How is the Scottish cancer strategy faring one year after launch?
The government promised ‘world class’ cancer services – but the view from nurses suggests there is still a way to go before we reach the promised land.
The government promised ‘world class’ cancer services – but the view from nurses suggests there is still a way to go before we reach the promised land
One year ago, ministers in Scotland unveiled a cancer strategy, which they said should create ‘world class’ cancer services. The five-year plan, Beating Cancer: Ambition and Action, was accompanied by a promise of £100 million of investment in equipment, treatment and staff. So how is it working out?
Clearly it is early days, but Royal College of Nursing cancer and breast care forum chair Susanne Cruickshank does not get the impression ‘anything radical is happening at the moment’.
being invested in cancer services over the next five years under the strategy
She compares it to the strategy in England, which was launched in the summer of 2015 and has led to the creation of ‘vanguards’ to pioneer new ways of working.
‘Here it doesn’t seem to have the impetus,’ says Dr Cruickshank, who is based at the University of Stirling. ‘It’s still a work in progress.’
The Scottish Government says this is understandable given much of the focus in the first 12 months has been on management rather than on the front line.
It says the taskforce, which is leading the implementation of the strategy, has been working with health boards to develop an ‘outcomes-focused programme management action plan’.
But tangible changes are about to be introduced, it maintains.
increase in cancer diagnoses seen a year in Scotland over the past decade
The Improving the Cancer Journey model pioneered by Macmillan Cancer Support in Glasgow is expected to be launched in other areas later this year. The approach uses link workers to provide emotional, financial and practical support to cancer patients alongside their medical care. This was a major priority in the strategy, which set aside £9 million to help make it happen.
Progress on screening is also happening – although some of this was set in train before the strategy under Scotland’s Detect Cancer Early Programme, which has been running since 2012.
Bowel screening programme
A new faecal immunochemical test (FIT) is expected to be introduced into the bowel screening programme by the end of the year. It is considered more user-friendly than the current test, which relies on multiple samples rather than the one needed with FIT. The government says this should increase participation, particularly in deprived areas – another key priority in the strategy.
A bowel scope study has also been undertaken within three boards in Scotland to determine if offering flexible sigmoidoscopy will be beneficial. The results are being analysed.
But progress appears to have been slower in other areas. By far the biggest chunk of investment set aside for cancer is going on radiotherapy. Half the £100 million is due to be spent on upgrading equipment and to support radiotherapy training and recruitment.
the number of cancer diagnoses a year predicted by 2027 – a rise of 25%
The investment has started being made but, as yet, there has been no major overhaul of services. The Scottish Government says ‘procurement is complex’ and it expects to provide more information about progress soon.
There was also investment planned in treatment, to speed up referrals through the system and, in the long term, improve waiting time performance – the 62-day target for treatment to start following an urgent referral is being missed.
And it is this aspect of the programme that worries Dr Cruickshank. ‘What the strategy doesn’t address is the workforce issues,’ she says.
‘If we are going to improve access to radiology and diagnose more patients at an earlier stage, that is going to have an impact on the numbers needing surgery and other treatments. But we have a real shortage and vacancies for cancer nurses in some areas,’ she adds.
People aged between
45 to 74
face risk of death from cancer if they are living in the most deprived areas – double compared to those in the least deprived areas
‘There are also some huge pressures that are not being picked up. You can find there are waits for chemotherapy, for example. Nurses are having to deal with that. It is difficult.’
In fact, problems getting access to nurses was one of the issues flagged up in Scotland’s first cancer patient experience survey, published last summer – three months after the strategy was released.
It revealed that nearly one in six patients did not have access to a clinical nurse specialist, while less than one quarter reported having agreed care plans. NHS Tayside Macmillan cancer nurse consultant Cara Taylor says this illustrates the challenges that will have to be faced if the strategy is going to be a success.
‘We have some remote and rural areas that can make it difficult with the pressures we have in the workforce. We don’t have enough cancer nurses and we have a lot coming up to retirement age.
‘We need to ensure there is good education so we can develop the next generation of specialist nurses. The problem is that we are trying to do that and redesign services when there are limited resources. There is no slack in the system to help us.’
How Glasgow led the way
Glasgow has been providing financial, emotional and practical support to cancer patients since 2014.
Under the city’s Improving the Cancer Journey (ICJ) project patients are given a link worker as soon as they are diagnosed to carry out a holistic needs assessment, draw up a care plan and coordinate the support they need, whether that is from the NHS, council or third sector.
More than 2,000 patients have been helped so far, with an average of six concerns raised by each. The main concerns have been money, housing, tiredness and mobility.
The project – a partnership between Macmillan Cancer Support, the NHS and local government – was recently evaluated by Edinburgh Napier University.
Researchers found of the 1,300 cases analysed, 81% reported the support improved their quality of life, 90% said their concerns were reduced and 93% said it had lowered their feelings of isolation.
It seemed particularly effective at tackling inequalities with 61% of people supported from the most deprived areas.
The researchers found the link workers had helped patients access £1.7 million of financial support. ICJ head Sandra McDermott says it has transformed the lives of those it has helped and is a model of care that should be available to everyone.
The rest of the UK
Scotland is not the only part of the UK forging ahead with new plans for cancer services.
England launched its own five-year cancer strategy in July 2015, which highlighted early diagnosis, investment in equipment and improving services post-treatment as priorities.
Since then an implementation plan has been published and cancer alliances created bringing together local leaders. Three sites are testing new approaches to cancer care under NHS England’s vanguard programme.
The Welsh Government published its new cancer delivery plan in November 2016. There was also a focus on early diagnosis and on lung cancer services as the nation has the worst survival rates out of the UK countries.
In Northern Ireland, the most recent cancer plan dates back to 2008. Campaigners have said a new one is long overdue.
- UK Lung Cancer Coalition (2016) 25 By 25: A ten-year strategy to improve lung cancer survival rates
- Wales Cancer Network (2016) Cancer Delivery Plan for Wales 2016-2020