By Donna Smith, Director of Strategic Solutions, Insource
Cancer care is one of Scotland’s most urgent health system challenges and alarmingly 1 in 2 patients will have a cancer diagnosis in their lifetime.
Thousands of people each year experience the fear and uncertainty whilst waiting for a cancer diagnosis.
For me, the importance of timely diagnosis is personal. In my early 30s I was recalled following a routine cervical screening.
Even though I worked in the NHS at the time, the experience was frightening.
My diagnostic journey was completed in days, but these were some of the longest days of my life.
I still remember the Medical Director (my Gynaecologist) phoning me with the good news. Speed really mattered to me as it meant the uncertainty didn’t drag on.
Two decades later, I was recalled from the Breast Screening Programme.
Once again, the service moved quickly, with a same day diagnostic visit within 48 hours. The fear returned and was all consuming.
Once again there was compassion, dignity and speed. This should be the rule not the exception, but for many, pathways diagnosis is taking too long.
The National Framework
Scotland already has a planned, co-ordinated approach with its National Framework for Effective Cancer Management, published in March 2025.
The report sets out the right objectives and highlights how a joined-up approach should follow 10 recommended steps to streamline pathways and enhance data reporting collectively across the country – something it aimed to put into action within three years.
Scottish Health Boards are working hard to implement the framework in their areas, yet the pace of improvement still feels too slow for those waiting for a diagnosis and treatment today.
Understanding diagnostic bottlenecks, systemic pressures, and socioeconomic impacts is all possible with real-time data and the right analytical focus.
Top of the agenda, but is the Framework being followed?
Cancer waiting times are on the agenda for every Scottish NHS Board and the latest Public Health for Scotland figures show incremental improvements, with 31-day targets being met.
However, only 69.9 per cent of patients referred with an urgent suspicion of cancer begin treatment within the 62-day target window.
This falls far short of the 95 per cent standard that has not been met since 2012.
These headline figures don’t reveal the full picture: they do not show how the NHS across Scotland is missing out the opportunity to carry out a systematic review of how cancer pathway delivery is failing and where delivery could be significantly improved.
Where to invest first?
A question I often hear is where to invest first: workforce, equipment or data?
In reality these are not competing choices. They are interdependent.
Without high-quality, real time-data, the workforce cannot be deployed effectively, equipment cannot be used efficiently, bottlenecks aren’t identified early enough.
Data acquisition and visibility are not luxuries.
They are key enablers to maximise the impact of every pound spent, and every professional’s effort to improve patient outcomes.
Real time insights enable the targeted deployment of capacity, optimised use of equipment to make the greatest difference.
With consistent definitions and interoperable datasets, Boards can rapidly test and spread improvements, reduce unwarranted variation, manage inequalities, support recruitment to clinical trials, and so much more.
A proven approach
This data-driven approach has been proven elsewhere and was fundamental to transforming cancer care in Denmark, identifying two key blockages of understanding and optimising the pathway, and then using the data to improve the system infrastructure and progress patients through the system.
Much has been written about Denmark’s success in recent years.
Comparable to the UK, and a valid benchmark, in the 1990s, both countries had similarly poor cancer survival rates, according to International Cancer Benchmarking Partnership (ICBP) data.
Today, Denmark has achieved some of the biggest improvements among ICBP members. Sadly, the same progress has not been mirrored across the UK, including in Scotland.
A key driver of Denmark’s turnaround has been their use of real-time, comprehensive data, including stage-at-diagnosis reporting.
Data has helped inform the national strategy and plan, enabling targeted action, continuous learning, and observable improvements.
Key aspects of Denmark’s success include:
- Streamlined referral pathways and centralised data systems for faster diagnosis and treatment
- Reduced regional inequalities through consistent use of cancer tracking tools across all hospital trusts
- Publication of stage-at-diagnosis data alongside waiting times to inform early detection strategies
- Real-time dashboards for clinicians and administrators, allowing proactive management of delays
Population-level data continues to guide Denmark’s efforts, revealing that diagnosis rates remain higher than the EU average (partly due to increased screening), prevention and public health initiatives still need strengthening, and longer waits for first treatment correlate with poorer outcomes.
Applying the approach in Scotland
Closer to home, some of Scotland’s cancer programmes and Board level initiatives are demonstrating what is possible when data and improvement go hand in hand.
Within just 100 days NHS Greater Glasgow and Clyde reduced their longest diagnosed cancer waits by 42 per cent.
That’s been made possible with access to complete, accurate data that identified and removed key bottlenecks in selected pathway cohorts to speed up the process between referral and diagnosis, supporting the longest waiting patients to get their treatment faster.
Data can, and should, be used to replicate similar successes across the whole of Scotland to identify constraints, redesign flows, and allow quicker diagnosis, and faster access to treatment for all.
Cancer does not observe Board boundaries, yet accountability structures do.
Each Scottish Health Board, rightly, has the responsibility for meeting waiting time standards.
However, this fragments the ownership of the end-to-end pathway.
Patients travel for diagnostics and treatment, capacity varies by site and specialty, information often sits in local systems and patients can get lost in the system.
Without a single, coherent national view of demand, capacity, activity and waits, unintentional variation is created, effort is duplicated and opportunities are missed to treat patients sooner.
The solution is shared, near real time, visible pathway management that follows the patient rather than the organisation.
When Boards see the same data, in the same way, mutual aid becomes practical, escalation becomes timely, and patients experience a more seamless journey.
The Targeted Operating Model for Oncology can be delivered at pace, with this cross-boundary visibility, delivered through complete and consistent datasets, with a single operational view linking demand, staffing, chair time, pharmacy preparation and transport.
With that visibility, Scotland can deliver timely starts, minimise cancellations and deliver safe and equitable access across sites.
Where to start:
- Create a national real-time view of capacity and flow built from local data
Implement a common data layer that links referral, diagnostic, staging, and treatment steps across Boards that can be viewed by locality drive proactive care, based on up-to-date information. We can remove the burden from staff searching for siloed data and producing reports. Releasing time which can be dedicated to identifying and solving the root causes of delays and bottlenecks.
- Highlighting health inequalities
Cancer must be front and centre of this data-driven insight, especially given that cancer incidence is 24% higher in Scotland’s most deprived communities. Little or no data is visible to operational staff to help them successfully implement the strategy. Making stage of diagnosis, deprivation, geography, travel times available can help operational teams direct earlier access particularly in communities with higher incidence and lower uptake of services.
- Revealing the full cancer picture
To gain a true and complete picture of cancer across Scotland, national reporting must include not only patients referred under urgent suspicion of cancer (USC) or with a decision to treat, but also those diagnosed incidentally or through routine pathways. These patients make up a significant proportion of cases and must not be overlooked.
- Finding the real bottlenecks
Cancer diagnosis is a complex, multi-faceted pathway. The 62-day standard, for example, begins at urgent referral, but diagnostic imaging, pathology results and specialist reviews are integral to the diagnosis process. Pressures and delays in these areas, can only be fixed if they’re visible in the data.
It’s about uncovering where the real issues lie and tackling them.
It isn’t about blame. It’s about focusing effort and resources where they will count most.
A constructive proposition
Scotland has many of the right components and the right ambition set out in the National Framework to solve the cancer challenge.
By treating data as an enabler, not a competitor for resource, improvement can be accelerated across Scotland in a way that is practical for operational teams and tangible for patients.
The correct solutions, to the real problems, will reduce waiting times.
With tools such as our PP+ CPM available we can make that happen now and give every cancer patient in Scotland an equal chance.
Accurate, real-time cancer data doesn’t just inform, it empowers. And that power, used now, not later, is what will finally break the cycle of delay.
Scotland’s cancer patients deserve nothing less, and they deserve it now.
