Cancer strategy 2023-2033 and cancer action plan 2023-2026: monitoring and evaluation framework - August 2023

Appendix 4: Key steps of change to achieve the strategic vision

The ambition-level theories of change have fed into an overarching theory of change that summarises the key steps of change that we anticipate happening over ten years to achieve the strategic vision. The infographic below provides a summary of these anticipated changes, showing how each ambition will lead to the high level summary outcomes that are set out in Figure 1 (Page 10), which connect to the vision of improved survival and excellent, equitably accessible care. The theory of change will necessarily evolve over time as interventions are implemented and assumptions are refined in light of emerging evidence.

Cancer Strategy for Scotland – Steps of Change across 10 Years towards the vision of improved survival and excellent, equitably accessible care

Preventing more cancer

1-3 years

• Optimised HPV vaccination, including targeted approaches
• Improved knowledge of health behaviours associated with increased risk for some cancers

4-6 years

• Higher and more equitable coverage of HPV vaccination
• People adopt healthier lifestyles, with reduced smoking and alcohol use leading to reduced risk

7-9 years

• The incidence of cervical cancer is reduced
• Risk factors for some cancers are reduced

Reduced relative population burden

Earlier & faster diagnosis

1-3 years

• Optimised screening, including risk stratificaton
• Improved awareness of signs and symptoms of cancer amongst the public, and sense of empowerment to seek help
• Improved education for primary care to effectively manage and refer people with a suspicion of cancer
• Optimised quality and efficiency in diagnostic pathways with a Once for Scotland approach
• Enhanced diagnostic capacity and improved access, including improved testing turnaround

4-6 years

• Increased participation in national screening programmes
• People present earlier with a suspicion of cancer
• Equitable access to enhanced diagnostic services, including for people with non-specific cancer symptoms
• Faster pathways to diagnosis, with less unwarranted variation

7-9 years

• Earlier access to treatment
• Fewer cancer diagnoses via emergency admissions
• Reduced later stage disease, particularly among people from areas of deprivation
• People experience improved clinical outcomes

Reduced relative population burden; Reduced later stage diagnosis; Timely access to treatment; More people receiving curative treatment; Improved experience of services

Best preparation for treatment

1-3 years

• Increased understanding of the role of prehabilitation amongst a wider variety of stakeholders
• Wider coverage of universal prehabilitation services in clinical management pathways
• Genomic testing and interpretation is signposted in clinical management pathways

4-6 years

• Prehabilitation screening and assessment are carried out routinely with appropriate management plans
• Improved support and access to prehabilitation services across Scotland for defined pathways
• More precision and effective treatments are delivered

7-9 years

• People respond better to treatment and are more resilient to the effects of treatment due to better overall health
• People experience fewer side effects from treatment
• People experience improved clinical outcomes

Timely access to treatment; More people receiving curative treatment; Improved experience of services; Optimised quality of life

Safe, realistic & effective treatment

1-3 years

• Increased service integration across specialisms, regionally and nationally where appropriate
• Optimised quality of cancer treatment and therapy via clinical management pathways
• Clearer relationship between national cancer and medicines groups
• More coherent single source of data and evidence on cancer medicines and real world outcomes
• Appropriate and equitable access to expanded surgery, radiotherapy and chemotherapy treatment options

4-6 years

• Reduced unwarranted variation in treatment across services
• Fewer complications and less time spent in hospital
• Appropriate adoption of new treatments that is aligned to clinical capacity
• More equal access to appropriate treatment

7-9 years

• More consistent and equitable treatment provided
• People experience improved clinical outcomes

More people receiving curative treatment; Improved experience of services

Excellent care & support after treatment

1-3 years

• Improved knowledge of the rehabilitation landscape and embedding the six principles of good rehabilitation into practice
• Improved knowledge of the principles of good practice for palliative care and care around death

4-6 years

• Improved rehabilitation practice across services
• Improved supportive care, palliative care and care around death across services

7-9 years

• People have access to holistic rehabilitation that supports them to live well with fewer side effects and better recovery
• People receive well-coordinated, timely and high-quality palliative care and care around death

Improved experience of services; Optimised quality of life

Sustainable & skilled workforce

1-3 years

• Better understanding of workforce numbers and gaps
• More staff are attracted and retained through Workforce Strategy and review
• More staff are trained in care/ support relevant to cancer

4-6 years

• Optimised deployment of staff across cancer services
• Increased capacity to diagnose and provide care from additional staff capacity

7-9 years

• People feel well supported by a sustainable, skilled workforce

Improved experience of services; Optimised quality of life, Embedded research, innovation & data capture in all services

Person-centred care for all

1-3 years

• Improved psychosocial care is delivered via holistic needs assessments, care planning and realistic medicine
• People experience easier navigation through pathways with single point of contact operating
• People have access to the right support and information to make the right decisions about their care

4-6 years

• Improved support that is timely, relevant, appropriate, and sufficient for people's needs
• People feel more knowledgeable about care and treatment, including the benefits and the harms of treatment

7-9 years

• People are at the centre of their care and have a strengthened ability to self-manage via support
• People are able to make shared decisions that are right for them, and experience less regret

Improved experience of services; Optimised quality of life

Mental health as part of basic care

1-3 years

• Staff feel well supported and confident about how to deliver/ signpost psychological care and treatment
• Improved understanding of service demand and capacity for psychological care and treatment

4-6 years

• Services incorporate appropriate psychological care and treatment into routine pathways of care

7-9 years

• People have the network of care they need to manage the psychological impact of a cancer diagnosis

Improved experience of services; Optimised quality of life

Flourishing research & innovation

1-3 years

• Improved understanding of how to increase equitable access to clinical trials
• Increased awareness and uptake of Scottish Health Technologies Group advice
• New technologies for diagnosis and treatment are identified and supported

4-6 years

• Increased involvement and improved equity of access to clinical trials
• Higher rates of implementation and optimisation of effective diagnostic tools and treatments

7-9 years

• Cancer diagnosis, treatment and care are routinely informed by evidence-based advice

Embedded research, innovation & data capture in all services

Cancer information & intelligence led services

1-3 years

• More data and better intelligence are available to policy makers, clinicians, health managers and the public

4-6 years

• Comprehensive cancer data (with limited time lag) supports optimised clinical, policy and managerial decision-making

7-9 years

• Cancer diagnosis, treatment and care are supported by high quality data and intelligence

Embedded research, innovation & data capture in all services