NHS Recovery Plan 2021-2026: annual progress update report 2024

Cancer Care

The Scottish Government published our Cancer Strategy for Scotland 2023-2033 along with an initial 3-year Cancer Action Plan for Scotland 2023 – 2026 in June 2023. Over this 10-year period, our strategic aim is to improve cancer survival and provide excellent, equitably accessible care.

The strategy and plan take a comprehensive approach to improving patient pathways from prevention and diagnosis through to treatment and post-treatment care. By 2033 we will improve cancer survival, particularly among the currently less-survivable cancers. We have outlined 11 ambitions and will work to deliver 7 outcomes for cancer in Scotland. We are driving forward 136 actions in the first three years of the strategy, through the cancer action plan.

Progress on Delivering Commitments During 2024

Refresh of the Framework for Effective Cancer Management – A further review of the Framework for Effective Cancer Management is underway in 2024 to provide NHS cancer management teams with the tools to effectively manage patients from the point of referral to first treatment, improving patient experience as well as cancer waiting times performance.

The refreshed guidelines will include two additional key elements to incorporate demand and capacity modelling and patient voice. The refreshed framework is closely aligned to the aim of our Cancer Strategy for Scotland to provide excellent, equitably accessible care, and is due to be published in early 2025.

A toolkit is also being developed to support implementation of the 10 key elements of the framework and will ensure that best practice is shared across NHS Scotland.

Through our national cancer network, improve access to the best treatments and care for rarer cancers – The SCOT-HPB pilot was commissioned for a time-limited period to scope potential options to host a pilot co-ordination layer across established pathways for HepatoPancreatoBiliary (HPB) cancers.

Following an extensive options appraisal exercise and clinical, patient and third sector engagement, recommendations regarding the lessons learned from the pilot were generated before its closure. These will now inform the development of standardised patient centred national pathways that improve outcomes for patients in an equitable and sustainable way.

Delivery of the National Cancer Plan – The final report of the National Cancer Plan 2020 to 2023 was published in November 2023. The Cancer Strategy 2023-2033 and Cancer Action Plan 2023-2026 were published in June 2023. The first annual progress report of the action plan was published on 1 July 2024, providing an update on progress against the 136 actions between June 2023 and March 2024.

Continued roll out of the pioneering partnership with MacMillan – Agreements are now in place in all areas of Scotland with funding agreed until March 2032. Services have gone live in three areas of Scotland in 2024 to date – Borders, Shetland and North Lanarkshire. Staff have also been recruited to services in Orkney, Western Isles, Dumfries and Galloway, North Ayrshire, East Ayrshire, South Ayrshire, Clackmannanshire, Forth Valley and Stirling, with procurement underway in Aberdeen, Aberdeenshire and Moray. Since Jan 1st – Sept 30th 2024, 4147 unique holistic needs assessments have been carried out, supporting people to access dedicated financial, practical and emotional support.

Support the Detect Cancer Earlier (DCE) Programme – Work to develop and support implementation of Scotland’s Optimal Cancer Diagnostic Pathways continues, with pathways already in place for lung cancer and head and neck cancers, supported by almost £6m investment. These pathways aim to reduce variation and provide services with a gold standard delivery model to improve performance and patient experience.

Work is now underway to develop the next optimal diagnostic pathway for colorectal cancer.

A Detect Cancer Earlier campaign – “Be the Early Bird” - launched in March 2023 aiming to reduce fear of cancer and empower those with possible symptoms to act early. Following successful independent evaluation, the campaign re-ran in September 2023 and August 2024 to prompt health-seeking behaviour, targeting those aged 40+ from areas of deprivation. In parallel to the campaign, a DCE roadshow targeting the most deprived areas visited communities across Scotland in March and September 2024 to reinforce key messages – this resulted in almost 10,000 engagements with the target audience.

A clinical refresh of the Scottish Referral Guidelines for Suspected Cancer is underway to support primary care clinicians to identify those with symptoms suspicious of cancer and identify those who require urgent assessment by a specialist. 14 peer review sessions have taken place to ensure engagement and input from key stakeholders such as the Scottish Primary Care Cancer Group, Healthcare Improvement Scotland, secondary care clinicians and various third sector organisations. A draft of the updated Guidelines will be shared in mid-December 2024 for wider consultation across the clinical community in Scotland, with the final version to be published in Spring 2025.

A new primary care cancer education platform – Gateway C – was launched on 30 April 2024 , supported by NHS Education for Scotland (NES). Gateway C provides innovative and tailored information to support earlier cancer diagnosis efforts and enable effective decision-making. This free online platform is accessible to all primary care clinicians including pharmacists, dentists, and optometrists.

Provide all cancer centres in Scotland with the most up-to-date radiotherapy equipment – the Capital Equipment Replacement Programme, which includes linacs, radiotherapy imaging equipment, treatment planning and Oncology Management Systems continues to ensure that patients attending the 5 radiotherapy centres in Scotland benefit from modern technology and treatments. This also includes provision for brachytherapy. The Technical Specification and Evaluation (TSE) Group oversees all replacements to ensure we plan for the future and embrace opportunities for collaboration in procurement to maximise public value for these cost effective treatments.

Greater provision of Magnetic Resonance Imaging (MRI) in radiotherapy continues to be considered within the recognised increasingly challenging financial context. Opportunities to optimise and sustain radiotherapy services in Scotland, whilst meeting the increase demand, are being addressed through the Oncology Transformation Project, including radiotherapy resources.

Establish a network of Early Cancer Diagnostic Centres, now known as Rapid Cancer Diagnostic Services (RCDSs) – We continue to focus on improving timely access to cancer services, which is why our Programme for Government (PfG) has committed to opening a further Rapid Cancer Diagnostic Service, bringing our national total to six. Funding has been released to NHS Forth Valley to develop a Rapid Cancer Diagnostic Service and the service expected to open to referrals in early 2025.

The University of Strathclyde were commissioned to carry out an evaluation of Scotland’s first five pilot RCDSs in November 2021. This aimed to better understand their role in detecting cancer and ensure optimal components are embedded in future models, with an interim report published November 2022 and the full report published February 2024.

Covering a two year period, the report shows that RCDSs are achieving what they set out to do – find cancer – while delivering a high standard of quality care at speed, reducing the time from referral to diagnosis for patients with non-specific symptoms suspicious of cancer, with a median wait of 14 days.

There have been some fantastic improvements, including:

• In NHS Fife, the wait from referral to diagnosis has reduced from an average of 77.5 days to 11.4 days (when compared to a general surgical clinic).
• In NHS Dumfries & Galloway, the wait from referral to diagnosis, reduced from around 78.7 days to 13.6 days (when compared to a general surgical clinic).
• Positive patient experience appears to be mainly attributed to the speed of referral, reduction in waiting times for diagnostic tests, having a single point of contact and enhanced information and communication throughout the RCDS pathway.

We are now working with Boards across Scotland to reflect on the evaluation report, embed learning and work towards establishing further RCDSs as reflected in PfG and Cancer Strategy commitments.

Developing and already piloting a “single point of contact” for cancer patients to support them throughout their treatment – Funding to support the 12 pilot projects continues with a scalability assessment underway. Project sites continue to report bi-annually with progress reports and scalability assessment demonstrating positive impact on patient experience, clinical workload, travel burden, and waiting times (to treatment and results). For example, waiting times for PSA results reduced by 20 days to 2 days in one Health Board, 17.4 weeks of CNS time per year released in another Health Board, and a 7-day nursing service enabled in another Health Board.

Develop a ‘prehabilitation’ programme for patients with cancer – Following initial Scottish Government investment, in the year 1st April 2023 – 31st March 2024, 1273 were supported through the Maggie’s universal-level prehabilitation workshops. This offer is now part of the core service delivered by Maggie’s in their eight centres in Scotland. From 1st April – 31st Oct 2024 another 695 people have taken up the offer. Resources developed to support the delivery of these workshops are set to be tested via additional organisations in late 2024/early 2025 that should see access to universal prehab improve.

Work is ongoing to integrate prehabilitation into clinical pathways. A screening pilot has been initiated with test sites across Scotland. This will demonstrate feasibility of screening and help to understand demand for universal, targeted and specialist prehabilitation.

Funding to further test and develop prehabilitation has been allocated across Scotland via Regional Cancer Networks. This has been used for a variety of uses. For example, education sessions have been delivered in multiple Board areas to improve knowledge and understanding of prehabilitation and key principles for implementation in Scotland. In other areas patients are being supported with a targeted and/or specialist multi-modal prehabilitation offer as appropriate, with outcomes being monitored and new ways of working explored.