Scottish Cancer Patient Experience Survey 2018: national report

3. Context

There have been wide reaching programmes of reform to health services in recent years, which are consistent with the wider principles of Public Service Reform^[2]. This chapter provides an overview of the key developments.

This survey supports and informs all of these developments, by describing their impact from a user perspective. It is worth noting that this survey includes experiences of cancer care from over a two year period, with some respondents receiving their cancer diagnosis in July 2016. This means that some experiences being reported may have taken place when some of these programmes were at the early stages of implementation.

The 2020 Vision

In 2011, the Scottish Government set out a 2020 Vision^[3] for achieving sustainable quality in the delivery of healthcare services across Scotland, in the face of the significant challenges of Scotland’s public health record, our changing population and the economic environment. All healthcare policy in Scotland drives the delivery of this Vision, which states:

By 2020 everyone is able to live longer, healthier lives at home or in a homely setting, and that we will have a healthcare system where:

• We have integrated health and social care;
• There is a focus on prevention, forward planning and supported
  self-management;
• Where hospital treatment is required, and cannot be provided in a
  community setting, day case treatment will be the norm;
• Whatever the setting, care will be provided to the highest
  standards of quality and safety, with the person at the centre of all
  decisions;
• There will be a focus on ensuring that people get back into their
  home or community environment as soon as appropriate, with
  minimal risk of re-admission.

The Vision will be delivered according to three Quality Ambitions^[4]:

• Safe: There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times.
• Person-centred: Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making.
• Effective: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

A National Clinical Strategy for Scotland^[5], published by the Scottish Government in February 2016, reinforced the importance of these ambitions and called for a new clinical paradigm that incorporated person-centred approaches to care.

Scotland’s Chief Medical Officer has also articulated her vision for delivering care in this context through her Annual Reports ‘Realistic Medicine’ ^[6], ‘Realising Realistic Medicine’ ^[7] and ‘Practicing Realistic Medicine’ ^[8]. She said:

"You should expect the doctor (or other health professional) to explore and understand what matters to you personally and what your goals are, to explain to you the possible treatments or interventions available with a realistic explanation of their potential benefits and risks for you as an individual, and to discuss the option and implications of doing nothing. You should expect to be given enough information and time to make up your mind. You should consider carefully the value to you of anything that is being proposed whether it be a treatment, consultation or diagnostic investigation and be prepared to offer challenge if you feel it appropriate."

Recent Changes to Cancer Care Policy

The Scottish Government published Beating Cancer: Ambition and Action ^[9], a new cancer strategy, in March 2016. It sets out the Scottish Government’s ambitions on improving cancer services across Scotland.

The strategy outlines more than 50 actions to be taken forward, with actions to reduce health inequalities and to provide person-centred care being central to its delivery. It also specifically recognises that understanding individual’s experiences of cancer care is vital to help make improvements in cancer care services and directly supports the continuation of the SCPES as a vital source of data on this area.