NHS recovery plan: progress report 2023

Cancer Care

Cancer remains a top priority for NHS Scotland, and we are committed to ensuring those with a suspicion of cancer are seen and treated as quickly as possible to reduce patient anxiety, improve experience and meet cancer waiting times standards. The actions we have undertaken will improve cancer outcomes through better prevention and diagnostics, including expanded Rapid Cancer Diagnostic Services.

Improving Cancer Services

As reported in last year’s progress report, we published a refreshed Framework for Effective Cancer Management in December 2021. The Framework provides NHS Cancer Teams with the tools to effectively manage patients from the point of referral to first treatment, to improve patient experience as well as cancer waiting times performance. Further to the refreshed framework, we have now published a ‘Once for Scotland Effective Breach Analysis’ for cancer teams across NHS Scotland to develop a local process to follow. If a cancer patient breaches cancer waiting times standards it is crucial that the journey is analysed to ensure- lessons learned and future breaches can be avoided.

We have also published ‘Urgent Suspicion of Cancer: National regrading guidance to ensure Urgent Suspicion of Cancer (USC) referrals can be directed appropriately. It is intended to encourage cancer teams to triage referrals using a specialist tool, Active Clinical Referral Triage (ACRT), ensuring patients are on the right pathway at the right time.

We continue to work closely with Cancer Management Teams across Scotland to fully embed the Framework for Effective Cancer Management and provide hands-on tailored support to cancer services across Scotland, helping share best practice where identified.

A progress report on the National Cancer Plan was published in August 2022, with detailed progress of the actions, with the majority delivered or met in part. The Plan came to an end in March 2023, and the final report is due to be published in Autumn 2023. Of the 68 actions, 47 were delivered, 9 met in part and 12 remain in progress.

Delivered actions include:

• Rollout of the Transforming Cancer Care (TCC) programme across Scotland, in partnership with Macmillan.
• Completion of the Maggie's “Prehabilitation” pilot and launch of the “Prehabilitation for Scotland” website.
• Publication of guidance for the safe delivery of systemic anti-cancer therapy (SACT, and expansion of the delivery of oral SACT.
• Delivery of innovative solutions, such as increased use of Near Me, a video consulting service; Non-Medical Prescribing (NMP); Connect Me, offering various services for patients to communicate with healthcare professionals; and upscaling of Colon Capsule Endoscopy (CCE).
• Ongoing review and publication of Cancer Quality Performance Indicators (QPIs).
• Publication of the Equity in Screening Strategy and action plan in July 2023.

Those actions that were not delivered in full continue under the new Cancer strategy 2023 to 2033 published in June 2023.

We also continue to support the Detect Cancer Earlier (DCE) Programme with a new earlier diagnosis vision for Scotland, which sets the direction for the Programme over the coming years with an ambition to reduce later stage disease by 18% in year 10. A key plank of this is the new behaviour change campaign - 'Be the Early Bird' which launched in March 2023. The multi-media campaign included TV, radio, social media PR and press case studies and a 15 day roadshow, targeting areas of deprivation. Evaluation is underway and will inform the campaign re-run in September 2023 encouraging those aged 40 and above who may be worried about unusual persistent symptoms to let their GP practice know.

We committed to establishing a network of Early Cancer Diagnostic Centres, which are now known as Rapid Cancer Diagnostic Services (RCDS’s). The University of Strathclyde published an interim report on Scotland's first three Rapid Cancer Diagnostic Services in November 2022 which showed that that more than 12% of patients cared for by one of Scotland’s three Rapid Cancer Diagnostic Services received a cancer diagnosis, with a further 33.8% receiving a diagnosis of a non-cancerous health issue, and reported positive patient experience using the services. Following this, two more RCDSs have since been established in 2023 in NHS Borders and NHS Lanarkshire, and a final two year evaluation report is due in November 2023 which will help inform wider roll-out, ensuring patients with non-specific symptoms suspicious of cancer have access to a diagnostic pathway from primary care.

We are ensuring that all cancer centres in Scotland with the most up-to-date radiotherapy equipment, and our ongoing replacement programme continues to ensure that patients attending the 5 radiotherapy centres in Scotland benefit from modern technology and treatments. The Technical Specification and Evaluation 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 also continues to be pursued for all cancer treatment centres, and the planned investment in this programme is essential to meet increasing demand, increasing complexity, and to facilitate more personalised radiotherapy treatment in the future.

We are also continuing to improve access to the best treatments and care for rarer cancers with funding of £653,000 over two years for the Pancreatic and Hepatocellular Cancer Pathway Improvement Project, and an evaluation of its effectiveness will be undertaken by the end of this year, comparing patients who have been referred through the improved pathway compared to patients before the project and those current patients who have not been referred through the pathway.

Support for people with Cancer

We continue our pioneering partnership with MacMillan, and annual funding to support the Scottish Government partnership with Macmillan Cancer Support has been agreed to March 2032 . Health and Social Care Partnerships in Scotland have agreed to the ‘Improving the Cancer Journey’ (ICJ) model, which means that Scotland is now the first country in the UK where all cancer patients will have access to a key support worker to receive dedicated financial, practical and emotional support.

“Prehabilitation” is a term used to cover support for actively improving physical and mental wellbeing for those diagnosed with cancer. Our commitment to develop a ‘prehabilitation’ programme for cancer patients is progressing through a pilot programme 'Prehabilitation for cancer patients', which involved over 1,522 people affected by cancer. Based on the success of this pilot, as part of our new cancer strategy, further funding to March 2024 has been provided to the cancer charity ‘Maggie's’ to extend and embed their universal prehabilitation programme in each of the 8 Maggie’s centres in Scotland. Supporting the concept of rehabilitation, the Nutrition Framework for People Affected by Cancer was published and made available online in November 2022, an implementation of this framework has been carried forward into the new cancer strategy.

We are continuing with our pilots to provide cancer patients a “single point of contact” to support them throughout their treatment and funding is in place to support 12 pilot projects under the new cancer strategy. Early indications are that the pilots are impacting positively on both patient experience and clinical workload, with a formal evaluation and options of how to potentially scale up these pilots under consideration.