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 QualityWatch blog in January 2018 that considered the structure of cancer waiting time targets and how performance has changed over time.
A review of NHS access standards is currently being undertaken. 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, in place of the current standard of seeing a specialist within 14 days. The most recent data presented here is unaffected by the field testing.
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 the most recent year where it declined further. The two-week standard has been missed for the last five quarters. In quarter one (Q1) 2019/20, only 90.2% of patients had their first consultant appointment within two weeks.
Waiting times for patients with breast symptoms were similar to those with suspected cancer between 2010 and 2014. However, over the last four years performance has declined at a faster rate, especially in Q1 of each financial year (April to June). In Q1 2018/19, only 77.5% 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 replaced by a new faster diagnosis standard. This would measure 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. This operational standard has always been met, however performance has declined over time. In Q1 2019/20, 96.1% 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 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 four quarters; in Q1 2019/20, 91.6% 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 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 significantly over time. In Q1 2010/11, 87.5% of patients started treatment within 62 days, compared to 77.8% in Q1 2019/20. 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 six quarters.
As with the 31-day targets, the interim review of NHS access standards proposed that the maximum 62-day wait targets should 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.