Cancer strategy: consultation analysis

Introduction

Cancer in Scotland

The number of new cancers in Scotland decreased by 8% between 2019 and 2020, though this is likely due to under-diagnosis caused by the Covid-19 pandemic with patients being less likely to seek help and delays occurring in screening.^[1] Cancer incidence projections for Scotland prior to the onset of the pandemic suggested, among others, a 33% increase in the number of new cancer cases between 2008-2012 and 2023-2027, estimating the total number of cases to be over 40,000 in 2023-2027 (from over 30,500 cases in 2008-2012) with lung cancer expected to remain the most common cancer in 2023-2027.^[2]

The growing population of older people in Scotland (with a 29.7% increase in over-65s projected by mid-2045 compared to 2020^[3]) increases cancer's significance as a public health issue. In addition, the rising number of people surviving cancer in Scotland^[4] creates new challenges for the public health system due to health needs becoming more complex, therefore driving up demand for specialist and primary care services.

Furthermore, the incidence of cancer in Scotland differs significantly by socio-economic status, creating challenges for policymakers to reduce health inequalities relating to cancer incidence and care. For example, lung cancer is three times more prevalent in the most socio-economically deprived areas relative to the least deprived areas, and the probability of being diagnosed with a wide range of advanced cancers increases with socio-economic deprivation.^[5]

These existing difficulties were compounded by the emergence of the Covid-19 pandemic, which significantly disrupted cancer pathways due to health protection measures, workforce isolation and other pressures experienced by the NHS. These disruptions are likely to persist with the Covid-19 becoming endemic, highlighting a new imperative to improve cancer services' resilience to rises in Covid-19 cases as well as any future pandemics.

The need for evidence and strategic decision-making

Taken together, the trends and challenges described above raise the need for evidence and strategic decision-making. This has led to the Scottish Government developing a new cancer strategy for Scotland that has the intention of being responsive to evolving needs and is able to achieve maximum effectiveness (including in terms of survival rates, prevention, and minimising negative impacts on the wellbeing of patients and their friends and family) given resource constraints.

This can be achieved by defining priority areas of actions, including in terms of the groups of cancers that should be focused on, and the various aspects of the cancer journey (e.g. prevention, diagnosis, treatment) that need most investment. In turn, this requires strategic decision-making considering the medium- and long-term as well as the short-term.

Written consultation

In this context, the Scottish Government launched a written consultation on a new cancer strategy, which sought views on areas to prioritise in relation to cancer prevention, management and care. This constitutes best-practice in policy-making as it increases the evidence-base for decision-making (including adding evidence on lived experiences) and enhances the democratic process behind it by building an understanding of public priorities and preferences.

Responses submitted to the written consultation have been rigorously analysed in order to provide transparent evidence that will effectively inform the decision-making process and socialise the evidence-base gathered from this exercise.

Overview of respondents

The consultation was open to the public and received 257 responses in total, either through the online platform Citizen Space or via e-mail. The vast majority of responses (96%) were submitted through Citizen Space, while the remaining 4% of responses were submitted via e-mail. Out of the 257 responses, 156 were submitted by individuals and 101 were submitted by organisations.

Though the research team could not verify whether all responses identifying as organisations were submitted in an official capacity, a breakdown of the types of organisations that responded to the consultation is provided below.^[6] It was also evident from reading the responses that some of those who participated in an individual capacity had professional experience in cancer care through working in relevant charities, industry associations or the NHS.