Recovery and redesign: cancer services - action plan

Governance And System Support

The national cancer governance landscape has been greatly impacted by COVID-19. Swift actions were taken to develop appropriate groups to deliver national consensus on how to adapt our cancer services. These groups are clinically led, with representation from each regional cancer network, covering a range of cancer recovery topics and linking with wider COVID-19 efforts.

Regional Cancer Networks or Alliances are key elements in the governance of cancer services and pivotal in bringing together clinical and managerial leadership from all organisations. They support collaborative improvement in the quality and outcomes of care, from diagnosis to end of life care, for cancer patients across Scotland. Their roles can help enable care to be more effectively planned locally, regionally and nationally by working together, with Health Boards and the Scottish Government to ensure delivery of this plan.

As we have learnt over recent months, we must be flexible in our diagnosis and treatment approach/options to account for the changing levels of COVID-19 in the community. Underpinning this recovery plan are a wide range of datasets which in large part have been developed through commitments made in previous cancer strategies. The ready availability of relevant data is, and will continue to be, a major driver in the recovery phase and beyond.

The following data areas and subsets will be captured and analysed, with some still in development, by the cancer governance groups in order to monitor actions and make evidence-based decisions in our ongoing responses:

Diagnosis/Detection

• Primary care presentation referrals
• Screening attendance and referrals
• Diagnostic demand

Treatment

• Surgical prioritisation
• Systemic Anti-Cancer Treatment and Radiotherapy capacity and delivery
• Cancer waiting times performance

Wider system support

• Cancer Quality Performance Indicators
• COVID-19 Prevalence
• Testing uptake
• Impact of COVID-19 on patient outcomes

A number of data projects and programmes will continue throughout the delivery of the recovery plan to improve the data landscape within Scotland, including:

• Innovative Healthcare Delivery Programme
• Scottish Cancer Registry and Intelligence Service
• Cancer Medicines Outcome Programme

We will continue to invest in our data services, with an additional £2.55 million in funding to take forward the various workstreams outlined in this plan. We will ensure the data captured for cancer services aligns with our new Data Strategy for Health and Social Care as it is developed.

In parallel with data collected specific to cancer services, there is a clear need to consider the data in light of the COVID-19 prevalence levels. As these fluctuate it will be critical to find a balance between the management of COVID-19 in the community and the available capacity in diagnostic and clinical care and treatment services.

We will aim to deliver this by:

Governance

54. National governance for cancer has changed significantly in response to COVID-19. We will conduct a rapid review of overall national cancer governance to ensure it is optimised for the recovery and redesign phases.

55. A Dedicated National Resource for Cancer

The response to COVID-19 within the NHS has driven significant national collaboration in a range of areas, and ‘Once for Scotland’ approaches to clinical guidelines and treatments. Everyone in Scotland should expect equitable access to treatment and care no matter where they live in Scotland.

We will establish and invest up to £2.78 million into a dedicated national resource for supporting a ‘Once for Scotland’ approach to cancer. Clinical consensus, ongoing improvement and equitable access will be key founding principles for this resource.

It will initially focus on the development of clinical management guidelines and improvement in patient pathways, including surgery, for less common cancers.

56. The Cancer Managers Forum is made up of operational and clinical Cancer service managers to discuss, share and support best practice within NHS Scotland. We will continue to support the Forum to share learning, challenges and best practice across Scotland to improve cancer care and services, as well as patient experience, encouraging a ‘Once for Scotland’ approach.

57. We recognise that a number of cancer patients receive treatment through clinical research trials and that the pandemic has impacted the ability for these trials to continue. We will establish a National Cancer Trials Resilience subgroup to oversee their safe resumption.

58. The Scottish Health Technologies Group (SHTG) provide evidence, support and advice to NHS Scotland on the use of new and existing health technologies. We will promote the use of the SHTG to analyse health technologies related to cancer, prior to their implementation.

59. Our COVID-19 response has led to a range of positive innovations and changes in the health service, such as the use of the Near Me video consultation tool. Through our national governance groups, we will remain alert to potential service innovation and redesign benefitting patients which could be introduced quickly with our national support.

60. Standardising patient consent across Scotland is a priority to ensure all patients are receiving the appropriate information regarding both benefits and risks before making an informed decision on their treatment. We will ensure a consistent approach to patient consent, including electronic consent, for Systemic Anti-Cancer Treatment is used across Scotland.

Data Needs

61. The technical challenges in sharing Systemic Anti-Cancer Treatment data to build a national picture of utilisation are considerable and include the need for all five instances of ChemoCare (the electronic prescribing system) to be upgraded to version 6. The recently established CEPAS User Group will support the upgrade to ensure it achieves a uniform approach across the country.

62. The Scottish Cancer Registry and Intelligence Service (SCRIS) continues to prioritise and develop the integration of Systemic Anti-Cancer Treatment and radiotherapy data into a national cancer dataset and is on track to complete this work in 2021/2022.

63. Treatment summaries provide a record of an individual’s treatment, side effects or consequences of treatment experienced and any potential recurring signs or symptoms. Building on the Innovative Healthcare Delivery Programme’s earlier work highlighting the value of treatment summaries, work is now underway in partnership with NES Digital Service (NDS), Public Health Scotland (PHS), and Health Boards, to map the data needed to populate the summaries, and develop technical solutions. The work will involve patients and clinical teams with NDS committed to delivering a national prototype product by June 2021.

64. Patient Reported Outcome Measures (PROM) have the potential to provide vital information in how we configure our services. A range of very effective digital solutions are in place to support these. We will provide national support to assessing the potential and value of these, linking with other digital strategies, and guiding pan-Scotland approaches to adoption.

65. The Cancer Medicines Outcomes Programme (CMOP) has successfully demonstrated the feasibility of electronic dataset linkage to assess real world clinical outcomes from cancer medicines. Over the duration of the plan we will support phase 2 of CMOP, with funding up to £822,000, to better understand the effects of medicines on patients in the real world and determine the feasibility of scaling up.

66. Public Health Scotland will conduct an audit of the application of Cancer Waiting Times data & definitions to ensure consistency of data capture and adherence to exclusion criteria across Scotland.

67. Cancer Quality Performance Indicators (QPIs) provide powerful data on our cancer services and help drive improvement. We will consider how these can continue to be best used to further inform and drive cancer recovery.

68. We are committed to improving the efficiency of cancer data collection and to providing a centralised space for data linkage and analyses. SCRIS is currently developing a Cancer Intelligence Platform, which will allow this ambition to be fully realised. Phase 3 of this SCRIS work stream is now underway, with phases 4 & 5 anticipated over the lifetime of this plan.

The graphic shows a timeline, displaying the end of each quarter and running from December 2020 to March 2023, and the expected completion times for action points 54 to 68, as described above. The table shows that action points 54 and 57 are to be completed by December 2020. Action point 55 is shown to be finished by the end of March 2021.

Action points 56, 58, 59, 60, 61, 64, 65, 67 and 68 are shown to run the length of the plan, and be completed by March 2023. Point 62 is expected to be complete before the end of March 2022, while point 63 will be completed earlier, by end of June 2021. Finally, point 66 will be undertaken from June 2022 to September 2022.