FAQs

NATCAN was established in October 2022 as a new national centre of excellence. It aims to provide regular and timely evidence to NHS services about where and why patterns of care vary and to support local quality improvement. NATCAN is commissioned by the Health Quality Improvement Partnership (HQIP) on behalf of NHS England and the Welsh Government

NATCAN is part of the Clinical Effectiveness Unit (CEU) in London – a collaboration between the Royal College of Surgeons of England (RCSEng) and the London School of Hygiene & Tropical Medicine (LSHTM).

NATCAN is home to the ten national cancer audits, six of which –breast (primary and metastatic), ovarian, pancreatic, and kidney cancer and non Hodgkin lymphoma – are ‘new’ audits, set up for the first time by NATCAN. The four pre-existing ‘established’ cancer audits – in bowel, lung, oesophago-gastric, and prostate cancer – moved to sit under the NATCAN umbrella in 2023.

NATCAN was initially funded by NHS England and the Welsh Government for an initial three-year period from the 1st of October 2022. NATCAN has since secured a two-year contract extension, enabling the centre to continue the delivery of national cancer audits through to September 2027.

Our multidisciplinary audit teams bring together a broad range of expertise in cancer care, methodological development, data science, statistics, clinical epidemiology, performance assessment, organisation, and logistics. By bringing together all ten national cancer audits in one centre of excellence, NATCAN is able to enhance and expand the information available to the cancer care community.

Learning from one cancer audit can be shared across all other projects; there is increased opportunity for wider collaboration across the cancer care community; and all audits benefit from the increased expertise available within the centre. NATCAN’s focus on developing a better understanding of the science of improvement, and sharing this expertise from a central hub to all audits, is vital for increasing the equity and quality of cancer care in England and Wales.

All audits within NATCAN only use existing, national routinely collected datasets for its core outputs. This makes the process of producing relevant and robust performance indicators more efficient.

Rapid cancer registration data allows timely (three months following diagnosis) quarterly reporting to providers on our data dashboards is used alongside more delayed State of the Nation reports based on “gold-standard” cancer registration datasets (data available at least 18 months after diagnosis). Concise State of the Nation reports are produced annually.

Each audit in NATCAN is carrying out quality improvement interventions using the rapid cancer registration data, a first at national level for cancer audits.

NATCAN is continuing to generate updates to its interactive data dashboards on a quarterly and annual basis and national Quality Improvement (QI) interventions have been launched across all audits. NATCAN continues to work closely with a wide range of stakeholders to ensure alignment with other organisations like the Care Quality Commission (CQC) and NHS Wales Quality Improvement (QI) programmes.

Looking beyond 2026, there are several exciting ways in which the work of NATCAN could expand in both scale and influence. One consideration is whether other cancer types should be added to the audit portfolio; another is whether the audits could expand beyond England and Wales. There is also potential to further develop the methodology used within the audits, for example by including patient-reported outcomes and experiences measures (PROMS and PREMs, respectively) and by linking with primary care data about care delivered by general physicians in the community; this would likely provide a better understanding of the impact of cancer on a person’s long-term function and quality of life. Finally, there is scope to explore additional ways in which NATCAN’s findings can drive QI initiatives to ensure patient care continues to improve.

Clinical audit is a method that healthcare professionals use to look at and improve patient care in their hospital. They compare how patients are treated, and the outcomes of the care they receive, against set standards and guidelines.

National clinical audits determine variations in care by looking at hospitals across the country. The audits in NATCAN use information on the care received by patients diagnosed with cancer in hospitals across England and Wales. They examine this data in order to make valid comparisons, and identify improvements where they are needed.

The established audits in bowel, lung, oesophago-gastric, and prostate cancer which have already helped provide a wider understanding of cancer treatments, and created better results for patients. They have also promoted improvement initiatives within NHS cancer services, and identified areas of best practice.

Each of the ten national cancer audits which sit within NATCAN produce quarterly (currently England only) and annual updates (England and Wales) to its data dashboards. Each audit also produces an annual State of the Nation report which is accompanied by a range of supplementary materials including an Action Plan template and a Methodology Supplement.

The bowel, lung, oesophago-gastric and prostate cancer audits moved into NATCAN in 2023; bringing all cancer audits together under one roof for the first time. This enables us to collaborate more closely to deliver better results, as well as sharing learning and best practice.

Patients and patient charities are involved in all aspects of the delivery of the cancer audits. For each audit, there is a Patient and Public Involvement (PPI) Forum to provide insight from a patient perspective on strategic aims and specific audit priorities. This includes shaping the development of each audit’s Quality Improvement (QI) interventions by ensuring this work is relevant from a patient perspective. A key activity of the PPI Forums is active participation in the production of patient-focused audit outputs (including patient and public information, patient summaries of reports, infographics, and the design and function of the NATCAN website). This helps to guide NATCAN on how best to make this information accessible. The chair of each audit’s PPI Forum is a member of that audit’s Clinical Reference/Advisory Group to further strengthen the patient voice in the audits and also represents the audits at NATCAN’s People Involvement Network (PIN).

The audits don’t just examine data about the cancers themselves, they also look at different hospitals and different methods of treatment. That means NATCAN focuses on how cancer care varies from one hospital to another, with the aim of learning lessons and identifying how we can diagnose and treat different cancers most effectively. We make recommendations to healthcare providers based on our findings, which includes, for example: how patients are diagnosed, the treatments patients receive such as the use of surgery, radiotherapy and/or chemotherapy, and outcomes following treatment.

To make fair comparisons, we also take into account the fact that all patients are different and have different characteristics. The factors we consider are age, whether a patient has pre-existing conditions, and the social or economic circumstances that patients find themselves in. When the data tells us where improvements are needed, NATCAN will lead the drive to deliver change.

Yes, patient involvement is central to everything we do. We are determined to give patients and carers a greater voice at every stage of the process. NATCAN has collaborated closely with various patient charities, in order to identify patient and carer representatives for each of the Patient and Public Involvement (PPI) Forums we have established for each audit. Our patient representatives help us to ensure that the questions the audits ask are appropriate, and that we are reporting information in ways that are useful to the public as well as to health care professionals and hospitals.

NATCAN does not collect patient data. Instead, we use information about patients that is collected by national organisations in England and Wales. This includes nationally mandated data flows from hospitals to the National Disease Registration Service (NDRS) and NHS Wales Performance and Improvement, reducing burden on hospital staff. These organisations are allowed to collect data on patients diagnosed with cancer, the treatments they receive, and the results of these treatments.

NATCAN is committed to using only routinely collected data to remove the need for bespoke, manual data entry by clinicians and data managers solely for the purpose of clinical audit. Since joining NATCAN, the oesophago-gastric and bowel cancer audits – which previously used a bespoke data collection platform – have aligned with this principle.

We use information about patients that is collected by national organisations in England and Wales. These organisations include the National Disease Registration Service (NDRS) and NHS Wales Performance and Improvement. They are allowed to collect data on patients diagnosed with cancer, the treatments they receive, and the results of these treatments.

National data on patients with cancer is the richest it has ever been, and NATCAN receives clinical information for every person diagnosed with cancer across England and Wales for the ten cancers we audit. These cancer data are linked to selected items from other national datasets to provide information on the diagnosis, management, treatment, and outcomes of all patients newly diagnosed with each cancer type. This includes staging, mode of admission, comorbidities, surgical procedure or intervention, and oncological treatments including systemic anticancer therapy and radiotherapy.

These rich data allow the audits to understand the complexity of the cancers that patients have, as well as their pre-existing medical conditions and fitness. Taking these characteristics into account when producing indicator values enables fair comparisons between hospitals.

In general terms, what we call the gold standard data is a much richer dataset which provides more detailed information about cancer. It might, for example, provide data on what particular cancer cells look like under a microscope, which may tell us whether they are likely to be more aggressive. The rapid data has information about the patient, their diagnosis and their treatments. It has more limited information about the tumour – it only gives us information on staging, which is how medical experts determine the extent to which a cancer has grown and spread. So it can be really useful because it is available so quickly, but we still need the gold standard data to ensure we can perform more in-depth analyses.

Yes. We now have access to more rapid cancer data, which is available three months after diagnosis. More traditional cancer data (gold standard data) is only available eighteen months after diagnosis. This is a key innovation, which means NATCAN can feed results back to hospitals more frequently, to enable them to improve their cancer services. We can also measure whether these improvements are having the desired results. The emergence of rapid data was driven by the COVID-19 pandemic. These more recent data enabled the impact of the pandemic on the care and outcomes of patients diagnosed with cancer to be investigated.

All the data we use is anonymised, and doesn’t include the names of any individual patients or information such as an NHS number. You can find more detailed information about NATCAN’s Information Governance and Privacy Policy.

All patient identifiable information including name, address, date of birth, address, postcode and NHS number is removed (de-identified) by NHSE in England and NHS Wales Performance and Improvement in Wales before they are securely transferred to the NATCAN team.

In line with the National data opt-out policy, opt-outs are not applied to the data provided to NATCAN because the data are not Confidential Patient Information as defined in sections 251(10) and (11) of the National Health Service Act 2006.

Where individuals have opted out of disease registration by the National Disease Registration Service (NDRS), their data has been permanently removed from the registry and is not provided. More information can be found here.

All NHS Trusts in England and Health Boards in Wales that provide cancer services.

Yes, participation is mandatory for NHS providers of cancer care under HQIP-funded projects.

Yes, the audits are included in the quality accounts list. Visit the HQIP website for more information.

Your local Data Improvement Lead, NDRS, will be able to help you find out information about your Cancer Outcomes Services Dataset (COSD) submissions. The key COSD data requirements for each audit are available here.

Please see below the list of regional contacts.

National
Karen Graham
[email protected]

East Midlands
Simon Cairnes
[email protected]

Eastern
Marianne Mollett
[email protected]

London
Katrina Sung
[email protected]

North West
Gemma Feeney
[email protected]

Northern and Yorkshire
Rachel Mann
[email protected]

Oxford
Maddie Purvin
[email protected]

South West
James Withers
[email protected]

West Midlands
Maddie Purvin
[email protected]

If a trust believes there is a discrepancy between their local data and what appears on the audits’ quarterly dashboard, we suggest first reviewing the indicator information and methodology. It can also be helpful to look at data completeness on the dashboard, as incomplete data may affect how performance indicators are displayed.

If it looks like there may be a data submission issue, your team can contact the National Disease Registration Service (NDRS) regional data liaison lead for support. We’ll work with you to resolve your query together. For NDRS regional contact details, please see the NATCAN FAQ no. 23 titled “How do I check completeness of cancer data submissions?”

Cancer data is submitted by NHS Trusts through the Cancer Outcomes and Services Dataset (COSD) upload portal. Trusts use this to send their monthly data submissions securely without the need to share files by email. Access requires a secure NHS network connection (N3/HSCN), an individual login, and appropriate permissions. Once submitted, all data is encrypted and only error reports remain visible. This can only be seen by authorised users within that NHS Trust.

If you are a NHS trust employee and you have questions about the submission process, refer to the NDRS website and contact your regional National Disease Registration Service (NDRS) Data Liaison Manager (For NDRS regional contact details, please see the NATCAN FAQ no. 23 titled “How do I check completeness of cancer data submissions?”).

Historically, Cancer data in Wales has been submitted through the Cancer Network Information System Cymru (CaNISC), a national repository used by all Health Boards, Trusts, hospices, and other organisations involved in cancer care. It allowed for capture of the full patient pathway, from referral and diagnosis through to treatment and follow-up. Data is also linked to cancer registry records held by the Welsh Cancer Intelligence and Surveillance Unit (WCISU).

More recently, CaNISC has been replaced by the Welsh Clinical Portal (WCP) as part of the Cancer Informatics Programme (CIP), which aims to improve access and integration across NHS Wales. This has involved the implementation of Cancer Dataset Forms which have been designed to improve the data capture and reporting capabilities of NHS Wales.

From 2027 onwards NHS Wales will supply quarterly data to NATCAN using this new integrated, and more accessible digital platform.

This varies depending on the IT systems and software used locally.

If you work in a NHS Trust and have concerns regarding local data submission, please speak to your local IT team or data manager for guidance on how cancer data is collected and extracted within your organisation.

If you work in a Health Board, please contact [email protected].

The audits report results at NHS trust and Cancer Alliance level for England, and at Health Board level for Wales. The audits do not routinely report hospital‑level results, so data for individual hospitals are not available.

It is worth noting that hospital‑level reporting, especially on a quarterly basis, would often involve very small numbers, which can make results less stable and limit their usefulness.

The NATCAN audits develop their performance indicators in collaboration with stakeholders, including representative professional bodies and Patient and Public Involvement (PPI) forums. Indicators are aligned as closely as possible with national guidance and guidelines, and with the measurement strategies of other relevant national initiatives.

Detailed information on each indicator and its associated methodology can be found in the Methodology Supplement produced for each audit’s annual State of the Nation report or on the data dashboard.

For the State of the Nation Reports produced by each of the audits, indicator definitions are provided within the respective State of the Nation Report Methodology Supplement document.

For the quarterly dashboard, indicator definitions can be found in the “Indicator information” tab for each selected indicator. Trusts/ Health Boards are also encouraged to review the “Methods” tab for further details on the underlying methodology.

The NDRS Data Quality and Insights Hub* and the audit’s dashboard use different definitions and approaches to data completeness, which can lead to variations in the figures reported for your trust. We are currently in the process of developing a process flow map to help support understanding of this complex process.

*The NDRS Data Quality and Insights Hub can only be accessed via a secure Health and Social Care Network (HSCN). If you are an NHS trust employee and you have questions about your data submissions, please contact your regional NDRS Data Liaison Manager (For NDRS regional contact details, please see the NATCAN FAQ no. 23 titled “How do I check completeness of cancer data submissions?”).

No. NATCAN uses nationally mandated data flows from hospitals to the National Disease Registration Service (NDRS) and NHS Wales Performance and Improvement. Patients who are diagnosed and treated outside an NHS organisation in England or Wales are not included in national cancer registration datasets and cannot be reported in the audits.

Yes, NATCAN has an outlier policy which can be found here. It includes appendices with specific details for each NATCAN audit. It is updated regularly, in line with the State of the Nation report publications preparation and when required by changes to the HQIP’s Outlier Guidance for the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

Please contact audit mailboxes if you have any questions related to a specific audit outlier process policy.