Acute Oncology Service (AOS) in NHS Scotland: principles

3. Strategic Context

There are a number of existing policy frameworks and performance targets that are central to the overall strategic context for the future delivery of AOSs in Scotland. The refreshed Cancer Strategy, Beating Cancer: Ambition and Action², outlines the aim of ensuring equity of access to sustainable, high quality, timeous and person centred cancer treatment.

Acute Oncology: Increasing engagement and visibility in acute care settings¹ - produced collaboratively by the Royal Colleges of both Physicians and Radiologists, and the Association of Cancer Physicians, sets out the core principles and benefits of the AOS.

The Chief Medical Officer’s report Realistic Medicine³ sets the challenge for services to consider how we can further reduce the burden and harm that patients experience from over treatment and reduce unwarranted variation in clinical practice.

Cancer waiting times standards⁴ state that 95% of all patients diagnosed with cancer should commence treatment within 31 days of decision to treat, and 95% of those referred urgently (including patients presenting through emergency departments) with a suspicion of cancer should begin treatment within 62 days of receipt of referral.

Accident and emergency (A&E) waiting times standard⁵ states that 95% of all A&E patients should be admitted, discharged or transferred within four hours of arrival at an A&E department.

Re-mobilise, Recover, Re-design: The Framework for NHS Scotland⁶, set out how NHS Boards should safely resume services which were paused during the Covid-19 pandemic. The effects of the pandemic are far reaching across all services, dedicated specialist AOSs have the ability to free capacity and alleviate pressure in multiple areas: beds in general medicine; diagnostics to expedite discharges across specialities; acute medicine units (AMUs) and emergency departments.

Sepsis is a major cause of avoidable death in hospitals. The Scottish Patient Safety Programme (SPSP) Sepsis Six care bundle⁷, which is a component part of the deteriorating patient work stream, aims to implement a process for structured responses and treatment for sepsis by ensuring compliance with ‘sepsis six’ within 1 hour of sepsis being suspected . Patients commencing antibiotics within 1 hour is a key element of ‘sepsis six’.

Malignant Spinal Cord Compression (MSCC) is believed to occur in approximately 5% of all patients with cancer and is a major cause of morbidity. The presentation of MSCC may vary but early identification and prompt referral for investigation and treatment are paramount to optimise patient outcomes. NICE guidance⁸ is available and many NHS Boards have existing guidelines for MSCC which promote a consistent approach to management and clear referral and investigative pathways for patients with suspected or actual MSCC, encouraging prompt referral and treatment to optimise patient outcomes in relation to quality of life and survival.

Every Story’s Ending⁹ published by the Scottish Palliative Care Partnership, explores what can be done in Scotland to improve people’s experience of serious illness, dying and bereavement. It acknowledges the valuable roles of palliative care in hospitals, and identifies palliative care in the acute setting as an area for collaboration and improvement. The Scottish Government, in its 2021 programme for government, has committed to publishing a new National Strategy for Palliative Care during 2022.