Cancer Action Plan for Scotland 2023-2026

Objectives

The Cancer Strategy for Scotland 2023–2033 sets a 10-year vision to prevent more cancers, improve survival and ensure compassionate, consistent, excellent and equitably accessible treatment and support throughout the cancer journey. It places people living with cancer, their families and carers at the centre, with reducing inequalities in access and outcomes as a central aim.[1][2]The first action plan, covering 2023–2026, prioritises recovery, stabilisation and redesign of cancer services following COVID-19 pressures while sustaining cancer as a national priority.[3]

• Prevent cancer by reducing smoking, obesity, alcohol-related harm and physical inactivity, and by progressing towards elimination of cervical cancer through human papillomavirus vaccination and equitable screening.[4][5]
• Improve earlier and faster diagnosis by reducing later-stage disease, with an ambition to reduce stage III and IV diagnoses by 18 percentage points over 10 years, initially focusing on lung, head and neck, and colorectal cancers while improving pathways for all cancer types.[5]
• Prioritise lung cancer and other less-survivable cancers, including brain, liver, oesophageal, pancreatic and stomach cancers, recognising lung cancer as Scotland’s largest cause of cancer mortality.[4]
• Optimise screening, diagnostics, prehabilitation and holistic needs assessment so that each person diagnosed with cancer receives timely, effective and individualised preparation for treatment.[6][7]
• Provide safe, realistic and effective surgery, radiotherapy and systemic anti-cancer therapy, with equitable access to the best available curative treatment, innovative technologies and genomic medicine.[8]
• Strengthen post-treatment rehabilitation, recurrence detection, follow-up, supportive care, palliative care, end-of-life care and bereavement support, tailored to cancer type, individual needs and preferences.[9][10]
• Develop a sustainable, skilled and valued workforce, and deliver person-centred care through shared decision making, accessible information, care plans, treatment summaries and single points of contact.[10][11]
• Integrate mental health and psychological support into basic cancer care, match interventions to individual need, and address inequalities in access to wellbeing services.[12][13]
• Embed research, clinical trials, precision oncology, digital innovation and comprehensive cancer intelligence within treatment, care, prevention and service improvement.[13][14][15]

Implementation

Delivery uses three-year action plans spanning prevention, diagnosis, treatment, recovery, research, workforce development and data, aligned with wider National Health Service recovery, workforce, digital health and care, and service-redesign programmes.[3]The Scottish Government provides strategic direction; the Scottish Cancer Strategic Board owns the strategy and action plans and reviews progress; and responsibility for individual actions sits at national, regional or local level as appropriate.[16]

• Coordinate clinical delivery through the Scottish Cancer Network, which will develop national Clinical Management Pathways, host national networks and support Once for Scotland working, alongside Regional Cancer Networks, cancer centres, National Managed Clinical Networks and other National Health Service partners.[8][16]
• Continue four flagship actions: single points of contact, prehabilitation, Rapid Cancer Diagnostic Services and the Scottish Cancer Network.[3][2]
• Modernise screening and diagnostics by commissioning targeted lung cancer screening for high-risk adults aged 55 to 74, advancing the Equity in Screening Strategy, expanding Rapid Cancer Diagnostic Services and diagnostic hubs, improving primary-care access to imaging, and investing in workforce capacity and digital pathology.[6]
• Implement prevention measures through tobacco control, healthier food and weight policies, the Active Scotland Outcomes Framework, alcohol-harm measures, vaccination, public awareness campaigns and strengthened primary-care referral and decision support.[4][5]
• Develop genomic medicine through the Scottish Strategic Network for Genomic Medicine, updated test directories, standardised testing and treatment pathways, expanded testing and molecular tumour boards linking National Health Service, academic and industry expertise.[7][8]
• Strengthen treatment capacity by delivering the National Radiotherapy Plan, capital equipment replacement, stereotactic ablative body radiotherapy rollout, robotic-assisted surgery development, Acute Oncology services and electronic chemotherapy prescribing.[8][9]Up to £67.4 million is provided for capital radiotherapy replacement over three years, up to £10 million per annum for systemic anti-cancer therapy and Acute Oncology services, and up to £2.8 million for stereotactic ablative body radiotherapy rollout.[8][9]
• Deliver rehabilitation and person-centred support through national and local rehabilitation leadership, Improving the Cancer Journey with Macmillan Cancer Support, 12 pilot single point of contact sites, psychosocial support, holistic needs assessment and shared decision making.[9][11][12]
• Work with third-sector organisations, the Scottish Cancer Coalition, Maggie’s, Macmillan Cancer Support, Public Health Scotland, NHS Education Scotland, academia, industry, professional bodies, trade unions and research networks to improve access, experience, innovation and workforce capacity.[1][6][10][12]
• Expand research and innovation by establishing a delivery group to prioritise 51 recommendations on equitable cancer clinical-trial access, supporting Experimental Cancer Medicine Centres and the NHS Research Scotland Cancer Research Network, and strengthening research-to-practice pipelines.[13][14]
• Build interoperable data systems through a cancer data roadmap, improved registry and clinical datasets, cross-boundary systems, standardised genomic outputs, patient-reported measures and trusted research environments. Up to £800,000 supports regional cancer intelligence and software interoperability, while up to £3 million supports the Scottish Cancer Registry Intelligence System.[15]
• Monitor implementation through a Monitoring and Evaluation Framework for each action plan, proportionate use of routine data, short-term output and outcome measures, cancer waiting-time monitoring, local evaluation evidence and learning-system methods.[16]Patient-reported experience and outcome measures, Care Opinion, the Scottish Cancer Patient Experience Survey, Quality Performance Indicators, rehabilitation self-assessment and the Cancer Medicines Outcomes Programme contribute to quality improvement and evaluation.[2][9][12][14]

Monitoring & Evaluation

Monitoring and evaluation will be governed through a framework for each three-year action plan, aligned with the Cancer Strategy for Scotland 2023–2033. The first plan emphasises outputs and outcomes achievable during its initial three years while cancer systems and services are stabilised.[16]

• Measure short-term outcomes, implementation processes and activity outcomes through indicators and core evaluation questions, using routine data where possible to minimise reporting burden.[16]
• Review strategic progress through Scottish Government oversight and Scottish Cancer Strategic Board ownership of the strategy and action plans; assign responsibility for individual actions at national, regional or local level as appropriate.[16]
• Monitor cancer waiting times, system performance and variation, and use Healthcare Improvement Scotland’s learning-systems approach to identify effective practice and share learning.[16]
• Connect national monitoring with National Health Service Board evaluations and capture transferable evidence from local programmes and projects.[16]
• Use incidence, stage at diagnosis, deprivation, survival, COVID-19 effects and pathway pressures to set action-plan priorities, with an evidence-framework review planned for the next action plan.[5]
• Evaluate Detect Cancer Earlier campaigns continuously and independently against key performance indicators, using findings to improve campaign materials and symptom awareness.[5]
• Publish more timely staging data, emergency-presentation diagnoses and validated urgent suspicion of cancer referral data through Public Health Scotland; improve primary-care, diagnostic and pathway datasets, including data for blood and neurological cancers.[6][7]
• Monitor implementation of optimal diagnostic pathways for head and neck and colorectal cancers, and test prehabilitation approaches while evidencing their outcomes.[6][7]
• Apply multidisciplinary governance to targeted lung screening, clinically review waiting-time evidence and standards, and use the Once for Scotland Cancer Regrading Framework and Effective Breach Analysis procedure for performance improvement.[6][7]
• Monitor treatment quality through agreed Quality Performance Indicators within the Cancer Quality Programme, and assess rehabilitation through service self-assessment and benchmarking against the Six Principles of Good Rehabilitation.[9]
• Assess cancer medicines through the Cancer Medicines Outcomes Programme, generating evidence on effectiveness, safety, value, benefits and harms for the Scottish Medicines Consortium and National Cancer Medicines Advisory Group.[9]
• Measure person-centred care through the Scottish Cancer Patient Experience Survey, Care Opinion, patient-reported experience measures and patient-reported outcome measures; develop and test a continuous person-centred measurement framework.[2][12][14]
• Complete workforce modelling and reviews to inform recruitment, training and allocation, and evaluate the single point of contact programme before expansion.[10][11]
• Benchmark psychological-care demand and capacity nationally, then develop an improvement action plan and options paper linked to performance indicators.[13]
• Use integrated cancer intelligence for clinical management, surveillance, audit, quality improvement, research, policy development and prevention.[14][15]

The extracts do not specify a single consolidated indicator set, reporting timetable, evaluation design or formal accountability process covering every action; the framework combines strategy-level oversight with topic-specific quality, survey, audit and evaluation mechanisms.[9][10][16]

Costing & Financing

Financing is framed as financially prudent delivery during a period of substantial and increasing pressure on health services from population ageing, improving survival, more people living with cancer, and growing test and treatment volumes.[1][3]The supplied extracts identify targeted investments but do not provide a consolidated programme budget, annual expenditure profile, funding-gap assessment, financing plan or economic assumptions.[8][9][15]

• Allocate up to £30 million to improve cancer waiting times.[7]
• Provide up to £80,000 for the future sustainability of universal prehabilitation through Maggie’s centres by March 2026.[7]
• Invest up to £5 million in the Scottish Cancer Network, National Managed Clinical Networks and the Managed Service Network for Children and Young Adults by March 2026.[8]
• Allocate up to £2.8 million for continued rollout of stereotactic ablative body radiotherapy by March 2026 and up to £67.4 million for the capital radiotherapy replacement programme over three years.[8]
• Provide up to £10 million annually in additional funding for systemic anti-cancer therapy and Acute Oncology services, and up to £690,000 to continue the National Cancer Medicines Advisory Group’s work by March 2026.[9]
• Provide up to £800,000 in regional investment for national cancer intelligence systems and interoperable clinical software by March 2026.[15]
• Invest up to £3 million in the Scottish Cancer Registry Intelligence System to expand the Scottish Cancer Registry and Cancer Intelligence Platform datasets.[15]
• Continue investment in 12 single point of contact pilot sites, additional local psychological support, cancer research infrastructure and matched Cancer Research UK funding for Scottish Experimental Cancer Medicine Centres during 2023–2028; the extracts do not quantify these amounts.[11][12][14]

Further resource needs are identified for screening, diagnostics, workforce capacity, genomic medicine, digital systems, research, innovation, radiotherapy, cancer medicines and clinical networks, but quantified allocations are not supplied for most of these areas.[6][8][9]