Healthcare Policy and Strategy Directorate, Healthcare Planning


Scottish Government                        Member
Jennifer Armstrong (JA) (Chair)            Audrey Birt (AB)
Rachael Dunk (RD)                          David Brewster (DB)
Sarah Grierson (SJG)                       John Davies (JD)
Gillian Knowles (GK)                       Peter Gent (PG)
Tracy McKen (TMcK)                         Peter King (PMK)
Louise Unwin (LU)                          Bill O’Neill (BON)
Jill Vickerman (JV)                        Kate Price (KP)
                                           Alan Rodger (AR)
                                           Evelyn Thomson (ET)

In attendance
Hilary Dobson (HD), WoSCAN Lead Clinician for Breast Cancer Managed Clinical
Network (observing)
Maggie Grundy (MG) (deputising for Elinor Smith)
David Linden (DL) (deputising for Stephen Gallagher)


1.    Jennifer Armstrong chaired the meeting as Aileen Keel was unable to attend.

2.    Audrey Birt was welcomed as new Chair of the Scottish Cancer Coalition and
      the group noted thanks to Elspeth Atkinson who has stepped down. Hilary
      Dobson was welcomed as an observer. Louise Unwin was welcomed as a
      new member of the Cancer Strategies team.

3.    In addition to Aileen Keel, apologies were received from Mike Cornbleet, who
      has recently retired and stepped down as Chair of the Chemotherapy
      Advisory Group. Apologies had also been received from Robert Masterton,
      Elinor Smith, Stephen Gallagher, Richard Carey and Pamela Warrington.


4.    The minutes from the meeting on 9 July 2009 were agreed as accurate and
      will be posted on the Scottish Government website.
                                                                   Action: LU


5.    At the previous meeting, John Davies raised the issue of cancer out-patients
      being charged for dental care, this being a particular issue for patients with

      head and neck cancer. Paper SCT 09/46 set out clarification of charging
      arrangements from the Chief Dental Officer. It was agreed that the group
      would not seek further recourse to the Chief Dental Officer but Dr Davies
      would write to her directly in his capacity as Lead Clinician for SCAN; he
      agreed to inform the group of the outcome at a future meeting.
                                                                       Action: JD


6.    It was noted that the Better Cancer Care website is now live and minutes will
      be posted here once signed off by the group:

7.    There has been discussion at previous meetings regarding ways to improve
      communication of the SCT and subgroups work programmes to key
      stakeholders. Rachael Dunk presented paper SCT 09/47a which set out a
      proposal for a SCT newsletter which would enable the group to communicate
      key pieces of work to stakeholders. Kate Price was thanked for providing
      examples of SCAN newsletters (paper SCT 09/47b-d). Audrey Birt offered to
      send a copy of the Long Term Conditions Alliance e-newsletter as an example
      of a simple format.
                                                                       Action: AB

8.    The group agreed that a newsletter would be valuable and discussed the
      resources needed to produce it and whether it would be electronic or paper-
      based. An electronic version would be easier for recipients to disseminate to
      colleagues and networks. Jill Vickerman informed the group that the Scottish
      Government Communications Directorate is developing a communications
      strategy for the Quality Strategy and suggested that they may be able to offer
      the SCT advice. It was suggested that an annual report may be sufficient as
      regional cancer networks distribute their own updates throughout the year and
      minutes (or action notes) from the SCT and subgroups are available online.
      However, other members felt that there was a need to provide short updates
      to clinicians and patients/carers which would be widely disseminated. It was
      therefore agreed that the content of the newsletter would be submitted by
      members of the SCT (particularly chairs of subgroups) with the Cancer
      Strategies team coordinating.

9.    The first newsletter should be sent out in early 2010.

                                                    Action: Cancer Strategies team


10.   The draft NHSScotland Healthcare Quality Strategy is now available online: Comments and feedback may be submitted
      until 27 November 2009.

11.   Jill Vickerman provided an update on the strategy. Since the last SCT
      meeting (9 July 2009), the Healthcare Planning and Policy team have met
      with clinicians, policy colleagues and patients and carers to discuss the draft
      strategy, which was agreed in principle by the Cabinet Secretary for Health
      and Wellbeing on 12 October 2009. The document reflects a wide range of

12.   The strategy is intended to provide an overarching integrative context for
      future NHS policies to enable the development of a world leading health
      service. There are two dimensions to the approach: firstly, to inform the
      public and train staff in the new strategy, whilst ensuring a system-level
      commitment to support this, and secondly, to focus on three themes including
      person-centredness, safety and clinical effectiveness.

13.   Although not an official consultation, comments and feedback will be
      considered until early December 2009 and a series of events for NHS staff
      are planned for the next few weeks. The strategy will be formally launched in
      January 2010, as will the concurrent communications strategy. The group
      were invited to advise Jill Vickerman of any events or meetings where an item
      on the quality strategy would be appropriate.
                                                                        Action: All

14.   The group enquired about incentives and deterrents with regard to the
      implementation of the strategy. Mechanisms to focus activity as intended
      could include performance management, annual reviews, HEAT targets and
      Chief Executive/Cabinet Secretary discussions. There is no intention to
      consider financial incentives. Further consideration is required regarding
      incentives and feedback to Jill Vickerman was invited.

15.   The current economic context was discussed, as this inevitably impacts on
      boards’ ability to deliver services. There was some concern that this
      document would raise expectations amongst NHS staff and the general
      public. The group were assured that the goal of this strategy is to prioritise
      activities and work to develop sustainable services.

16.   Concerns were raised about the prioritisation of themes, particularly with
      regard to clinical excellence, and about the importance of ensuring a joined up
      approach. Identifying clinical excellence as the key deliverable would make
      difficult decisions more justifiable. Jill Vickerman assured the group that there
      is no prioritisation of themes and the goal of the strategy is to promote a
      joined up approach. The strategy aims to reduce variation in clinical

17.   Audrey Birt offered to set up a meeting with the Scottish Cancer Coalition and
      the Healthcare Planning and Policy team to discuss how to maximise the
      person-centred approach.
                                                                        Action: AB

18.   The group discussed the possibility of particular clinical services that may not
      fit with the new framework and it was agreed that further consideration of
      these would be needed.

19.   It was agreed that the Cancer Strategies team would collate a response on
      behalf of the SCT and members should send comments to Rachael Dunk by
      10 November 2009. Members can also submit individual responses directly if
      required, which can be done via the online link by 27 November 2009:
                                                                  Action: All/RD

      [Secretariat note: Jill Vickerman left the meeting at this point.]


20.   Rachael Dunk informed the group that the three cancer pilot programmes are
      ongoing. She had discussed the pilots with Carol Sinclair, Better Together
      Programme Manager, who had advised that early outcomes were anticipated
      for March 2010. As such, Carol Sinclair will be invited to attend a future
      meeting to provide an update.
                                                                       Action: RD

      [Secretariat note: Results from the Better Together Patient Experience
      Programme's inpatient importance survey are now available online:]


21.   Evelyn Thomson presented paper SCT 09/48, which sets out the current
      position regarding the use of TNM classification system across Scotland and a
      proposal for ensuring a coordinated approach to rolling out the new TNM 7
      system across Scotland following its publication in December. The proposal
      stated that a national clinical lead is identified in order to lead the
      implementation of TNM 7 consistently across tumour networks. The group
      agreed that this was a good idea in principle but acknowledged that it would
      be a complex process as some networks, for example breast cancer, use
      alternative, more comprehensive, classification systems. Comparative data
      would be more accessible and useful if networks used the same system. The
      TNM 7 classification presents an opportunity to ask networks what system
      they currently use and which system for each tumour type should be used
      across Scotland.

22.   It was agreed that John Davies would lead this project and discuss how to
      progress this with Evelyn Thomson and David Brewster. John Davies will be
      asked to provide feedback to the group at future meetings.
                                                                     Action: JD


      [Secretariat note: this issue was a late addition to the agenda]

23.   Jennifer Armstrong presented the PID for the development of a register of IPs,
      which NHS QIS have begun. This will include around 300 projects per year,
      starting in January/February 2010.

24.   In summary:
          NHS QIS will set up a register of new IPs from early 2010. This will
           record who is doing which IPs and where.

          Each month NHS QIS will send out details of new IPs to local Clinical
           Governance leads.

          The Clinical Governance leads in each NHS Board will be responsible for
           sending in details of any of these IPs being conducted in their board

          NHS QIS will follow up with boards that do not submit any returns.

          In the future, NHS QIS may develop the web-based register to record
           whether audit and training requirements are being met.


25.   Rachael Dunk presented paper SCT 09/49 which set out a number of
      commitments in Better Cancer Care which are still to be considered in detail
      by the group, particularly around awareness raising and early presentation of
      symptoms. She also noted that an updated SCT work plan would be an
      agenda item at the next meeting.
                                                 Action: Cancer Strategies team

26.   Professor John Frank, Director, Scottish Collaboration for Public Health
      Research and Policy, has been invited to speak at a future SCT meeting
      about the epidemiology of cancer in Scotland. Dr Paul Ballard, Deputy
      Director of Public Health, has also been asked to speak about his pioneering
      work in NHS Tayside around prevention and awareness raising, which
      focuses on reducing health inequalities.

27.   It was agreed that the SCT January meeting be used as a workshop-type
      event with a series of presentations/discussions on the awareness-raising
      work stream. Issues raised in the discussion included encouraging people
      with symptoms to seek early advice, raising awareness of how lifestyle factors
      (e.g. obesity) can increase risk of some cancers, inappropriate referrals, and
      the use of ‘teachable moments’ for example, following a negative result from
      one of the cancer screening programmes. The latter may be considered at a
      future date if time does not allow in January.

28.   Prevention will not be considered at the January workshop as there will be
      insufficient time to address such a major issue in addition to the
      aforementioned topics. In addition, the Scottish Government is already
      progressing healthy lifestyle initiatives on obesity, physical activity, alcohol
      and smoking. The aim of these programmes is to promote health and active
      living and reduce people’s chances of developing a range of illnesses,
      including cancer.

29.   It was agreed that the work shop should be opened up to a wider audience
      than solely SCT members and Rachael Dunk would consider a suitable venue
      and numbers for the January workshop. Each network would be advised of
      the number of spaces available.
                                                                   Action: RD


30.   Jennifer Armstrong presented paper SCT 09/50a, a letter to Dr Aileen Keel
      from John Glennie, Chair of the Breast and Cervical National Advisory Group,
      regarding their recommendations following consultation responses from
      Regional Cancer Networks and Chief Executives on the Screen Detected
      Impalpable Lesions paper (SCT 09/50c). The paper is guidance for Boards
      considering setting up a new unit, although it was noted that a proliferation of
      new units is not expected. Key points to note from the paper include:
          Current units are already achieving high standards which the National
           Advisory Group would wish to be maintained
          NHS Boards are accountable for breast screening services in their areas
          Quality Assurance Reference Centre (QARC) has a role in reviewing
           audit outcomes.

31.   It was asked if there is a mechanism to address situations in which a unit did
      not meet these standards. It was acknowledged that the QIS standards are
      goals to aim for; that all boards should be able to meet the essential standards
      and that if all boards were also achieving the desirable standards, these would
      be reviewed. An action plan is developed with the board if essential
      standards are not being met and this process has worked extremely well.

32.   It was noted that on the last line of page 2 of SCT 09/50a, the word
      ‘regulation’ should read ‘regular’.

33.   It was agreed that a letter from the SCT chair should be drafted and along
      with the guidance be distributed to NHS Boards. The guidance would be
      reviewed on a regular basis under the auspices of QARC.
                                                                      Action: AK


34.   Tracy McKen presented paper SCT 09/51a and gave an update on the cancer
      screening work streams. It was noted that Shetland has now rolled out bowel
      screening. A screening DVD has been developed for the Bowel Cancer
      Screening programme and has been distributed to NHS Boards on 12

35.   On behalf of the Scottish Cancer Coalition, Audrey Birt asked if there would
      be a review of the breast screening letter sent to women. It was noted that
      this is being considered, however the Department of Health are currently
      conducting some research and consulting women on this issue. They will
      then produce a new letter in early 2010, which the NAG in Scotland will then


36.   Jennifer Armstrong presented paper SCT 09/52 which outlined the
      development of this guideline. The guideline has been further amended by
      the Bowel Cancer Advisory Group following previous discussions with SCT.
      Audit Scotland produced a report in 2005 highlighting variability in diagnostics
      for patients with colorectal cancer symptoms and these guidelines are
      intended to streamline the investigation process in secondary care. The
      paper has been subject to extensive consultation and was signed off by the
      Bowel Cancer Advisory Group at its meeting on 9 October.

37.   It was asked if there is a SIGN guideline for colorectal cancer. It was noted
      that as one of the authors of these guidelines was a member of the group
      involved in developing the SIGN guideline it was likely this had been
      considered. Furthermore, these guidelines refer to large bowel pathology,
      not just colorectal cancer, and is intended to complement the Scottish Referral
      Guidelines for Suspected Cancer: Lower Gastrointestinal Cancer (HDL, 2007

      [Secretariat Note: The Cancer Strategies team have checked that the relevant
      SIGN guideline had been considered, which has been confirmed by the
      authors, and as such this will be added to the evidence]

38.   It was noted that the investigation guidelines would be very helpful,
      particularly in respect of smaller services, such as those in the North, where a
      higher than average percentage of the population receive endoscopies.

39.   Bill O’Neill questioned the role of the SCT in approving such guidelines. He
      also noted that in addition, there is a risk that since GPs cannot perform
      procto-sigmoidoscopies in primary care, there will be an increase in the
      number of referrals to secondary care. Jennifer Armstrong asked Rachael
      Dunk to raise this point with the authors.
                                                                       Action: RD

      [Secretariat Note: This issue has been discussed and wording amended in the

40.   There was further discussion about the SCT role in agreeing and sending out
      guidelines, as it is not the groups remit to send out all cancer related
      guidelines (i.e. NHS QIS standards or SIGN guidelines). However, it was
      noted that output of subgroups had in the past sent out guidance, for example
      PET clinical protocols, and therefore this was not setting a precedent. As the
      route for the impalpable lesions guideline was as a letter from the SCT chair
      to NHS Boards it was felt that a similar approach should be used here.
      Jennifer Armstrong offered to discuss this further with Aileen Keel.
                                                                           Action: JA

41.   It was agreed that it would be preferable for the guidelines to be sent to the
      Boards as they, not the networks, will have responsibility for implementation
      and monitoring. It was therefore agreed that the reference to networks having
      a monitoring role would be removed. The guideline will also be subject to
      Scottish Government Legal Directorate opinion before dissemination.

                                                                            Action: RD


42.   Peter King presented paper SCT 09/53a, which is an update on eHealth with
      specific reference to how it supports Better Cancer Care. He asked the group
      to endorse the ongoing work in the regions to make eCASE a fit for purpose
      tool to support the eHealth cancer agenda and an audit tool to help underpin
      the quality work stream.        Further progress can be made once the
      requirements for the Business Objects are clear.

43.   NoSCAN, WoSCAN and the hepato-biliary national tumour networks are
      already using e-CASE, although there have been a few issues, for example, in
      interfacing with SCI gateway. Kate Price reported that the generic clinical
      system is being used in the SCAN breast cancer service and that further roll
      out is under consideration. John Davies confirmed that SCAN is still to
      determine the most appropriate audit tool to use. It would be desirable for all
      regions to be capturing data in the same way. John and Kate agreed to
      update members on the outcome of SCANs decision for an audit tool,
      meanwhile Kate Price is a member of the e-CASE group thereby ensuring
      SCAN is aware of all relevant discussions.

44.   It was agreed that Peter King could report at the Scottish Government’s
      (eHealth) Clinical Change Leadership Group meeting in November that two
      regions are using eCASE and SCAN is considering options and consulting
      users. He should also highlight to this group any other cancer eHealth
      priorities and Peter Gent is currently liaising with the other networks to identify

45.   It was noted that there has been a significant reduction in the number of
      referrals for urgent suspected cancers in NoSCAN, following the introduction
      of the electronic SCI gateway system, although this reduction is attributed to
      the re-categorisation of ‘urgent referrals’ to ‘urgent with suspicion of cancer’. It
      was agreed that Peter Gent would discuss this further with Bill O’Neill and
      David Linden, as it may be a model that can be used elsewhere in Scotland.

                                                                   Action: PG/BON/DL

46.   It was suggested that appendix 1 in SCT paper 09/53a should include NSD
                                                                 Action: PMK


47.   Evelyn Thomson presented paper SCT 09/54 which is the National Cancer
      Quality Steering Group (NCQSG) workplan with amended leads and
      timescales. Key points to note are that it has been agreed to repeat the
      baseline audit review in two years time; that the development of national
      quality performance indicators will begin with kidney and prostate cancers in
      the first instance; and that the sequencing of the development of national
      Quality Performance Indicators (QPIs) for other tumour groups, including
      other urological malignancies, will be subject to wider discussion.

48.   A workshop is being planned for MCN clinical leads and other interested
      parties on 13 November 2009, in Edinburgh, to discuss and develop the wider
      quality work programme. The aim of this event is to:
           Develop a shared understanding of the vision for assuring quality cancer
            care in Scotland.
          Further develop and refine the proposed methodology for the
           development of national cancer QPIs.
          Agree the approach to be taken to determining the sequence for
           developing national QPIs for all cancers.
          Shape development of proposed national governance framework for
           assuring the quality of cancer care across NHS Scotland.


49.   David Linden presented paper SCT 09/55, which provided an update on work
      being undertaken around cancer access/waiting times, under the relevant
      commitments in Better Cancer Care.

50.   A workshop had been held on 7 October 2009 which brought together the
      screening programmes and the symptomatic services staff. A report of the
      event is currently being collated.

51.   The Cancer Access team are undertaking ‘readiness’ checks to ensure that
      Boards are prepared to implement the new targets. There are concerns about
      the number of referrals affected by the change in category from ‘urgent’ to
      ‘urgent with suspicion of cancer’ and so David will speak to Peter Gent.

                                                                           Action: DL/PG

      [Secretariat note: Audrey Birt left at this point in the meeting.]


52.   Alan Rodger gave an update on work being progressed by the Scottish
      Radiotherapy Advisory Group (SRAG). Membership of SRAG has been

53.   Information Services Division (ISD) has refined the ongoing demand and
      capacity modelling work with updated cancer incidence projections. This work
      will be presented to SCT in 2010. Further work during 2010 will assess the
      capacity requirements for Scotland.

54.   The Technical, Specification and Evaluation subgroup (TSE) is monitoring the
      replacement of equipment up to 2020 and is supporting the procurement
      process for the Boards.

55.   The Gynae Brachytherapy NoSCAN Review has concluded that a high-dose
      (HDR) machine will be installed in Aberdeen, with a pulsed-dose (PDR)
      machine in Dundee as a short-medium term solution for the North.
      Contingency plans are currently being updated, facilitated by SRAG.

56.   A national review of all brachytherapy services is now required for Scotland:
      SRAG is drawing up a remit and membership for a sub group to take this
      forward, with a view to reporting back to SCT in December 2009. Peter King
      noted that he would like to see the number of centres delivering
      brachytherapy services in Scotland being included in the scope of the review.


57.   Following his retirement Mike Cornbleet has stepped down as Chair of the
      group and John Davies had agreed to take over as Chair. The group wished
      to thank Mike for his contribution. A formal update on work being undertaken
      by the Chemotherapy Advisory Group will be presented to the SCT December


58.   The Short Life Working Group (SLWG) held its final meeting on 5 October
      2009. Jennifer Armstrong presented paper SCT 09/56 which included the
      output of the SLWG as Annex D - specifically Appendix 1 which is a proposed
      template for Boards to develop individual patient cancer treatment request
      panels for SMC and NHS QIS not recommended medicines. The Chief
      Executive Letter (CEL) consultation commenced on Friday 9 October and has
      been sent to various stakeholders.

59.   The SLWG does not intend to meet again and Bob Masterton was thanked in
      absentia for chairing.

60.   It should be noted that the draft CEL refers to the introduction and availability
      of new medicines in the NHS in Scotland and is not intended to be cancer
      specific. The CEL also includes in Annex C – how new cancer medicines
      might be introduced in a co-ordinated way at regional level.

61.   If SCT members wish to provide comments on the draft CEL they should do
      so by emailing Veronica Moffat ( before
      20 November 2009.
                                                                       Action: All

62.   Rachael Dunk advised members that Nicola Sturgeon, Cabinet Secretary for
      Health and Wellbeing, will appear before the Public Petitions Committee at the
      end of November 2009 to provide them with an update of the work undertaken
      to date.


63.   Bill O’Neill presented paper SCT 09/57, which is an executive summary of the
      successful Living with Cancer event that took place in Stirling on 20 August

64.   It was noted that a common criticism of patient and carer groups is that they
      do not represent an accurate demographic of cancer patients. The Living with
      Cancer group will profile the delegates who attended the Living with Cancer
      event, those who engage with the patient participation programmes in the
      three cancer networks and comparable programmes in the voluntary sector.

65.   The workplan for the Living with Cancer group will, along with the
      commitments in Better Cancer Care, be based around four themes which
      emerged as the key priorities from the event feedback. The themes are:
      information; psychological/emotional support; patient involvement in decision-
      making and family/carer/community support.

66.   The report will be circulated to attendees, the Living with Cancer reference
      group and published on the Better Cancer Care website.

                                                 Action: Cancer Strategies team

67.   The group were informed that the Children and Teenagers Scottish Cancer
      Network (CATSCAN) has been invited to the next Living with Cancer group
      meeting. It was suggested that the Living with Cancer group should also
      engage with the Teenage Cancer Trust.
                                                                 Action: BON


68.   John Davies updated members on the development of the National Tissue
      Bank workplan. The National Tissue Bank group met in early October 2009
      and is considering two main issues: how to obtain consent and the use of
      tissue for commercial use. The group will also work to establish a framework
      for a national tissue collection.

69.   In addition, the group is considering management of Biobank samples,
      starting with colorectal and renal cancers. Rare biopsy samples will also be

70.   The national tissue repository has been linked to electronic databases and
      national quality archive, and John Davies will be meeting David Brewster to
      discuss how it can also be linked with C-PORT and CEPAS. The group will
      use guidance from the Scottish Academic Health Sciences Collaboration to
      determine the method of governance and access to the National Tissue Bank.
      Costs of around £20,000 have been estimated for the quality assurance
      element, and peripheral costs, including those for pathology departments,
      have yet to be confirmed.


72.   SCT paper 09/58 models of patient and user involvement and SCT paper
      09/59 had been provided to members for information. Members were asked
      to consider both of these papers. They we also advised that Rose Marie Parr
      from NES would be attending the December SCT meeting so would be able to
      answer any questions in relation to the work of NES at that time.


4 December, 10:00-13:00, Scottish Health Services Centre, Edinburgh.

Cancer Strategies
October 2009


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