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.
NHS England told trusts that essential cancer treatment must continue during the coronavirus (Covid-19) pandemic, however delays to treatment were widely reported. Modified Cancer Waiting Times guidance was issued which stated that, where capacity was constrained, processes should be in place to prioritise particularly urgent cases, including downgrading or avoiding referrals where possible. At the end of July 2020, as part of the third phase of the NHS response to the pandemic, trusts were asked to fully restore all cancer services.
A Review of NHS Access Standards is being undertaken, but the publication of its recommendations is currently delayed due to the Covid-19 pandemic. 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 trusts will not be subject to performance management against the new standard during the pandemic. 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 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 Q2 2020/21 (July to September 2020), the percentage of patients who had their first consultant appointment within two weeks fell sharply to 88%.
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 Q2 2020/21, only 82% 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. Trusts are not yet subject to performance management against the faster diagnosis standard, due to the Covid-19 pandemic.
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 95.8% of patients waiting less than 31 days for a first treatment for cancer following a decision to treat. In Q1 2020/21, performance fell to 94.7% where it remained constant in Q2 2020/21. The number of patients starting a first treatment for cancer was 17% lower in Q2 2020/21 than in Q2 2019/20 (data not shown), due to disruptions to cancer treatment during the Covid-19 pandemic.
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 and the target has not been met for over two years. In Q2 2020/21 (July to September 2020), during the Covid-19 pandemic, performance declined further. 87% of patients waited less than 31 days for surgery following a decision to treat in Q2 2020/21.
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, and the target has not been met since Q3 2013/14. In Q1 2020/21 (April to June 2020), after the onset of the Covid-19 pandemic, only 73% of patients started treatment within 62 days following an urgent GP referral. In Q2 2020/21, performance recovered slightly to 77%.
Prior to the Covid-19 pandemic, compared to those referred by a GP, a higher proportion of people referred via a national screening service started treatment within 62 days. However, performance worsened over time, and the target has not been met for over two years. In Q1 2020/21, the percentage of patients starting treatment within 62 days following referral from a national screening service fell dramatically to 62%, increasing only slightly to 64% in Q2 2020/21. The absolute number of patients starting treatment following referral from a screening service fell from 5,529 in Q2 2019/20 to 1,356 in Q2 2020/21 – a 75% drop (data not shown). This follows cancer screening services being paused during the first national lockdown.
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.