Cancer strategy 2023-2033: equalities (records) impact assessment

1. Screening

1.1 Policy Aim

Background

Cancer remains one of Scotland’s single biggest health challenges, representing the largest burden of disease. The number of deaths from cancer has increased over the last decade, mainly due to the increasing number of cancer cases.

There have been huge changes in the understanding of the disease and how to prevent, diagnose and treat it better. Increasing cancer survival and the ageing population of Scotland means that the population of survivors is likely to grow substantially in the coming decades, leading to increased demand on the health service.

The current national cancer plan ‘Recovery and Redesign: An Action Plan for Cancer Services’ was published during the first year of the Covid-19 pandemic and set out a number of priorities to pave the way for remobilisation and recovery of cancer services. This plan comes to an end in March 2023 and a new strategy is required to continue with and improve on the services available to all those affected by cancer, which includes people living with cancer and their families and carers, as well as the workforce.

The new strategy will be in place for 10 years and will be underpinned by three consecutive action plans.

Policy objectives

Our 10-year vision is that: “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”.

The new strategy will provide a common direction to all affected by cancer, defining a clear strategic intent - improve cancer survival and provide excellent, equitably accessible, care - along with a range of priority ambitions to help meet that aim.

The initial three-year period of the strategy will focus on stabilising systems and services, maintaining cancer as a priority while recovery from the Covid-19 pandemic and careful management of finances continues across all health systems. This will be followed by a reform of services and approaches to cancer control, recognising opportunities for change and better meeting strategic ambitions. Towards the end of the strategy, progress will be accelerated to truly transform services, embracing innovation and digital opportunities to best deliver services and support patients.

Throughout the lifetime of the strategy, there will be a focus on those cancer types that are the largest burden and have poorer survival. These include lung, breast and bowel cancer and other less-survivable cancers.

We recognise that a skilled, compassionate and valued workforce is critical in delivering treatment and care to those facing cancer. Recognising the potential of integrated and collaborative working, technological advances, and transformation of service, we will:

• aim to ensure we have the right people in the right place at the right time
• provide career opportunity and appropriate training, and
• support and nurture our staff.

Person-centred care will be key to successful delivery. We will continue to develop and implement support through a single point of contact (SPOC) for each person facing cancer, recognising that treatment and care that reflects what matters personally to people with cancer are as important as clinical outcomes. This includes equal access to services; support for non-clinical needs; and regular and reassuring information and communication. Patient voice and experience will be sought and listened to on a regular basis throughout the lifetime of the strategy, to provide feedback and co-design services where appropriate. Additionally, the Realistic Medicine approach to healthcare should be fundamental to all cancer care. By encouraging healthcare professionals to consider and discuss the impacts that a treatment may have on each individual and their loved ones, cancer patients will continue to receive compassionate care.

There is a broader aim to reduce inequalities which disadvantage people and limit their chance to live longer, healthier lives. Inequalities in cancer survival may be due to specific factors, such as age, whilst others may be more systemic, such as deprivation or geographical difference. By addressing the socio-economic causes of inequalities within society, as outlined in the Programme for Government, we will focus actions in areas and communities most in need to improve outcomes. We will drive to improve screening uptake and thus reduce late stage cancer incidence, by targeted screening and use of new methodologies. We will also focus on enabling more equal access to diagnostic and treatment services as well as clinical trials, wherever any patient lives, as this is crucial to ensuring optimal outcomes and development of and access to new treatments. Whilst travel may be required to access specialist treatment and trial sites, no-one will be disadvantaged due to their financial or geographical position, with support available where appropriate.

To support service delivery and re-design, data collection and intelligence will be used to inform decision-making, policy, and future planning, as well as for audit and improvement purposes and potentially measuring inequalities. We aim to develop a more integrated intelligence system so that all data captured will be a national asset in terms of service provision, planning and costs; clinical use; and measuring outcomes.

By tackling risk factors, such as smoking, obesity, excess alcohol use and physical inactivity, and implementing prevention strategies, we recognise that a significant proportion of cancers can be prevented. Healthy living will be promoted and encouraged through other plans addressing these risks with the aim of both reducing the risk of developing cancer and enhancing outcomes, if a diagnosis of cancer is made. Pre-treatment interventions, including prehabilitation, will support this approach to improve quality of life, maximise treatment rates, and minimise side effects of treatment.

Beyond prevention, earlier and faster diagnosis plays a fundamental role in cancer control and is vital in further improving cancer survival rates in Scotland. For example, innovation and redesign of diagnostics services, such as further roll-out of Rapid Cancer Diagnostic Services, will enable timely access to tests, whilst raising public awareness and encouraging uptake in screening programmes will also help address this ambition.

The provision of safe, effective treatments and cancer medicines is necessary in improving outcomes and quality of life. A range of treatments and medicines will continue to be offered, depending on diagnosis, safety, and effectiveness. New ways of working, including community-based treatment and embracing new technology, will continue to be developed and matched by available resources to support implementation. We will strive to embrace innovation and technological advances. The Centre for Sustainable Delivery (CfSD), established to pioneer and deliver new, better, and more sustainable service delivery, will be particularly important in driving innovation.

To ensure quality of life during and after treatment, rehabilitation, palliative, supportive, and end-of-life care are required. A personalised approach to rehabilitation is key to meeting the needs of each individual, embedded within their pathway of care and aligned with the Once for Scotland Rehabilitation Approach (2022). When needed, high-quality palliative care, care around death, and bereavement support will be available, based on the needs and preferences of the patient and their families and carers.

The Scottish Cancer Network (SCN) will be at the heart of our strategic ambitions. The SCN will continue to be at the forefront of defining clinical management pathways for cancer, from diagnosis, treatment, and care through to the end of life. They will set out clinically agreed best practice in all these areas, assuring patients of common standards of care regardless of where they are in the country.

Rationale for government intervention

Cancer control (decreased incidence and mortality and increased survival) has improved over time, but Scotland still has lower survival rates and improvements have not been as rapid as in other comparable countries.

It is therefore important that the government keeps pace with all the ways to better control and manage cancer within the population. The scope of possible interventions is wide-ranging, for example:

• doing what matters to patients, and building care and treatment around them
• introducing new diagnostic and treatment techniques
• continuing the search for better scientific understanding of the disease.

Cancer control is important in meeting our National Outcome that we are healthy and active, through providing treatment and care for those with cancer, but also through population measures that will help prevent cancers in the future. These will be addressed through continuation of screening programmes and public health interventions targeted at specific preventable risk factors.

Governance and direction will be overseen by the Scottish Government, with a national oversight group owning the strategy and associated action plans, and responsibility for reviewing progress against them. Beyond this, responsibility for delivery of actions will vary from national to regional and local levels. The ‘Once for Scotland’ approach will be a core principle with national decisions and implementation made wherever possible for work that is universally applicable across Scotland. The cancer action plans underpinning the strategy will be owned and driven by relevant governance structures, recognising the breadth of responsibilities involved in delivering the comprehensive set of ambitions.

In addition, delivery of this strategic ambition will be interdependent with a range of other plans in health and beyond, including:

• NHS Recovery Plan (2021)
• National Workforce Strategy for Health and Social Care (2022)
• Digital Health & Care Strategy (2021)

1.2 Who will it affect?

Those people in the adult population who engage with cancer services, including population screening programmes, will be affected. This includes those who receive a cancer diagnosis, for those who are referred on a suspicion of cancer, and for those that are captured in the national screening programmes. In addition, this strategy affects individuals who are indirectly impacted by cancer, namely family, including parents and carers, of individuals who have received a cancer diagnosis. Wider groups affected by the plan include healthcare professionals, NHS boards, national bodies, and the Third Sector.

1.3 What might prevent the desired outcomes being achieved?

Implementation of the new cancer strategy and accompanying action plans will aid continuity, development, improvement of, and innovation within cancer services across Scotland. Equitable access and consistent and efficient delivery of care and treatment will be available to all patients with cancer, regardless of where they live. Failing to implement the strategy would likely lead to inconsistent and inequitable access to cancer care and treatment and, in turn, poorer cancer outcomes. This would likely have a negative impact on those people who may be more vulnerable to certain types of cancer and/or their recovery, for example in terms of their age, sex or race/ethnicity.

Although not protected characteristics, it is well-evidenced that health inequalities are directly linked to social deprivation and geographical location. The new strategy will endeavour to ensure that equitable access to timely treatment, care and support will be provided to all patients facing cancer in Scotland, regardless of their financial position or where they live.

1.4 Initial assessment – is an EQIA required?

As a diagnosis of cancer could affect anyone in the Scottish adult population, it is considered necessary to conduct an EQIA.