Shorter cancer waiting times can lead to earlier diagnosis, faster treatment, a lower risk of complications, an enhanced patient experience and improved cancer outcomes. The cancer pathway in the NHS, from urgent GP referral to first treatment for cancer, is currently spanned by eight operational standards. Here we look at how the NHS in England has performed against these standards in each quarter since 2009.
The most recent data presented here are from Q4 2019/20 (January to March 2020). Data from March 2020 will be affected by the coronavirus (Covid-19) outbreak. Trusts were told that essential cancer treatment must continue, however some delays to treatment have been reported. Modified Cancer Waiting Times guidance was issued which states that, where capacity is constrained, processes should be in place to prioritise particularly urgent cases, including downgrading or avoiding referrals where possible.
A Review of NHS Access Standards is being undertaken, but the publication of its recommendations is currently delayed due to the Covid-19 outbreak. The Interim Report proposed a simplification to three standards for cancer, one of which would be a new faster diagnosis standard. Eleven hospital trusts began testing the use of a 28-day faster diagnosis standard in late August 2019, in place of the current standard of seeing a specialist within 14 days. This new standard was introduced in April 2020, however NHS trusts will not be subject to performance management against the new standard during the Covid-19 outbreak. The adoption of the other two proposed standards for cancer will depend on the proposals set out in the review’s final publication.
Cancer waiting times data were explored in a blog in January 2018 that considered the structure of the targets and how performance has changed over time.
The target relating to the first part of a patient's journey states that, following an urgent GP referral for suspected cancer, at least 93% of patients should be seen by a specialist within two weeks. The standard is the same for patients with breast symptoms (where cancer is not initially suspected).
Between 2009 and 2014, the percentage of people with suspected cancer having their first consultant appointment within two weeks of an urgent GP referral fluctuated at around 95%. After this, performance dropped slightly to about 94%, until 2018 where it declined further. The two-week standard has been missed for the last two years. In Q4 2019/20 (January to March 2020), only 92% of patients had their first consultant appointment within two weeks.
Between 2010 and 2014, waiting times for patients with breast symptoms were similar to those with suspected cancer. However, over the last four years performance has declined at a faster rate, especially in Q1 of each financial year (April to June). In Q4 2019/20, only 86% of patients with breast symptoms had their first consultant appointment within two weeks of an urgent GP referral.
In April 2020, a new faster diagnosis standard was introduced. This measures a maximum 28-day wait for patients to be told whether or not they have cancer after an urgent referral from their GP or a cancer screening programme.
There are three main types of treatments for cancer: drug therapy, radiotherapy and surgery. It is common for cancer patients to need more than one treatment, which could be a combination of several episodes of one type of treatment, or a combination of multiple types.
The target, for all cancer treatment types, is for at least 96% of patients to start a first treatment for a new primary cancer within one month (31 days) of the decision to treat. Performance has declined over time, and this operational standard was missed for the first time in Q4 2019/20 (January to March 2020), with 95.9% of patients waiting less than 31 days for a first treatment for cancer following a decision to treat.
The anti-cancer drug regimen target (operational standard: 98%) and radiotherapy target (operational standard: 94%) have both consistently been met since they were introduced. Performance against the surgery target (operational standard: 94%), however, has declined since 2014. The surgery target has been missed for the last seven quarters; in Q4 2019/20, 90.9% of patients waited less than 31 days for surgery following a decision to treat.
The interim review of NHS access standards proposed that the four cancer treatment standards would be brought together into one simplified standard. This implies that there would be one operational threshold for the maximum one-month (31-day) wait from decision to treat to starting any cancer treatment.
The target that spans the patient pathway is for at least 85% of patients to start a first treatment for cancer within two months (62 days) of an urgent GP referral. Patients who are referred from an NHS cancer screening service should also start treatment within 62 days, but the operational threshold is set at 90%.
The proportion of patients waiting less than two months to start cancer treatment following an urgent GP referral has decreased considerably over time. In Q4 2008/09, 87% of patients started treatment within 62 days compared to 76% in Q4 2019/20 (January to March 2020). A higher proportion of people referred via a national screening service start treatment within 62 days, but performance has worsened over time and the target has not been met for over two years. Performance against both targets fell to the lowest levels since records began in Q4 2019/20.
As with the 31-day targets, the interim review of NHS access standards proposed that the maximum 62-day wait targets be brought together into one simplified standard.
About this data
These indicators use data from NHS England that are derived from patient records held on the Cancer Waiting Times Database. The national levels of activity and performance are provider-based figures. For further information outlining the methodology, please see the NHS England website.