1. What is NATCAN?
The National Cancer Audit Collaborating Centre (NATCAN) is a new national centre of excellence which will shine a spotlight on the care and treatment of patients who are diagnosed with cancer in England and Wales. The Healthcare Quality Improvement Partnership (HQIP), on behalf of NHS England and the Welsh Government, has commissioned the development and establishment of NATCAN, which is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). It aims to:
- Provide regular and timely evidence to cancer services of where patterns of care in England and Wales vary
- Support NHS services to identify the reasons for the variation in care in order to guide quality improvement initiatives
- Stimulate improvements in cancer detection, treatment and outcomes including survival
2. Which cancers will NATCAN cover?
NATCAN delivers six new national cancer audits:
- National Audit of Primary Breast Cancer (NaoPri)
- National Audit of Metastatic Breast Cancer (NaoMe)
- National Ovarian Cancer Audit (NOCA)
- National Pancreatic Cancer Audit (NPaCA)
- National Non-Hodgkin Lymphoma Audit (NNHLA)
- National Kidney Cancer Audit (NKCA)
The following ‘existing’ national cancer audits moved into NATCAN during 2023
- National Prostate Cancer Audit (NPCA)
- National Bowel Cancer Audit (NBOCA)
- National Oesophago-Gastric Cancer Audit [NOGCA])
- National Lung Cancer Audit (NLCA)
3. When did the centre start and who pays for it?
Work on setting up the new centre began on October 1 2022. NATCAN is funded by NHS England and the Welsh Government, with £5.4m for an initial period of three years.
4. Where is it based?
NATCAN is part of the Clinical Effectiveness Unit (CEU) in London – a partnership between the Royal College of Surgeons of England (RCSEng) and the London School of Hygiene & Tropical Medicine (LSHTM). T
5. When will the existing cancer audits join NATCAN?
NPCA, NBOCA, NOGCA and NLCA have now moved into NATCAN bringing all cancer audits together under one umbrella for the first time. The aim is to deliver closer collaboration and better results, sharing learning and best practice.
6. How will NATCAN work?
NATCAN is all about effective collaboration. Each audit is led by a multidisciplinary team of clinical experts and senior academics to ensure that we ask the right questions about cancer care and treatment, and then use the right methods to answer those questions. NATCAN collaborates closely with all relevant stakeholders to inform the quality improvement (QI) priorities and goals of each audit. That includes professional groups, patient charities and patients.
In this way, the new audits are produced to the same high standard as those that the CEU has run for years, maintaining the standards of excellence the CEU is renowned for. More information about our approach can be found here:
7. How are patient data being collected?
In order to reduce the burden on hospital staff, the audits in NATCAN do not ‘collect’ clinical data. The cancer audits utilise the nationally mandated flows of data from hospitals to the National Disease Registration Service (NDRS) in NHSE and the Wales Cancer Network in Public Health Wales. Each NATCAN audit has published key data items (Cancer Outcomes Services Dataset – COSD) for each cancer site, which hospitals can check are being completed and submitted to NDRS. More information regarding COSD and the COSD submission schedule can be found here: Cancer Outcomes and Services Data set (COSD) – NDRS (digital.nhs.uk).
Using this approach, NATCAN receives clinical information for every patient diagnosed with bowel, breast, lung, oesophago-gastric, ovarian, pancreatic, prostate, non-Hodgkin lymphoma and kidney cancer in England and Wales. Data from Trust/Health Board data submissions are linked to selected items from national datasets to provide information on the diagnosis, management and treatment of all patients newly diagnosed with each cancer type. That includes staging, mode of admission, comorbidities, surgical procedure or intervention.
Therefore, there is no need for NHS organisations to formally register for this audit, or input data on patients through a separate database portal. Additionally there is no audit specific deadline for trusts to submit data.
8. What is NATCAN doing differently?
- All audits within NATCAN only use linked national routinely collected datasets for its core outputs. This will make the process of producing relevant and robust performance indicators more efficient.
- Rapid cancer registration data, that allows timely (three months following diagnosis) Quarterly reporting to providers, 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 will be produced annually.
- Each audit in NATCAN will carry out a quality improvement initiative using the rapid cancer registration data at least once in the first three years. The aim is to “close the audit cycle”, following an approach commonly referred to as the “plan-do-study-act” method. This will be a first at national level for cancer audits.
9. Who can take part in the audit?
All NHS Trusts in England and Health Boards in Wales that provide cancer services.
10. Does my hospital have to participate in the NATCAN audits?
Yes, all NHS healthcare providers of cancer care are expected to participate in relevant HQIP-funded projects within the National Clinical Audit and Patient Outcomes Programme.
Details of the statutory and mandatory requirements for clinical audit are available on the HQIP website.
11. How do I check the completeness of my cancer data submissions to NDRS?
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 ‘new’ 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 | Paul Stacey | [email protected] |
Northern and Yorkshire | Rachel Mann | [email protected] |
Oxford | Gemma Feeney | [email protected] |
South West | James Withers | [email protected] |
West Midlands | Gemma Feeney | [email protected] |
12. Does the national data opt-out policy apply to the data provided to NATCAN?
All patient identifiable information including name, address, date of birth, address, postcode and NHS number is removed (de-identified) by NHSE in England and WCN 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.
13. When will the results from the NATCAN audits be available?
The first year was a period of development – building organisational structures, recruiting staff, mapping the cancer service configuration in England and Wales, creating common data access channels with our data providers, developing performance indicators, and designing quality improvement (QI) plans.
Each audit completed a scoping exercise during Summer 2023, in consultation with key stakeholders, to determine the QI priorities and goals. Scoping documents outlining the key QI priorities for each audit were published in November 2023. The performance indicators underpinning these QI goals will be reported from 2024 in a State of the Nation report which will be published in September 2024 for the six new audits. The existing audits published their first State of the Nation reports in January 2024 (prostate, oesophageal and bowel cancer).
Each audit will also report key performance indicators on a quarterly basis and on an interactive, web-based dashboard updated quarterly.
The current NATCAN reporting schedule is available here.
14. How are patients and the public involved?
Patients and patient charities are involved in all aspects of the delivery of the cancer audits. For each audit, there will be a Patient and Public Involvement Forum to provide insight from a patient perspective on strategic aims and specific audit priorities. This will include shaping the development of each audit’s QI initiatives by ensuring this work is relevant from a patient perspective.
A key activity of the PPI Forums will be to participate actively in the production of patient-focussed audit outputs (including patient and public information, patient summaries of reports, infographics, and design and function of the NATCAN website). This will help guide us on how best to make this information accessible.
The chair of each audit’s PPI Forum will be a member of that audit’s Clinical Reference/Advisory Group to further strengthen the patient voice in the audits.
15. What are the priorities for the centre and the next steps?
A priority for each audit in NATCAN is the development of a quality improvement strategy that includes explicit quality improvement (QI) goals aiming to improve cancer care and outcomes. Working closely with key stakeholders, including people with lived experience of cancer, each audit designed the scope of the audits and identified key QI goals that will lead to significant patient benefits.
Quality improvement plans for each audit were published in September 2024. These plans define ten performance indicators, and how they map to the key QI goals, national guidelines, and standards. The performance indicators will be used by the audits to monitor progress towards its improvement goals and to provide a better understanding of the determinants of variation in the treatment of people with cancer and the outcomes they experience. In addition, the QI plans set out the improvement methods and activities that will support implementation of the plans, including strategies for reporting and disseminating results, in addition to describing the approaches to evaluation.
NATCAN will ensure that its quality improvement programme will be closely aligned with related activities implemented by other relevant organisations (for example CQC and Getting it Right First Time in England, and NHS Quality Improvement and Patient Safety in Wales).
Each audit within NATCAN will design and implement a national QI initiative in 2025. Again, NATCAN will build on the CEU’s longstanding experience in targeting and designing QI implementation approaches. This will ensure that the audit feedback information and recommendations truly reach the clinicians who can act on it, and will also incorporate specific action plans.
16. When will the new NATCAN audits be included in the reporting for annual Quality Accounts?
NAoPri and NAoMe are included in the Quality Accounts list from 2023/24.
NKCA, NPaCA, NOCA and NNHLA will be included from 2024/25.
17. When will the new NATCAN audits carry out an outlier process?
For the first State of the Nation (SotN) reports in 2024, the new audits will not implement HQIP’s formal “outlier process” (i.e., a formal process to assess the performance of healthcare providers with results that are outside the expected range). This is because, although there is sufficient confidence to report the results publicly, it is the first time that provider-specific results are being provided with untested data completeness and quality, and risk adjustment methods are in development. Instead, where results highlight a potential cause for clinical concern, the audit team will contact the providers within one month following publication of the SotN Report, and work with them to explore factors that may explain their results, according to HQIP’s formal guidance. This process is with a view to being able to adopt the formal outlier process in 2025.
Last updated: 15 October 2024, 9:13am