Introduction

This quality standard covers the prevention, assessment, diagnosis and management of skin cancer (malignant melanoma and non-melanoma) in children, young people and adults. For more information see the skin cancer topic overview.

NICE quality standards focus on aspects of health and social care that are commissioned locally. Areas of national policy, such as changes to national commissioning arrangements and legislation, are therefore not covered by this quality standard.

Why this quality standard is needed

There are 2 main groups of skin cancer: malignant melanoma, which can prove fatal, and non-melanoma skin cancers (main types: squamous cell carcinoma and basal cell carcinoma), which are rarely fatal. Over the past decade the incidence of malignant melanoma in the UK has increased by almost 50%. There were about 14,500 new cases of malignant melanoma in the UK in 2013.

Non-melanoma skin cancers are much more common than malignant melanomas, but because of current registration practices their true number is significantly underestimated.

The quality standard is expected to contribute to improvements in the following:

  • skin cancer prevention

  • skin cancer awareness

  • early diagnosis of skin cancer

  • skin cancer referrals

  • appropriate excisions of skin cancer

  • skin cancer survival

  • patient experience.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS outcomes framework 2016–17

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults

1b Life expectancy at 75

i Males ii Females

Improvement areas

Reducing premature mortality from the major causes of death

1.4 Under 75 mortality rate from cancer*

i One-year survival from all cancers

ii Five-year survival from all cancers

v One-year survival from cancers diagnosed at stage 1&2**

vi Five-year survival from cancers diagnosed at stage 1&2**

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

3 Helping people to recover from episodes of ill health or following injury

Overarching indicators

Improvement areas

Improving outcomes from planned treatments

3.1 Total health gain as assessed by patients for elective procedures

i Physical health-related procedures

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

4b Patient experience of hospital care

4c Friends and family test

4d Patient experience characterised as poor or worse

i Primary care

ii Hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to inpatients' personal needs

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5b Severe harm attributable to problems in healthcare

Improving the culture of safety reporting

5.6 Patient safety incidents reported

Alignment with Public Health Outcomes Framework

* Indicator is shared

** Indicator is complementary

Indicators in italics in development

Table 2 Public Health Outcomes Framework 2016–19

Domain

Objectives and indicators

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.19 Cancer diagnosed at stage 1 and 2*

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.5 Under 75 mortality rate from cancer*

Alignment with NHS Outcomes Framework

* Indicator is shared

Safety and people's experience of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services relevant to skin cancer.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to people using services. Quality statements on these aspects of patient experience are not usually included in topic-specific quality standards. However, recommendations in the development sources for quality standards that affect people's experience of using services and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for skin cancer specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole skin cancer care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to people with skin cancer.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality skin cancer service are listed in related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people with skin cancer should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development sources on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with skin cancer. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.