FAQs for Professionals

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 will be 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 will be 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:

Our Approach

7. How are patient data being collected?

The audits in NATCAN, similar to the existing audits in prostate and lung cancer, 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.

Using this approach, NATCAN will receive 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 will 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 allow timely (three months following diagnosis) Quarterly reporting to providers, will be 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.

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 is a period of development. That means 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 will publish 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.

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 healthcare improvement strategy that includes explicit quality improvement (QI) goals aiming to improve cancer care and outcomes.

Working with stakeholders, each audit will design the scope of the audits and identify key QI goals that will lead to significant patient benefits.

Healthcare improvement plans will be built around clinically relevant and methodologically robust performance indicators consistent with existing national guidance. Each audit will develop these in consultation with key stakeholders and disseminate them. This will also set out the key drivers for each QI goal, alongside national and local improvement tools.

NATCAN will ensure that its healthcare 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 complete at least one national QI initiative. 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.