24 Jan 2024
The National Cancer Audit Collaborating Centre (NATCAN) – one year on.
Caroline Rogers, Associate Director, Quality and Development (NCAPOP), HQIP and Dr Julie Nossiter, Director of Operations, NATCAN
In 2023, Professor Peter Johnson, National Clinical Director for Cancer at NHS England acknowledged the transformative power of healthcare data, saying: “We’re in the middle of a real data revolution in the health service”. It goes without saying that the clinical audit community plays a pivotal role in that ‘data revolution’. However, to best realise the potential of data in healthcare, it too is going through a transformation. We look at the National Cancer Audit Collaborating Centre (NATCAN), which takes a truly collaborative approach to clinical audit.
Healthcare improvement strategies will be the guiding light for each audit, providing targeted, measurable goals for cancer outcomes and patient experience
NATCAN was set up to make the most effective use of the cancer data available, in order to bring about improvements in the care provided to patients. The Centre, which celebrated its one-year anniversary in October 2023, heralds a new approach to commissioning national clinical audits; one with collaboration at its heart. The Royal College of Surgeons of England (RCS) – in partnership with the London School of Hygiene and Tropical Medicine – was contracted to run the Centre by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and the Welsh Government.
Experts in relevant clinical disciplines, methodology, statistics, organisation, data, epidemiology and logistics have been brought together, with the aim of largescale healthcare assessment and improvement. More specifically, NHS England and the Welsh Government are providing £5.4 million over an initial three-year period for the Centre to manage new clinical audits covering all NHS hospitals in England and Wales that care for patients with:
- Ovarian cancer
- Pancreatic cancer
- Non-Hodgkin lymphoma
- Kidney cancer
- Primary breast cancer
- Metastatic breast cancer.
In addition, the following established audits, already hosted by the RCS, were also incorporated into the Centre:
- Oesophago-gastric cancer
- Bowel cancer
- Prostate cancer
- Lung cancer.
Within NATCAN, each clinical discipline has its own audit. The Centre focuses on ‘the three Rs’ of clinical audit best practice, ensuring that all its activities are:
- clinically Relevant (asking the right questions, as a result of close collaboration between clinical and academic experts)
- methodologically Robust (using the best epidemiological and statistical approaches to carry out fair comparisons between hospitals),
- and technically Rigorous (making sure data science is put to the best use, in order to drive quality improvement).
What are the aims of the new Centre?
The aim of NATCAN is to strengthen NHS cancer services and, ultimately, improve patient outcomes. People who have experienced, or are experiencing, cancer are important in this endeavour; and patients and patient charities are involved in all aspects of the Centre and its work. Each audit has its own Patient and Public Involvement (PPI), enabling patients to have a strong voice within the clinical committee. Everyone involved in cancer treatment knows it is complex. There may be multiple treatment options, including combinations of treatments, for different types of cancer. A patient’s treatment plan needs to take into account the stage of their cancer and how they respond to treatment. A key aim for each audit is to ensure that the information produced for cancer services recognises these differences, and supports hospitals to focus on specific parts of the care pathway. The Centre uses and links together the existing national datasets that are already routinely collected, reducing the burden and costs on the system as a whole. Organising clinical audits in this way creates a critical mass and capacity of experts, meaning that best practice can be shared.
So, what has been happening so far?
As of late 2023, each audit is drawing up its healthcare improvement strategy, which contains explicit quality improvement goals. These will be the guiding light for each audit – a set of targeted, measurable goals for cancer outcomes and patient experience. Meanwhile, staff and experts have been appointed, and applications made for the data required. As you would expect, the Centre will operate with the highest level of expertise in information governance and the rules surrounding the use of patients’ data; and robust processes are being put in place to support this.
When will we see the data?
The existing audits (lung, prostate, bowel and oesophago-gastric cancers) will continue to report data, while the new audits will produce analysed benchmarked results for each Trust and Health Board in 2024, to be released quarterly thereafter. From September 2024, summary annual ‘State of the Nation’ reports will be produced by each audit, containing key findings and national recommendations for improvements in cancer care. Alongside the data releases, the audits are each developing improvement tools that services can use to improve the care they provide.
Organising clinical audits in this way creates a critical mass and capacity of experts
As with any transformative change, taking a new approach in setting up this national centre of excellence has not been without challenges. But with benefits as significant as greater knowledge and best practice sharing, as well as efficiencies and economies of scale – and, of course, improved outcomes for patients – at stake, the team has worked hard to overcome them. We now look forward to strengthening NHS cancer services, using joined-up thinking and data to provide a wider understanding of cancer treatments and patient outcomes across the country.
This article was originally featured in HQIP’s quality improvement magazine, CORNERSTONE – to see more articles on topics such as healthcare inequalities and sustainability in healthcare, go to: www.hqip.org.uk/wp-content/uploads/2023/11/HQIP_Cornerstone_2024.pdf.
About NATCAN
The National Cancer Audit Collaborating Centre (NATCAN) was established as a new national centre of excellence in October 2022. It is a partnership between the Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, and was commissioned for an initial three-year period by the Healthcare Quality Improvement Partnership (HQIP), on behalf of NHS England and the Welsh Government. NATCAN brings national cancer audits together in one place, enabling the sharing of best practice and clinical excellence as part of the overall strategy of improving healthcare.
Find out more: www.natcan.org.uk.
Further information and resources
