10. Timely treatment

Framework for Effective Cancer Management (FECM)

Once a decision to treat has been made, patients should receive treatment without unnecessary delay. Equitable access to surgery, systemic therapy, and radiotherapy requires proactive planning and strong collaboration across clinical services. This element is about reducing anxiety, improving outcomes, and making sure the 31-day standard is consistently achieved.  

 

Case Study – NHS Lothian - urology/robotic prostatectomy

1. What was the issue/problem identified?

NHS Lothian had the longest waits for 62-day urology pathways in Scotland. Robotic prostatectomy patients were waiting 6–9 months from Decision to Treat. High demand as the regional centre for South East Scotland, alongside phased retirements and vacancies, reduced available specialist surgical capacity. 

2. What did you do?

To create short-term capacity, NHS Lothian funded additional sessions delivered by Glasgow consultants in Lothian theatres. At the same time, they developed a long-term plan that included recruiting new consultants and training nurses to deliver TRUS and TP biopsies, tasks previously carried out by consultants, thereby freeing consultant time for surgery. 

3. What was the outcome?

Within the first six months of 2025, 62-day patients with a pathway length over 100 days fell from 45 to 14. This was also a significant factor in improving Lothian’s 31-day performance, with June 2025 recording the Board’s best results since February 2022. 

Contact

Ben Winterton, Cancer Performance Manager — ben.winterton@nhs.scot  

 

Guidance

The Cancer Strategy for Scotland 2023–2033 is the foundation of the cancer pathway, setting the national direction for earlier diagnosis, faster access, and person-centred care. Together with the Clinical Management Pathways, it guides Boards to plan capacity, coordinate services, and deliver equitable, evidence-based treatment across Scotland. 

  • Cancer Strategy is Scotland’s long-term vision for cancer services — improving outcomes, reducing inequalities, and ensuring timely, safe, and accessible treatment for all. It provides the foundation for continuous improvement from prevention through to survivorship.

 

  • The CMPs provide tumour-site–specific, evidence-based guidance developed by national multidisciplinary teams. They promote consistency in treatment decisions, optimise coordination between clinical services, and support alignment with the ambitions set out in the Cancer Strategy. 

 

Resource and key links

These resources provide practical tools and frameworks to help Boards embed prehabilitation, value-based care, and continuous improvement in treatment delivery. 

  • This document sets out the national approach to helping patients prepare physically and psychologically for treatment. Prehabilitation reduces complications, shortens recovery times, and empowers patients to take an active role in their care.  

Prehabilitation in Scotland: Key Principles for Implementation

  • Part of the wider transformation programme supporting the Cancer Strategy, this portfolio helps Boards measure and improve value in treatment delivery. It focuses on achieving the best possible outcomes with available resources while maintaining patient-centred, sustainable care.  

Value-Based Health & Care Portfolio