivation and analysis of high cost or new drugs accessible through Patient Access Schemes.

3.116 SACT 30-day mortality data was published for the first time in July 2023 and a new SACT activity dashboard was launched in October 2023 and is now published on a weekly basis.

3.117 PHS continues building on the work of the Cancer Medicines Outcome Programme (CMOP) integration with other cancer information to better understand the benefits from SACT data to support clinical decision making.

• A variety of analyses of SACT data were performed relating to NCMAG and SMC approvals requirements as part of the CMOP.
• Planning for governance of CMOP in the medium to long term is underway.
• The National SACT team has been supporting CMOP as a key part of the CMOP project.

3.118 Work to implement a genomics module within the national LIMS system is ongoing, with funding secured and staff released to support development. The module is scheduled to go live in 2025. Data standardisation for cancer genomics tests is also happening ahead of incorporation into cancer registry datasets.

3.119 International Cancer Benchmarking Programme Boards have been held on a regular basis, with Scotland represented. Tumour site priorities for Scotland were submitted for Phase 3 of this programme.

3.120 Core principles for the collection of cancer PROMs have been agreed and were approved by the Scottish Cancer Strategic Board in September 2023 - Developing core principles for routine PROMs collection in cancer care in Scotland — University of Strathclyde

3.121 PHS has developed a cancer data development roadmap to identify data gaps, potential novel analytical work, and to build on COVID-19 specific work. The roadmap is subject to ongoing review, in terms of priorities and capacity, with oversight to this given by the SCSB.

3.122 Scottish Government and PHS officials met with NHS England to discuss their National Audit of Metastatic Breast Cancer: National Cancer Audit Collaborating Centre (natcan.org.uk). As a member of the European Network of Cancer Registries (ENCR), PHS is waiting for guidance on collecting recurrence data on cancer registries and will consider the feasibility of implementing recommendations before 2026.

3.123 Work commenced to consider a national approach to Identity and Access Management which will apply to all staff in NHS Scotland.

3.124 A survey of national and regional data safe havens has also been conducted to identify the cancer-related datasets available through these safe havens.

Governance

3.125 The SCN completed a national governance review of Scottish Government-owned cancer groups in December 2023. The SCN continues to develop new clinical management pathways, supporting a Once for Scotland approach, which are published on the Right Decisions website. A public-facing resource was also launched.

3.126 The Cancer Managers’ Forum (CMF) continues to meet on a quarterly basis. The CMF has provided support to implement optimal diagnostic pathways and has led on the development of the national breach analysis tool to support implementation of the Framework for Effective Cancer Management (FECM). They have also shared learning and best practice from local processes and pathways.