Cancer services action plan 2020 to 2023: final report

Actions met in part

Work to address these actions will continue under the new 10-year cancer strategy and accompanying action plan.

Action 10: Develop a programme of work and pilot approaches to cervical self-sampling

We committed to develop a programme of work and pilot approaches to vaginal self-sampling.

The Short Life Working Group continues to work with NHS National Services Division (NSD) colleagues to lay the groundwork for introducing cervical self-sampling, in preparation for a recommendation from the UK National Screening Committee (NSC).

Action 35: Identify opportunities to improve recovery after treatment

We committed to monitor and explore new initiatives and service changes to improve recovery after surgery.

The Centre for Sustainable Delivery continues to have over-arching responsibility for this action. Work continues to set up similar programmes within Ear Nose and Throat (ENT), Urology and Gynaecology. This is linked to and will benefit from work to progress the Prehabilitation Actions (24-27).

Action 42: Develop a national approach to non-medical SACT prescribing

We committed to develop a national approach to support the non-medical prescribing of SACT, to make best use of the existing workforce and help patients receive safe and timely treatment.

There is broad agreement for a national framework and a draft of the framework is nearing completion. Two models for non-medical prescribing have become apparent. Guidance has been developed and is near finalisation to address the model of a prescriber working autonomously on one or two cancer types only. This will continue to be discussed at the SACT Programme Board.

Action 46: Support nationally acute oncology services to cope with potential increased demand

We committed to support nationally acute oncology services, where required, to meet increased demand.

The Principles of an Acute Oncology Service (AOS) in NHS Scotland were published in November 2022. A commitment in the Health and Social Care Workforce Strategy outlined an increase in funding for SACT and Acute Oncology Services. This money is being rolled out on a phased approach and will reach £10 million by 2026/27.

Action 47: Optimise the provision of diagnosis, treatment, and prevention through precision medicine

We committed to look at the opportunities presented by precision medicine to optimise cancer services, and ways to implement precision medicine to enhance person-centred service delivery.

Within the Scottish Strategic Network for Genomic Medicine (SSNGM) we will be working closely with partners including the Cancer Research UK Scotland Centre, the Experimental Cancer Medicine Centres, the Scottish Cancer Network, the Scottish Pathology Network and the regional cancer networks to support precision medicine, including embedding testing within clinical pathways. Critical within this area is also engagement with pharmacy colleagues around the use and optimisation of different medicines and the interpretation of genomic information within these settings.

Action 48: Improve alignment of access to molecular pathology testing with new treatments

We committed to work to improve the alignment of access to molecular pathology testing with new treatments, to offer the opportunity to personalise medicines for individual patients and provide long-term remission.

The Scottish Government wants to ensure that genomic medicine in Scotland supports diagnosis and access to the right treatment and management, at the right time for the right person, with a national genomic test directory that is harmonised with clinical management pathways.

As service commissioners, NHS National Services Division (NSD) currently maintain two genomic test directories: the Scottish Cancer Test Directory and the Scottish Rare and Inherited Disease Test Directory. Through our upcoming genomic medicine strategy, we will ensure that the Scottish test directories are comprehensive, taking account of developments in genomic medicine and staying responsive to clinical need. To support our longer term service development, these directories will be aligned as far as possible with both the other nations of the UK and relevant international standards.

We recognise that an improved streamlined process for the implementation of new genetic tests linked to a Scottish Medicines Consortium (SMC) approved medicine is required. The SMC currently provides early information to NSD on cancer medicines in clinical development that are expected to require a companion diagnostic through regular horizon scanning reports. To support financial and service planning, the SMC also provides Health Boards with information, on a confidential basis, on medicines that may require a companion diagnostic through regular Forward Look reports, which include emerging new medicines, including Advanced Therapy Medicinal Products (ATMPs).

A key function of the Scottish Strategic Network for Genomics Medicine (SSNGM) is to horizon scan for new medicines to prevent delays for patients getting access to advanced therapies. To support this, the SSNGM has established Scottish Genomics Testing Assessment Groups (SGTAG) for cancer and rare disease. The SGTAG will work with the SMC and others to approve the availability of companion diagnostic tests in the genetic laboratories.

In addition, the Chief Pharmaceutical Officer is establishing a Horizon Scanning Oversight Board (HSAB) to identify and analyse new medicines currently in licensing and in the SMC’s appraisal pathway/pipeline that are due to be considered by the SMC for routine access in the next 18-24 months. The HSAB will use the SMC’s horizon scanning report, Forward Look, and its Advanced Therapy Medicinal Product report to consider high profile medicines/indications which potentially have a disruptive impact, to support advance planning for their managed introduction in Scotland.

Action 60: Standardise patient consent for Systemic Anti-Cancer Therapies (SACT) across Scotland

We committed to ensure that a consistent approach to patient consent, including electronic consent, for SACT is used across Scotland

Good progress has been made, with the use of standardised paper forms well established. An outline business case on the implementation of an electronic consent solution for Systemic Anti-Cancer Therapy (SACT) on a ‘Once for Scotland’ basis was finalised and presented to the SACT Programme Board in March 2023. The decision has been made not to continue with the project in the short-term due to the significant financial cost, the capacity to take forward at a time of significant pressure on SACT services throughout Scotland, and the need to align with broader digital health innovations.

Action 61: ChemoCare upgrade support

We committed to upgrade all five instances of ChemoCare (the electronic prescribing system) to Version 6 by the Chemotherapy Electronic Prescribing and Administration Systems (CEPAS) User Group to achieve a uniform approach across the country.

The upgrade to version 6 continues to progress well in the South East Cancer Network (SCAN) and West of Scotland Cancer Area Network (WoSCAN). Tayside cancer centre, one of the three North Cancer Alliance (NCA) cancer centres, has also upgraded to version 6. NCA continues to progress towards single implementation across other cancer centres.

Action 62: Integrate SACT and radiotherapy data into Scottish Cancer Registry and Intelligence Service (SCRIS)

We committed to continue to develop and prioritise the integration of Systemic Anti-Cancer Treatment (SACT) and radiotherapy (RT) data into the Scottish Cancer Registry Intelligence Service.

There is now a direct SACT data feed into the cancer registry. Weekly, monthly and annual activity reports are generated from the SACT data platform held by Public Health Scotland (PHS).

There are still some data issues in integrating RT data into SCRIS but PHS is working to resolve this. PHS continue to collect, quality assure and report on RT datasets to enable meaningful benchmarking of RT services in Scotland with rUK services.