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.
These data were explored in a blog in January 2018 that considered the structure of cancer waiting time targets and how performance has changed over time.
In March 2019, an interim clinically-led review into NHS access standards was published that put forward some significant changes to the current standards for cancer. This included a simplification to three proposed standards, with a focus on improving the time to diagnosis for urgent referrals.
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 of the referral. The standard is the same for symptomatic breast patients (where cancer was not initially suspected).
Between 2009 and 2014, the percentage of people with suspected cancer having their first consultant appointment within two weeks fluctuated at around 95%. Since then, performance has declined, particularly in the most recent three quarters, where the standard was missed and an average of 92% of people had their first consultant appointment within two weeks.
Waiting times for symptomatic breast patients were largely similar to those with suspected cancer between 2010 and 2014. However, over the last four years performance has dropped, especially in quarter one (Q1) of each financial year (April to June). In Q1 2018/19, only 84% of patients with breast symptoms had their first consultant appointment within two weeks of an urgent GP referral.
According to the interim clinically-led review of NHS access standards, the two-week wait standards may be removed and replaced by a new Faster Diagnosis Standard. This would measure a maximum 28-day wait to communication of a definitive cancer/not cancer diagnosis for patients referred urgently (including those with breast symptoms) and from NHS cancer screening.
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. This operational standard has always been met, however performance has declined over time. In Q3 2018/19, 96.7% of patients waited 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 their introductions. Performance against the surgery target (operational standard: 94%), however, has declined since 2014. The surgery target has been missed for the last two quarters; in the most recent (Q3 2018/19), 93.1% of patients waited less than 31 days for surgery following a decision to treat.
Note that the interim clinically-led review of NHS access standards has proposed that the four existing treatment standards will 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 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 a GP urgent 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 significantly over time. In Q3 2012/13, 88% of patients started treatment within 62 days compared to 79% in Q3 2018/19. 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 been missed for the last four quarters.
As with the 31-day targets, the interim review of NHS access standards has 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.