Cancer action plan 2023 to 2026

1. Background

1.1 Context

This is the first of our action plans to accompany our 10-year Cancer Strategy for Scotland 2023-33. This plan sets out a range of actions linked to our overall strategic aim. The strategy describes the broader context of cancer in Scotland and necessary links with wider strategies.

The actions within reflect the breadth of our ambitions along and beyond the cancer pathway. This first three-year action plan 2023-2026 therefore includes actions indirectly impacting on cancer services, on which our success depends.

Cancer remains a clinical priority for the Scottish Government. Cancer survival continues to improve, but not at a satisfactory rate. Our strategic priority is to tackle this. Improving cancer survival means the number of people who have, or have had, cancer will continue to grow substantially in the coming decades, as mortality rates decline. There will also be an increasing number of people with cancer[i] due to the ageing population and Scotland’s success in reducing mortality from other diseases. This will contribute to an increasing demand on the health service. Additionally, the volume of tests and treatment for each patient continues to increase, so it is vital that Realistic Medicine is embedded throughout our cancer services. People need holistic care and support throughout their cancer journey including palliative care and care around death.

Approximately 40% of cancers remain preventable[ii] with the biggest modifiable risk factors including smoking, obesity, physical activity and alcohol consumption. A clear focus and strong action will be required to address these.

As we publish this plan, the NHS is severely pressured as a result of the enormous impact of the COVID-19 pandemic and long-term challenges presented by the factors described above. Our priorities in this first 3-year action plan are therefore to recover and stabilise our systems and services, maintaining cancer as a priority while necessary recovery takes place in health systems and the wider economy.

Our plan is guided by broader strategies such as the NHS Recovery Plan (2021), Health and Social Care: National Workforce Strategy (2022), our Care and Wellbeing Portfolio and Digital Health and Care Strategy (2023), among others. It will link to the Re-mobilise, Recover, Re-design Framework (RRR) that was published on 31 May 2020, which set out the approach for Health Boards to safely and gradually prioritise the resumption of paused services.

In addition to working across strategies, we will be working with a number of key partners to deliver our strategic aims. The Scottish Cancer Network (SCN) will be at the heart of our ambitions, continuing at the forefront of defining, from diagnosis, clinical management pathways for cancer. This work will be underpinned by the Scottish Cancer Quality Programme, which will define and drive quality of care. The Centre for Sustainable Delivery (CfSD) will pioneer and deliver new, better and more sustainable ways of delivering services including improving service access for people with cancer across Scotland.

Evidence for this plan also comes from the National Cancer Plan: Progress Report (2022) that showed good progress in the four flagship actions (single point of contact, prehabilitation, rapid cancer diagnostic services (formerly Early Cancer Diagnostic Centres), and the Scottish Cancer Network), which will continue. There was progress in most other actions, with some delays due to the pressures COVID-19 continues to place on the health service and those working in it. Several actions are now completed, and a number will be taken forward here.

‘What matters’ to people with cancer must be reflected in our delivery. Evidence from people with cancer is that while clinical outcomes are clearly important, so too are treatment and care that reflect their personal preferences and what matters to them. Value-based health care and Realistic Medicine mean outcomes are delivered through shared decision-making and discussion about the potential benefits and harms of different treatment options, including the option to do nothing. This allows people to make an informed choice, as well as reducing waste and potential harm.

Person-centred care means putting people at the heart of what we do. We will continue to measure and act upon patient-reported experience and outcome measures, using tools such as Care Opinion and the Scottish Cancer Patient Experience Survey, while exploring new methods through collaboration with our third sector partners, such as the Scottish Cancer Coalition.

1.2 Our 10-year strategy

The Cancer Strategy for Scotland 2023-2033 sets out our vision and priorities for cancer over the next 10 years with the aim to improve cancer survival and provide excellent, equitably accessible care. It identifies associated outcomes and ambitions on how to reach them.

Our vision is that in 10 years time more cancers are prevented, and our compassionate and consistent cancer service provides excellent treatment and support throughout the cancer journey and improves outcomes and survival for people with cancer.

We have put people living with cancer and their families and carers at the centre of the strategy with a primary aim to reduce inequities in access to cancer care and in cancer outcomes. These are reflected in 11 priority areas that outline our ambitions:

Pathway

1. Preventing More Cancers

2. Earlier and Faster Diagnosis

3. Best Preparation for Treatment

4. Safe, Realistic and Effective treatment

5. Excellent Care and Support after Treatment

Cross-cutting

6. Sustainable and Skilled Workforce

7. Person-Centred Care for All

8. Tackling Inequalities

9. Mental Health as part of Basic Care

10. Flourishing Research and Innovation

11. Cancer Information and Intelligence led Services

Actions to tackle inequalities are addressed through each of the ambitions, for example reducing smoking rates among our most deprived communities; ensuring equitable direct access to imaging for primary care for those with non-specific symptoms suspicious of cancer; looking at where further use of robotic assisted surgery would be of most benefit; and undertaking novel analytical work to support a better understanding of survival, outcomes, demographics and inequalities.

We will focus on the cancer types that are the largest burden and have poorer survival. These include lung cancer and other less-survivable cancers (brain, liver, oesophagus, pancreas, stomach) that have seen very little progress in the last five decades. Lung cancer remains Scotland’s single biggest cause of cancer mortality and continued focus and action to address this are paramount.

A focus on lung cancer

At the time of publication, lung cancer is the single biggest cause of cancer mortality in Scotland and will require the focus applied to it in the National Cancer Plan 2020 to continue with vigour in the long term. Improved survival will require leadership, prioritisation, resourcing and strong action. The required actions will be set out in each plan accompanying this strategy and include preventative measures such as smoking cessation services and robust tobacco control; earlier and faster diagnosis, including targeted screening and delivering Scotland’s optimal diagnostic pathways; access to specialist treatment; and ongoing research, investment in innovation, and further data and intelligence gathering.