Cancer services action plan 2020 to 2023: final report

Actions facing delay

Action 4: Deliver the next iteration of the Scottish Cancer Patient Experience Survey (SCPES)

We committed to develop and deliver, with Macmillan Cancer Support, the third Scottish Cancer Patient Experience Survey, benefitting from benchmarking against previous surveys to further understand COVID-19 impacts on cancer patients.

We are continuing to progress this action however approvals and associated information requests have delayed the start of fieldwork. We anticipate approvals will be in place by the end of 2023 with fieldwork commencing early in 2024. Reporting is expected in autumn 2024.

However, the Scottish Government continues to utilise Care Opinion as a source of experience, regularly reading about cancer care in Scotland and using these stories as a learning opportunity. Monthly summary reports were produced and shared with the National Cancer Recovery Group members to inform discussions.

Action 14: Every Health Board in Scotland will have a GP direct access to CT pathway

We committed to continue to work with, and encourage, Health Boards to increase GP direct access to CT scans for people with symptoms potentially indicative of cancer, helping more people be tested more quickly.

This continues to be area of focus for the National Diagnostic Lead for Radiology. To assist primary care clinicians, guidance on Direct Access to CT for patients with non-specific symptoms suspicious of cancer was published in March 2023: SCIN Direct Access to Imaging – Scottish Clinical Imaging Network

Action 15: Evaluate the efficiency of Cytosponge and Colon Capsule Endoscopy (CCE)

We committed to introduce Colon Capsule Endoscopy and Cytosponge™ across Scotland and evaluate their efficacy and impact on patient outcomes.

Following the recommendation to adopt these procedures, work to progress adoption continues in the remaining health boards where they are not yet in use.

Action 17: Completion of roll out of gallium scanners

We committed to invest an initial £2 million in Gallium services to detect advanced prostate cancer across four Health Boards.

Glasgow & Aberdeen sites were aiming towards use of gallium scanners for neuroendocrine tumours from June 2023. Other Health Boards already have them in service. Patients in the two outstanding sites are currently referred to another health board or treated with a different radiopharmaceutical at present. However, all sites in Scotland have PSMA imaging available for prostate cancer.

Action 19: Audit of Scottish Referral Guidelines for Suspected Cancer

We committed to undertake an audit of the adoption of the Scottish Referral Guidelines for Suspected Cancer in Spring 2021.

The University of Aberdeen was funded to undertake an analysis of National Cancer Diagnosis Audit data to allow a comparison of primary care before and after the refresh of referral guidelines. Challenges in accessing and transferring data has delayed delivery.

Action 23: Form the urology optimal pathway

We committed to explore ways to reduce variation in urology pathways and ensure equitable access from the point of suspicion of cancer to post-treatment follow-up.

The £70m Endoscopy and Urology Diagnostic Plan was published on 30 November 2021. The Plan supports the redesign and implementation of Urology Diagnostic Hubs and 'One Stop' clinics. There are currently six one-stop Urology Diagnostic Hubs in NHS Scotland, supporting rapid access to cystoscopy and same day diagnosis. Other hubs are expected to come on stream.

Action 30: University of Edinburgh feasibility of lung health checks in Scotland research underway

We committed to appraise the options, opportunities, harms and benefits of targeted lung health checks in Scotland through exploratory research carried out by the University of Edinburgh.

As of 29^th September 2022, the UK National Screening Committee (UK NSC) has now recommended for all four UK nations to move forward with introducing targeted screening for lung cancer in adults aged 55-74 with a history of smoking. The UK NSC also acknowledged the significant complexities that must be worked through ahead of implementation, including development of the screening pathway, the delivery model, and identification of the eligible population. Scotland will play an active part in that work.

The Scottish Government will also follow the advice of National Screening Oversight (NSO) and Scottish Screening Committee (SSC) who will consider how the recommendation can best be taken forward in Scotland.

In the meantime, the Scottish Government has agreed to fund an extension, through to September 2023, to the University of Edinburgh's feasibility study, LungScot, into targeted lung health checks for high risk individuals. This feasibility study into lung screening in Scotland will add to the evidence base and could potentially be used to inform future approaches and ambitions for scaling up screening activity in Scotland.

Action 32: Review data on access to specialist surgery

We committed to work with clinicians and Health Boards to assess new ways of improving equity of access across all specialist surgical pathways.

The Centre for Sustainable Delivery (CfSD) is playing a central role in driving innovation in collaboration with Health Boards. Launched in 2021, CfSD was established to pioneer and deliver new, better and more sustainable ways of delivering services and improving access for patients. The work of the CfSD is key to supporting NHS recovery and aims both to reduce unnecessary demand for services, and also to develop new pathways of care that are more efficient and better for patients. This includes enhanced delivery of services in community settings, reducing the variation across Health Boards and improving overall patient experience. Not only does this maximise value for patients by avoiding waste, it also provides access to consistently high quality healthcare across Scotland.

Action 37: Continued investment in improving our radiotherapy equipment

We committed to invest £45 million in the Linear Accelerator (LINAC) Procurement Programme to ensure access to the most up to date radiotherapy equipment across Scotland’s cancer centres.

The LINAC 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 has not yet been realised but this continues to be pursued for all cancer treatment centres. Continued planned investment in this programme is essential to meet increasing demand, increasing complexity, and to facilitate more personalised radiotherapy treatment in the future.

Action 40: Increase community based phlebotomy services

We committed to explore how an approach that increases numbers of pre-treatment and follow-up tests can be embedded across Scotland.

Initial scoping by the Centre for Sustainable Delivery (CfSD) identified wide variation in community phlebotomy across and within health boards. It also revealed the challenge of addressing a single task (phlebotomy) for a single health area (SACT) that depended on and related to work on community services more widely (Community Treatment and Care (CTAC) services). In November 2022, the Systemic Anti-Cancer Therapy Programme Board (SACT PB) agreed to pause activities due to other competing pressures.

Action 43: Utilise and enhance the delivery of SACT through community pharmacists

We committed to work with pharmacy leaders to optimise the potential of community pharmacy and build on the successful pilots of community pharmacy dispensing of Systemic Anti-Cancer Therapies (SACT).

Limited progress has been made to address challenges related to community pharmacy infrastructure challenges, particularly in relation to several areas which would require clearance from UK Government.

Action 68: Complete phases 3-5 of the Cancer Intelligence Platform

We committed to implement a phased approach to developing a Cancer Intelligence

Platform, in order to provide a centralised space for data linkage and analysis.

Public Health Scotland (PHS) have commenced user acceptance testing (UAT) for the first three datasets (cancer waiting times, DCE and pathology). Some issues have been identified, with delay in completing, but are being addressed. Some of the development work on the reference files, such as populations, geography and deprivation have been brought forward. The next three datasets to focus on are deaths, acute and registry data.