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. It will bring all cancer audits together under one umbrella for the first time. The aim is to strengthen NHS cancer services by examining data on treatment and patient outcomes, in order to improve quality and results. It has been commissioned to produce new cancer audits by the Healthcare 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). The CEU brings together the best clinicians (the doctors on the front line against cancer who know what the problems are) and the best academics (the data scientists and statisticians who can interpret the results generated by the data in the most effective way). It has already been working on cancer audits for more than 15 years.
FAQs for Professionals
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:
Stimulate improvements in cancer detection, treatment and outcomes including survival
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
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 Lung Cancer Audit (NLCA)
National Prostate Cancer Audit (NPCA)
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.
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).
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.
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.
The design and delivery of the audits in NATCAN has been informed by our experience of delivering national audits in the Clinical Effectiveness Unit, built up since its inception in 1998. Key features of all audit projects within the CEU include:
- Close clinical-methodological collaboration
- Use of national existing linked datasets as much as possible
- Close collaboration with data providers in England (National Disease Registration Service [NDRS], NHS Digital [NHSD]) and Wales (Wales Cancer Network [WCN], Public Health Wales [PHW])
- A clinical epidemiological approach, informing quality improvement activities.
- “Audit” informed by “research”.
All these features will support NATCAN’s focus on the three “Rs”, ensuring that all its activities are clinically relevant, methodologically robust, and technically rigorous.
Each individual cancer audit is jointly led by two clinical leads, representing the most relevant professional organisations, and senior academics with a track record in health services research, statistics, data science and clinical epidemiology, affiliated to the London School of Hygiene and Tropical Medicine.
In addition, each audit will have a clinical fellow, who contributes to all aspects of the audits, reinforcing the audits’ clinical orientation and contributing to capacity building.
The delivery of the audit is coordinated by an audit manager who is supported by NATCAN’s wider infrastructure. Data scientists with experience in data management and statistics, and methodologists with experience in performance assessment and QI, work across audits.
This organisation creates “critical mass” and an audit capacity that is able to respond to the requirements of the funders (NHS England and Welsh Government), and to the wider stakeholder “family”.
In order to reduce the burden on hospital staff, the audits in NATCAN do not ‘collect’ clinical data which aligns with HQIP’s Guidance for Data Burden Reduction. 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.
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.
All NHS Trusts in England and Health Boards in Wales that provide cancer services.
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.
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
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]
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.
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.
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.
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.
NAoPri and NAoMe are included in the Quality Accounts list from 2023/24.
NKCA, NPaCA, NOCA and NNHLA will be included from 2024/25.
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.
FAQs for Patients
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. It will bring all cancer audits together under one umbrella for the first time. The aim is to strengthen NHS cancer services by examining data on treatment and patient outcomes, in order to improve quality and results. It has been commissioned to produce new cancer audits by the Healthcare 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). The CEU brings together the best clinicians (the doctors on the front line against cancer who know what the problems are) and the best academics (the data scientists and statisticians who can interpret the results generated by the data in the most effective way). It has already been working on cancer audits for more than 15 years.
NATCAN includes six new national cancer audits in breast cancer (primary and metastatic), ovarian, pancreatic, non-Hodgkin lymphoma and kidney cancer. These audits will cover roughly 90,000 newly diagnosed patients each year. The CEU has already delivered clinical audits in prostate, lung, bowel, oesophageal and stomach cancer, and it recently completed an audit of breast cancer in older patients. Over the next few years all these audits will become part of NATCAN. The aim is to deliver closer collaboration and better results, sharing learning and best practice.
NATCAN, comprising six new audits, is funded by NHS England and the Welsh Government, with £5.4m for an initial period of three years.
NATCAN is all about effective collaboration. Bringing senior doctors and academics together will ensure that we ask the right questions about cancer care and treatment, and then use the right methods to answer those questions. We’ll also work closely with different stakeholders including patient groups, to try to ensure that more people recover from cancer and lead longer healthier lives.
Clinical audit is a method that healthcare professionals use to look at and improve patient care. They compare how patients are treated, and the outcomes of the care they receive, against set standards and guidelines.
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 audits which have already been delivered have 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.
It’s important to remember that not all cancers are the same. So, we need to focus on each type of cancer individually. For example, over 70% of patients diagnosed with primary breast cancer will still be alive after ten years, but only 5% of patients diagnosed with pancreatic cancer will survive for ten years. We need to try to improve that.
We use information about patients that is collected by national organisations in England and Wales. These organisations include the National Cancer Registration and Analysis Service (NCRAS) in England and the Wales Cancer Network. They are allowed to collect data on patients diagnosed with cancer, the treatments they receive, and the results of these treatments.
No. All the data we use is anonymised, and doesn’t include the names of any individual patients or information such as an NHS number.
Yes. We now have access to more rapid cancer data, which is available three months after diagnosis. More traditional cancer 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 pandemic, and we are already using it to good effect in existing audits, to improve the diagnosis and treatment of patients.
In general terms, what we call the gold standard data is a much richer dataset which gives 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 give us a more sophisticated analysis.
Our audits don’t just examine data about the cancers themselves, they also look at different hospitals and different methods of treatment. That means NATCAN will focus on how cancer care varies from one hospital to another, with the aim of learning lessons and identifying how we can fight different cancers most effectively.
We will make recommendations to hospitals based on our findings, which will include:
- How patients are diagnosed
- The treatments patients receive such as the use of surgery, radiotherapy and/or chemotherapy
- Outcomes following treatment
To make fair comparisons, we also take account of the facts that all patients are different and have different characteristics. Among 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 will work with various patient charities, to create a patient forum for each cancer audit. These patients will help ensure that the questions we ask in the audits 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.
We now have our teams in place, and the next steps are to work with professionals and patients to make sure we ask the right questions and the quality improvement goals for each of the new audits are clear. Once the audit questions have been finalised, and the data has been gathered and analysed, we hope to be publishing results beginning in early 2024. We will also prepare short state-of-the-nation reports for each cancer audit, which will each include five specific recommendations. We aim to publish these reports by September 2024.