Article: The Big ‘C’ – Collaboration

Published: 06 Mar 2025

The power of an evidence-based, knowledge-sharing approach to cancer care – and how we can learn from this across healthcare

With more than 1,000 new cancer diagnoses, and almost half that number dying, every day in the UK1, the stakes have never been higher for those engaged in cancer care. But they are not alone. They have data. More importantly, they are supported by dedicated professionals across the healthcare system, all committed to harnessing that data to enhance care and, ultimately, improve outcomes.

Professor Danny Keenan, Medical Director at the Healthcare Quality Improvement Partnership (HQIP), shares his experience of being a part of that system, sharing knowledge and working collaboratively to target resources, and save and improve lives.

The National Cancer Audit Collaborating Centre (NATCAN) is a unique centre of excellence, commissioned by HQIP on behalf of NHS England and the Welsh government; the first of its kind in the UK. Delivered by the Clinical Effectiveness Unit (CEU) at the Royal College of Surgeons of England (RCSEng), it encompasses ten cancer audits including prostate, kidney and colon2. While a recent BBC article highlighted variations in care identified by NATCAN’s data for these cancers in particular, it is this level of detailed understanding that will be key to improving patient outcomes. These audits provide up-to-date essential data on diagnosis, treatment pathways, and outcomes, and, as such, have the potential to support more effective care delivery. Or, to quote Professor Ajay Aggarwal, Clinical Director at NATCAN: “We often hear people talking about what the next breakthrough is but, the fact remains, using what we have better could make a huge difference.”

While it’s important to share issues such as variations in care, we need to acknowledge the unbelievable work and dedication that goes into collecting and analysing the data to produce these insights, as they point the way to improvement. But data alone cannot bring about meaningful change. For that, you need the combined efforts of multidisciplinary professionals, to scrutinise the data, and its resultant recommendations, from a myriad of perspectives.

“We often hear people talking about what the next breakthrough is but, the fact remains, using what we have better could make a huge difference,” Professor Ajay Aggarwal, Clinical Director at NATCAN

The Executive Quality Group National Clinical Audit (EQG-NCA) is one such team (one of many, of course, dedicated to translating data into actionable improvement across healthcare). Reporting to the NHS England National Quality Board and the Welsh Government, this group exists to condense the national recommendations from the National Clinical Audit and Patient Outcomes Programme (NCAPOP), managed by HQIP, into clear actions improvement within the NHS.

At a recent cancer-focused EQG-NCA meeting (involving HQIP, NATCAN, NHS England and others3), we discussed the first major output from the Centre, reviewing the full breadth of outcomes from all ten NATCAN audits. Chaired by the National Lead for Secondary Care, Stella Vig, I was struck by how vibrant it was. With such an important issue to address, it was intense, as you can imagine – but this was fuelled only by a shared determination to understand what is working well and what is not, in order to deliver maximum benefit for patients.

“We’re in the middle of a real data revolution in the health service,” Professor Peter Johnson, National Clinical Director for Cancer at NHS England (2023)

The meeting began with presentations from HQIP, NATCAN and NHS England; the content of which immediately brought home to me the advantage of gathering such a diverse set of colleagues together. These presentations covered the first reports from the six newer NATCAN audits as well as annual reports from the remainder2 (see Resources – HQIP for these, and other, reports commissioned by HQIP). It was also a chance to share more about the benefits and logistics of having a single collaborative ‘umbrella’ centre to ‘house’ all the major cancer audits, as well as underline HQIP’s change in emphasis to fewer metrics and more focused recommendations. More specifically, we heard that the ten audits had reduced the total number of recommendations to just 48 – with Care Pathway and Treatment each accounting for 20%, and Staffing and Training representing 14%. This approach supports the translation of data into action.

The complexity of NATCAN’s work is exemplified by the fact that they collate data from a wide range of sources including the National Cancer Registration and Analysis Service (NCRAS), the Cancer Outcomes and Service Dataset (COSD), Hospital Episode Statistics (HES), and the Office for National Statistics (ONS) as well as seven other national datasets. This alone demonstrated to me the expertise needed to create their outputs. Speaking for NATCAN, Professor Agyarwal, highlighted some key points:

  • For some cancers, such as ovarian and pancreatic, outcomes remain poor with much variation nationally
  • Variation in the management of older cancer patients in particular is a key theme across the audits.

We also heard concerns about getting robust data back to units in a timely manner. There was discussion around the delays in receiving some sources of non-NATCAN data. The NHS England Treatment Variation team gave an update on the role of the Cancer Networks in addressing this issue. These are an invaluable resource in managing this and many other aspects of cancer care. They also emphasised the need to work closely together, as epitomised by NATCAN.

“There is an extraordinary richness of NHS datasets [that] is largely untapped…in clinical care,” Lord Darzi, NHS England 2024 review

There were many positive messages coming out of the data too. We heard about a great example of a positive outlier, and discussed how to share the learning from that unit. Professor Agyarwal concluded by stressing that clinical communities, professional bodies and others from across cancer care now need to use NATCAN’s data to define a new ‘standard of care’ for some measures.

Recent reports from NATCAN

Details of outcomes from England and Wales from the National Cancer Audit Collaborating Centre (NATCAN) published in January 2025 include:

  • National Oesophago-Gastric Cancer Audit (NOGCA) report(care received between 1 Apr 2021 and 31 Mar 2023).
  • National Prostate Cancer Audit (NPCA) report (care received from 1 Jan 2019 to 31 Dec 2023)
  • National Bowel Cancer Audit (NBOCA) report (care received between 1 April 2022 and 31 March 2023).

More data: All cancer, and other, clinical audit and outcome review reports commissioned by HQIP can be found here.

Following on from the presentations, there was an incredibly stimulating discussion led by the Chair, Stella Vig, and the National Clinical Director for Cancer, Peter Johnson (NHS England), together with Ajay Agyarwal. This covered multiple themes including integrating recommendations for GIRFT and registries. Other topics covered were: the need to highlight the influence of factors such as age, frailty and ethnicity; the use of Artificial Intelligence (AI); updating datasets; and the role of consultant job planning in supporting audits.

In summary, it was extremely inspiring to meet with a group of people with such diverse expertise, all of whom have the same aim: better outcomes for patients. For me, what was unique was the interplay and knowledge-sharing between clinicians, data analysts and healthcare civil servants and managers, all working together to better understand the data and recommendations, and identify actionable improvements. By virtue of the nature of the EQG-NCA, patients were not present, but they were very much front and centre of everyone’s minds throughout. Indeed, we concluded with a session concerning patient reported outcomes and experience, and how to better include these when setting up audits.

HQIP may be an obvious vehicle for a series of audit reviews, supporting an evidence-based, multi-disciplinary understanding of care

The aim of this article is to provide insight into what happens at a strategic level with the data that is produced from audits, with cancer care as an example. It is important to share that the evidence and outputs from national clinical audits, outcome reviews and registries play a critical role in understanding the changes needed to improve patient experience and outcomes. Through activities like the EQG-NCA meetings, you can see that this evidence also directly informs the actions needed to achieve that improvement. In other words, to quote Lord Darzi in his NHS England 2024 review, there is an “extraordinary richness of NHS datasets [that] is largely untapped…in clinical care” and, as such, the clinical audit community plays an important role in the NHS’s “roadmap to reform”.

The EQG-NCA has already held similar meetings concerning maternity and neonatal care. However, there are many other areas that could benefit from such reviews and, in fact, this does not have to be achieved through the EQG-NCA. Indeed, if we all work together outside of – but complementing the work of – this group, we could include service users and a more diverse group of healthcare professionals. On further reflection, given the success of this cancer themed meeting, HQIP may be an obvious vehicle for a series of such audit reviews, supporting an evidence-based, multi-disciplinary understanding of care related to a range of areas. These could include clinical disciplines, ranging from COPD to diabetes, as well as hospital-specific themes such as intensive care and paediatrics. Perhaps the way forward is to gather together an association of the willing, but possibly not so easily heard, to involve a wider, more diverse group of colleagues who, I am sure, have great ideas but need a forum for their release?

I hope you agree that building on the success of meetings such as this cancer review would be a very worthwhile and productive venture. I, for one, would embrace a platform where colleagues from across the healthcare system can work together to pool their collective knowledge – supported by clinical audit outputs – to contribute to a national approach to improved health outcomes for everyone through evidence-informed, patient-centred quality improvement (which just happens to be HQIP’s vision!). Watch this space…

Notes

1) Source: Cancer Research UK (2017-2019) – www.cancerresearchuk.org/health-professional/cancer-statistics-for-the-uk.

2) Audits included in the National Cancer Audit Collaborating Centre (NATCAN):

Added in 2023

Pre-2023

3) Organisations represented at the February 2025 meeting of the Executive Quality Group National Clinical Audit (EQG-NCA):