Cancer Action Plan for Scotland 2023-2026

Objectives

The Cancer Action Plan for Scotland 2023-2026 is the first three-year delivery plan for the Cancer Strategy for Scotland 2023-2033. It aims to improve cancer survival and deliver excellent, equitably accessible, compassionate and consistent care throughout the cancer journey, placing people with cancer, their families and carers at the centre.[1][2]The immediate priority is to recover and stabilise cancer services while maintaining cancer as a health-system priority.[3]

• Prevent cancers by reducing smoking, obesity, physical inactivity and alcohol-related risk, while improving diet and healthy weight.[3][2][4]
• Reduce alcohol-related cancer risk through minimum unit pricing subject to evaluation, possible restrictions on advertising and promotion, improved product labelling, and public awareness.[5]
• Prevent cervical cancer by introducing a one-dose human papillomavirus vaccination schedule, maintaining high coverage and pursuing World Health Organisation elimination targets while addressing inequalities.[5]
• Diagnose cancer earlier and faster by reducing stage III and IV diagnoses by 18 percentage points over 10 years, particularly in deprived communities.[5]
• Prioritise lung, brain, liver, oesophageal, pancreatic and stomach cancers because of their burden or poor survival, with initial focused action on lung, head and neck, and colorectal cancers.[2][5]
• Provide effective preparation, safe and realistic treatment, rehabilitation, follow-up, supportive care, palliative care and bereavement support as integral parts of cancer management.[1][6][7]
• Develop a sustainable, skilled and supported workforce, alongside person-centred communication, shared decision-making, mental-health support, research, innovation, genomics and intelligence-led services.[2][7][8][9]
• Ensure that people can discuss treatment benefits, harms and the option of no treatment, consistent with Realistic Medicine and value-based healthcare.[2][8]

Implementation

Implementation combines national direction, regional networks and local delivery across the full cancer pathway, linked to wider recovery, workforce, digital health and care policies.[1][3]The Scottish Government oversees strategic direction, while the Scottish Cancer Strategic Board owns the strategy and action plans and reviews progress; individual actions are assigned nationally, regionally or locally as appropriate.[10]

• Continue the flagship actions of single points of contact, prehabilitation, Rapid Cancer Diagnostic Services and the Scottish Cancer Network.[3][2]
• Use the Scottish Cancer Network to develop national Clinical Management Pathways, host national networks and advance a Once for Scotland approach to improve consistency and use clinical time effectively.[11][12]
• Target Detect Cancer Earlier campaigns and screening improvement towards people in deprived communities, while modernising breast screening, preparing targeted lung screening for high-risk adults aged 55 to 74, and assessing cervical self-sampling.[5][13]
• Strengthen primary care, pharmacy and community-based earlier detection through updated referral guidance, decision-support tools, clinician education, improved imaging access and targeted support for people facing multiple inequalities.[5][13]
• Expand diagnostic capacity through evaluation of Rapid Cancer Diagnostic Services, endoscopy, urology and lung diagnostic plans, optimal pathways for head and neck and colorectal cancers, workforce investment and digital pathology.[13]
• Accelerate proven innovation through the Accelerated National Innovation Adoption collaborative, including artificial intelligence-assisted chest X-ray reading, and work with third-sector organisations to spread effective interventions equitably.[14]
• Deliver universal prehabilitation through Maggie’s centres and other providers, supported by holistic needs assessment, shared decision-making, information and appropriate follow-up.[14]
• Coordinate genomic medicine through the Scottish Strategic Network for Genomic Medicine, a Genomics Strategy and Implementation Plan, updated test directories and planned molecular tumour boards.[11]
• Improve treatment through robotic-assisted surgery, the National Radiotherapy Plan, continued stereotactic ablative radiotherapy expansion, systemic anti-cancer therapy capacity, Acute Oncology services and a national electronic chemotherapy prescribing system.[11][6]
• Establish rehabilitation governance and local leadership, integrate physical, psychological, social and spiritual support, and standardise evidence-based recurrence follow-up that reflects patient preferences.[7]
• Expand workforce capacity through endoscopy training, additional undergraduate medical places, widening-access places, reporting radiographer posts and oncology training posts, alongside staff wellbeing and flexible employment measures.[8]
• Launch a national Improving the Cancer Journey service so that everyone diagnosed with cancer can access a key support worker, supported by care planning, treatment summaries, single points of contact and collaboration across acute, community, social-care and third-sector services.[15]
• Improve equity of access to clinical trials through a delivery group addressing 51 recommendations, while supporting Experimental Cancer Medicine Centres and the NHS Research Scotland Cancer Research Network.[16][9]
• Strengthen intelligence through the Scottish Cancer Registry Intelligence System, the Cancer Intelligence Platform, linked datasets, patient-reported measures, Quality Performance Indicators and a cancer data roadmap.[9][10]
• Apply a Monitoring and Evaluation Framework to each three-year action plan, focusing initially on achievable outputs and outcomes, process learning, routine data, waiting times and shared learning with NHS Boards and stakeholders.[12]

Monitoring & Evaluation

Monitoring and evaluation combine a national framework for each three-year action plan with routine service data, quality indicators, patient feedback, intelligence systems and targeted evaluations. The first action plan will focus on outputs and outcomes achievable within three years while cancer systems and services are stabilised.[12]

• Develop a Monitoring and Evaluation Framework for each action plan, guided by the Cancer Strategy for Scotland 2023-2033.[12]
• Assess short-term outcomes and implementation learning through process evaluation, using data indicators and evaluation questions addressing delivery processes and outcomes.[12]
• Use routine data where possible to minimise reporting burden, continue monitoring measures such as waiting times, and link national monitoring to existing NHS Board activity.[12]
• Publish more timely staging data, emergency-presentation diagnoses and validated urgent suspicion of cancer referral data through Public Health Scotland.[14]
• Strengthen analysis of survival, outcomes, demographics and inequalities, alongside improved primary-care and diagnostic datasets and data on routes to diagnosis.[2][14][10]
• Measure and act on patient-reported experience and outcome measures through Care Opinion, the Scottish Cancer Patient Experience Survey and a developing person-centred measurement framework.[2][15][9]
• Apply agreed priority Quality Performance Indicators through the Cancer Quality Programme, and use audits and benchmarking to improve rehabilitation and cancer-service quality.[6][7][9]
• Evaluate Detect Cancer Earlier campaigns independently against Key Performance Indicators, review the earlier-diagnosis framework for the next action plan, and strengthen screening reporting, monitoring and analysis.[5][13]
• Test direct or rapid access to the urgent suspicion of cancer pathway, assess prehabilitation outcomes, and undertake clinically led reviews of waiting-time standards and associated breach-analysis arrangements.[14]
• Assess psychological-care demand and capacity through national benchmarking, linking future options to the Psychological Therapies Matrix, national specification, data and performance indicators.[16]
• Expand the Scottish Cancer Registry Intelligence System and Cancer Intelligence Platform with relevant registry, radiotherapy, systemic anti-cancer therapy and Quality Performance Indicator audit data to support surveillance, audit, research, planning and quality improvement.[9][10]
• Review progress through the Scottish Cancer Strategic Board, which owns the strategy and action plans, while the Scottish Government provides strategic oversight and direction.[10]

Progress reporting will build on the National Cancer Plan: Progress Report 2022, which found good progress on the four flagship actions, progress on most other actions, some COVID-19-related delays and several completed actions.[3][2]The material does not specify a single consolidated indicator set, fixed reporting timetable or complete methodology beyond the frameworks, indicators, audits, evaluations and governance mechanisms described.[5][13][6][7][15]

Costing & Financing

Financing combines targeted commitments for service recovery, treatment capacity, radiotherapy, clinical networks and cancer intelligence, but no total implementation budget, financing model, funding-gap assessment or wider economic assumptions are specified.[14][11][6][7][16][9]

• Commit up to £30 million for cancer waiting-time improvements and pathways for less survivable cancers.[14]
• Provide up to £80,000 to sustain universal prehabilitation through Maggie’s centres.[14]
• Invest up to £5 million in the Scottish Cancer Network, National Managed Clinical Networks and the Managed Service Network for Children and Young Adults.[11]
• Invest up to £2.8 million in continued roll-out of stereotactic ablative radiotherapy.[11][6]
• Allocate up to £67.4 million over three years for the capital radiotherapy replacement programme.[6]
• Provide up to £10 million annually in additional funding for systemic anti-cancer therapy and Acute Oncology services.[6]
• Invest up to £690,000 to continue the National Cancer Medicines Advisory Group’s work.[6]
• Provide up to £800,000 in regional investment to strengthen national cancer intelligence systems.[9]
• Invest up to £3 million in the Scottish Cancer Registry Intelligence System to strengthen the registry and enhance the Cancer Intelligence Platform.[9][10]
• Match Cancer Research UK funding for the Scottish Experimental Cancer Medicine Centres during 2023-28, although no monetary amount is given.[16][9]

Further actions refer to investment or resourcing for lung cancer, diagnostics, workforce development, psychological support, single points of contact, research and innovation, but their allocations and funding sources are not specified.[4][13][8][15]The source also does not quantify the costs or funding arrangements for prevention, screening, innovation adoption, minimum unit pricing, or most remaining service-delivery actions.[5][13]