WIREDGOV

A new action plan to offer care and support to Scotland's cancer patients was unveiled yesterday.

'Better Cancer Care' outlines a comprehensive approach and builds on the significant improvements already achieved in delivering cancer services.

The plan highlights how cancer can be prevented, recommends action to encourage people with suspicious symptoms to seek medical advice early and includes more patients within cancer waiting times targets and introduces a new target.

It also details new action for supporting those living with and surviving cancer and involving them in the delivery and design of care.

The actions for change announced include:

• by 2011, all patients diagnosed with cancer, whatever the route of referral, will receive treatment within 31 days from the date of decision to treat
• the current 62 day urgent 'referral to treatment' target is to be extended to include patients who screen positive through one of the national screening programmes
• £500,000 is to be invested in supporting and extending Macmillan Cancer Support's network of benefits advice services and trialling an employability programme to support people with cancer to return to work where appropriate
• a new focus on 'survivorship' to help those tackling the disease to live with and beyond cancer
• increased investment in genetic services
• a focus on ensuring that patients have access to the most up to date treatments and technology. For example, "two view" breast screening will be introduced across Scotland by April 2010

Unveiling the plan at the Beatson West of Scotland Cancer Centre, Health Secretary Nicola Sturgeon said:

"Cancer will affect most of us at some stage in our lives, be it personally or through the impact it has on a family member, friend or colleague.

"I believe it is essential we ensure the right services are in place at the time when patients and their families need it most.

"The new measures announced today are deliberately designed to relieve the anxiety that accompanies a cancer diagnosis. This includes improved access to treatment through the new waiting times targets, our commitment to working with the voluntary sector to improve all aspects of cancer patients' care, for example funding to support the excellent work of Macmillan Cancer Support in relation to financial and benefits advice.

"For patients in the initial stages of a cancer diagnosis we must ensure action is taken at the earliest opportunity after diagnosis. All those patients screened must know that their access to treatment will be swift which is why we are extending Scotland's current urgent 'referral to treatment' target to screened positive patients.

"In addition, we are introducing a new target to ensure that by 2011 all patients - regardless of their referral route - start their treatment within 31 days of the decision to treat.

"With the advances in diagnosis, radiotherapy, surgery and chemotherapy, responses to treatment and, comprehensive screening programmes to identify cancers at earlier stages, many more people are living with cancer and it is increasingly being seen as a long term condition. With this comes a range of physical, social, emotional and often financial challenges. Scotland's new approach would be incomplete without a new focus on 'survivorship'.

"Our planning, our services and our outlook need to challenge cancer in a way which maximises the opportunities to enhance the lives of patients. Together with NHSScotland, the voluntary sector and other organisations, patients and their representatives, we are determined to meet these challenges together."

The plan draws on research data, the experience of patients and organisations, includes examples of good practice from across Scotland and Scottish Government-led initiatives and policies to give a comprehensive overview of the scale of the challenge and what needs to be addressed in order to reduce the incidence of cancer and the impact this has on the lives of people in Scotland.

Scotland's Chief Medical Officer, Dr Harry Burns said:

"While treatment is getting better, it is really important that we all do what we can to reduce the need for treatment. There's a lot we can do to prevent Cancer through stopping smoking, reducing alcohol consumption, eating healthily and taking more exercise.

"The measures in this new action plan will help to deliver real improvements for those diagnosed with Cancer but I am in no doubt that each and every one of us can take action ourselves to prevent putting ourselves at greater risk."

A new Scottish Cancer Taskforce, chaired by the Deputy Chief Medical Officer Aileen Keel CBE, will oversee implementation of the action plan and drive development and change.

St John Hattersley, Chair of the Scottish Cancer Coalition, said:

"The Scottish Cancer Coalition welcomes the renewed national focus on cancer this action plan provides. We are particularly pleased to see the Government's commitment to working in partnership with the voluntary sector, as well as with patients, their families and carers, to improve cancer services throughout Scotland."

The plan has been shaped by what the Scottish Government heard from respondents to the discussion document for a plan, roadshow events across Scotland and the Better Cancer Care conference.

Key recommendations include:

On prevention

• Continue to implement a wide-ranging and ambitious programme of action to reduce smoking levels in Scotland
• Consider the findings of the national consultation on alcohol and publish an action plan for Scotland on tackling alcohol misuse
• Support NHS Boards to implement the recommendations of Equally Well, the report from the Ministerial Taskforce on Tackling Health Inequalities
• Consider the potential ways in which community pharmacies can reduce inequalities on health, for example, by targeting services to address the health disadvantages of those groups of people living in the most deprived areas
• Improve public awareness about the risks of exposure to the sun through continuing support of awareness raising campaigns and the implementation of controls on the use of sunbeds

On the Early Detection of Cancer

• Provide advice through the National Advisory Group to NHS Boards on further national, regional and local actions that can be taken to increase the uptake of cervical screening services, particularly amongst younger women
• Fund a pilot for the test of care treatment pathway to determine how this programme may be integrated with the Scottish Cervical Screening Programme in both a clinically and cost effective way
• Ensure that the Bowel Screening Programme is rolled out across Scotland by the end of 2009
• Implement two views at each screening round by April 2010. There may need to be redesign of roles and services to achieve this
• Work with the Chief Scientist Office to examine opportunities to support Scottish researchers participating in lung cancer research trials

On Genetics

• Invest in more genetic consultants, genetic counsellors, laboratory staff and appropriate psychological support to strengthen Cancer Genetic Services and meet recommendations made in the 'Calman Review' of Genetics
• Convene a short-life working group to advise the Scottish Government on the feasibility of national collection of tissue and consider, in conjunction with patients and other key stakeholders, the issues surrounding consent, storage, and access
• Support the development of a public engagement network to raise awareness and understanding of the potential benefits of genetic services

On referral and diagnosis

• Work with the Scottish Primary Care Cancer Group NHS Health Scotland, health promotion teams, voluntary groups, patients and others to assess how to improve public awareness of common cancer symptoms to encourage patients to present early
• Establish systems in secondary and tertiary care services to triage all referrals (whether received electronically or by other means) in a timely manner, and support triage teams to establish arrangements that ensure appointments are sent for patients to attend directly for investigations or for specialist consultation, as appropriate
• Continue nationally devised and locally drive enhanced services for cancer care in primary care. These should support improvements in direct cancer care and in cancer services development

On Treatment

• Review chemotherapy safety and quality standards in 2011 and keep a watching brief in any new issues that may arise before then
• Encourage engagement and involvement in experimental cancer medicine to facilitate the evaluation and introduction of new cancer medicines for patients
• Provide a national forum for Scotland's five radiotherapy centres to enable a co-ordinated approach to contingency planning, workforce planning and horizon scanning

On Living with Cancer

• Under the direction of the Scottish Cancer Taskforce, establish a working group on Survivorship to maintain the national focus on this issue and identify requirements for further research
• Implement guidance on short breaks for carers
• Work with Macmillan Cancer Support for develop the work of benefits advisors throughout Scotland, including new funding to extend services in new ways to remote and rural communities
• Work with Macmillan Cancer Support to develop a pilot employability project to support people with cancer to enter and sustain employment in environments which reflect their needs

On Improving Quality of Care

• Extend the 62-day urgent referral to treatment target to include screened positive patients and all patients referred urgently with a suspicion of cancer and introduce a new 31-day target for all patients diagnosed with cancer (whatever their route of referral) from decision to treat to treatment (to be delivered by 2011)

On Delivery

• Form a new Scottish Cancer Taskforce to replace the existing Scottish Cancer Group
• Bring together the RCAGs, voluntary sector, NES, Directors of Workforce Planning and other stakeholders to look at the needs and challenges of the current and future workforce to support cancer care in Scotland. The Taskforce will take forward a work plan to meet those demands.

Projections show that the number of patients diagnosed with cancer is likely to rise to nearly 35,000 per annum between 2016 and 2020. This compares with about 30,000 patients per year between 2006 and 2010 which reflects the impact of Scotland's ageing population as well as improvements in diagnosis and treatment. More people will be living longer after their cancer diagnosis.

Over 15,000 people died of cancer in Scotland in 2007. Lung cancer accounted for the largest number of deaths in both sexes, (29 per cent of in men, 25 per cent of in women). Large bowel, breast and prostate cancer were the other major causes of cancer deaths. In the last decade overall cancer mortality rates have decreased by 12 per cent in men and 5 per cent in women.

October is Breast Cancer Awareness Month and November is Global Lung Cancer Awareness Month.

2008 is the twentieth anniversary year of breast screening in Scotland. Women aged 50-70 are invited for breast screening every three years by their GP practice. Screening can also be requested by women over 70. In 2006/07 over 166,000 women of all ages were screened in the programme. Over 8,400 women were recalled for further investigations, leading to a diagnosis of 1,395 cases of cancer.

The Scottish Cancer Coalition is a partnership of organisations dedicated to improving cancer services and outcomes for patients in Scotland, and promoting research and prevention efforts.

Related Links

http://www.scotland.gov.uk/Publications/2008/10/24140351/0

http://www.scotland.gov.uk/Topics/Health/health/cancer

http://www.macmillan.org.uk/