Recovery and redesign: cancer services - action plan

Responding To A Global Pandemic - Our Initial Actions

A National Response

Cancer services have been prioritised since the beginning of our response to the COVID-19 pandemic. We have taken steps to support our Health Boards to continue the safe delivery of cancer services in the context of the pandemic. During the initial response phase of the pandemic we rapidly convened key clinical leaders, who developed clinical consensus across cancer services to drive well-informed, safe and decisive actions.

Our National Cancer Treatment Response Group (NCTRG) met and provided national advice for cancer patients before our national lockdown was announced. Within that same week new clinical guidance for cancer treatment, in the context of COVID-19, was disseminated and implemented across Scotland.

‘Once for Scotland’ collaboration and rapid decision-making has been characteristic in our response; it has allowed us to drive consistency across Scotland. This approach collectively agrees strategic national decisions or direction for aspects of cancer services that do not require regional or local variance (such as the NCTRG advice). Distinct local and regional approaches will also remain and be required for many aspects of cancer treatment and care.

Many such treatments, including radiotherapy and specialist surgery are delivered in highly specialised centres where expert teams can deliver the safest treatments with the best possible outcomes. This plan will promote equitable access across Scotland, ensuring each cancer patient has the same opportunity to receive the same high-level of treatment and care available, no matter where they may live.

Our NCTRG has now been superseded by a National Cancer Recovery Group (NCRG), which provides strategic oversight of the entire patient pathway across all cancer services and drives improvement of services through the ‘Once for Scotland’ approach.

Shielding

Many cancer patients were advised to shield as cancer was thought to put people at an increased risk of a severe outcome from COVID-19. The initial approach to shielding was based on the best evidence available at the time. We now know more about the negative impact shielding can have on people’s quality of life, and mental health and wellbeing. As new evidence emerges we continue to refine our definition of who is at the highest risk. We know that different things matter to different people, and the degree of actual and perceived risk varies between individuals.

Our aim is to enable people to make informed decisions about how to keep themselves and others safe by helping them understand the changing levels of infection in the community and how to reduce their risk, as well as providing access to support that can help them make informed choices about their lives.

Screening Programmes

With the NHS placed on emergency footing, elective care was paused thereby increasing potential capacity for cancer treatments. The national cancer screening programmes were also temporarily paused on 30 March, in order to reduce the risk of participants becoming infected with the virus, to enable physical distancing and minimise the impact on essential NHS services as they responded to COVID-19. The screening programmes have now all restarted, and we continue to monitor the impact fluctuating levels of COVID-19 may have on service delivery.

Detection and Diagnosis

Near the beginning of lockdown, referrals with an urgent suspicion of cancer (USC) dropped significantly to a low of 27% of pre-COVID levels. We delivered the ‘NHS is Open’ campaign encouraging people to continue to present to their GP practice or hospital should they have worrying or urgent symptoms. Overall, referrals have since returned to above normal anticipated levels.

The symptoms of lung cancer have similarities with those of COVID-19 and to ensure that clinicians are able to signpost people to the correct NHS services, new detailed guidance to health service professionals for managing similar symptoms was published in July 2020.

The pandemic has accelerated innovative service delivery and made better use of digital technologies. For example, the use of Near Me video consultations is now widespread across all Boards within Scotland. This allows patients to reach their clinical team from their own home, minimising their risk to COVID-19.

Treatments

With the NHS placed on emergency footing, elective care was paused thereby protecting potential capacity for cancer treatments. The majority of cancer treatments have continued throughout the pandemic but in some instances individual treatment plans- mainly surgeries- have been changed in the interest of patient safety and to minimise individual risk. This should always be done on a clinical basis and in discussion with the patient and clinical care team, through a shared-decision making model.

We have therefore published, and require compliance with, a surgical framework to ensure a standardised clinical prioritisation of cancer patients for surgery across Scotland. This means that patients are receiving the earliest available appointments. Additionally, we purchased added capacity from the independent sector in order to continue to deliver cancer surgery safely.

Our National Cancer Medicines Advisory Group (NCMAG) was rapidly convened and at the time of this publication has provided advice to offer 17 new treatment options for cancer patients. The introduction of these new interim cancer medicines allow for greater flexibility and ensure patients have additional treatment options throughout this pandemic.

Other innovations have reduced the need for patients to attend hospital thereby reducing their COVID-19 risks. New guidance on remote consent for Systemic Anti-Cancer Treatment (SACT), means safe prescribing can continue remotely. Community hubs have been used for pre-treatment blood tests. More Systemic Anti-Cancer Treatment has been delivered orally, and closer to home.

The redesign of cancer services over the previous few months has been undertaken at an accelerated speed in order to adapt to the new reality of health and social care and to ensure patients continue receiving the care and support they require. Many of these changes have a positive impact on people’s experience of cancer services. As we continue to move forward throughout and after this pandemic, we will ensure that the pace of change continues, that patients are involved in decisions about service changes and positive changes become embedded in our cancer services beyond the COVID-19 pandemic.