We are delighted that Michael Matheson, Cabinet Secretary for NHS Recovery, Health and Social Care in Scotland has launched the new Scottish Cancer Strategy 2023 – 2033.
The strategy outlines 11 ambitions designed to reduce cancer risk, provide faster and earlier diagnosis, improve cancer treatment, make cancer care fit for the future and reduce the differences exacerbated by health inequalities.
Ambition is vital to drive change in cancer services. Services have been strained by increasing cancer diagnosis as the population ages and as the NHS resets itself following the trauma of the pandemic. Cancer is a health burden and a thus a health priority and the Scottish Government has marked this health priority by committing to a new standalone strategy, whilst NHS England has integrated cancer into the Long-Term Plan.
Underpinning the strategy are 3 three year action plan. The first has 137 actions to be implemented by June 2026. The range and scope of change reflects the need to accelerate diagnosis, to integrate our knowledge about types and sub-types of cancer which have targeted treatment and to innovate how we approach cancer care.
The scale of the challenge in lung cancer is clear, with 66% of people being diagnosed at stage 3 or 4 when the cancer has advanced and may be treatable but is unlikely to be curable. Lung cancer is identified as a priority and critical to transforming survival outcomes, being the largest contributor to cancer deaths.
The opportunity to improve early diagnosis by introducing targeted screening for those at highest risk, the recommendation by the National Screening Committee in September 2022, will need commitment and resource to develop the infrastructure and communicate the benefit to those who may have a pessimistic view on lung cancer. There is learning to be gained from the roll out of Lung Health Checks by NHS England, where 76% of those who had a lung cancer found were diagnosed at stage 1 and 2.Lorraine Dallas, Director of Prevention, Information & Support
Another key piece of action for the lung cancer community in Scotland is the implementation of an Optimum Pathway. Outlining how services can ensure testing, results and referral this “once for Scotland” model is designed to ensure patients, whether in Stornoway or Stirling, Glasgow or Galashiels have a clear and well organised route through diagnosis to treatment. We know from our Ask the Nurse service that those weeks and months of uncertainty take their toll on the wellbeing of families waiting news.
Whilst our understanding of types of lung cancer which have not been triggered by smoking grows, we welcome innovation on biopsy testing and genetic service integration. There is also still action required to drive down the risk created by tobacco smoking and nicotine addiction.
Evidence is growing that supporting people to keep well whilst preparing for, during and after treatment has benefits. So the commitment to improving access to prehabilitation health and wellbeing initiatives is a step forward. Mental health support services are an important focus. The role of the NHS and cancer charities in providing services that allow people to adapt and develop coping skills is highlighted. We hope this will foster more collaboration between the NHS and charities, including Roy Castle Lung Cancer Foundation, easing access to support for people affected by cancer.
The plan contains an explicit commitment to focusing improvements on the Less Survivable Cancers, brain, pancreas, liver, stomach, oesophagus, and lung. As part of the Less Survivable Cancer taskforce our work has been to highlight that these, sometimes more difficult to detect cancers cannot be left in the shadows. The improvements we see through initiatives such as the Single Point of Contact project and 12 Rapid Diagnostic Centres need to be applied to tumour types where awareness is lower, diagnosis later and outcomes poorer.
The importance of data and people are highlighted in the plan. Pandemic pressures have amplified the pre-existing stress on cancer workforce and this issue needs short term action and long term planning to build capacity and adapt to changing treatment pathways and impacts. Although people and data may seem the Ying and Yang in policy, they are closely aligned. Without people with the right skills, in the right location at the right time, the service is unreliable. With evidence that what those people are doing is in the right place at the right time the service has limited capacity to improve. We need both to run smooth and effective cancer services.
I heard a patient advocate talk about trying to manage cancer in a realistic way. She needed to focus on managing her way through health care, not trying to change cancer structures. Whilst the NHS can feel like too complicated a system and cancer services too fragile a resource to be disrupted, the need for ambition and innovation is shared by those affected by cancer, the charities working with them and the clinical, and other professionals who deliver cancer care. The contributions of all of us will lead to progress in Scotland in the decade ahead.