Shorter cancer waiting times can lead to earlier diagnosis, faster treatment, lower risk of complications, enhanced patient experience and improved cancer outcomes.
During the coronavirus (Covid-19) pandemic, NHS England told trusts that essential cancer treatment must continue. 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. As Covid-19 cases rose in winter 2020-21, there were further reports of cancellations to urgent cancer treatments. In March 2021, local systems were asked to fully restore all cancer services and ensure there was sufficient diagnostic and treatment capacity. Leaked data showed that by the end of July 2022 there were 327,395 people on the cancer waiting list, and around 3% had waited 104 days or more.
A review of NHS Access Standards was undertaken in 2022, and the final recommendations proposed to water down the list of cancer waiting standards from nine to three from October 2023 onwards. This was done to ensure that the standards retain only those measures which are clinically relevant and important to patients. Here, we look at how the NHS in England performs against these standards.
Wait time for a cancer diagnosis
A newly proposed target set by NHS England in April 2021 mandated faster diagnosis by March 2024, such that at least 75% of patients either receive a cancer diagnosis or have it ruled out within four weeks (28 days) of an urgent GP referral. This target was expected to be met from October 2021 onwards, but the NHS delivery plan pushed the ambition to meet the target back to March 2024. In August 2023, it was decided that 75% would be set as the operational standard.
Between April 2021 and January 2022, the proportion of patients waiting less than four weeks to receive a cancer diagnosis went from 73% to 64%. The operational standard of 75% was met for the first time in February 2022, and then again in February 2023, but the performance wasn’t sustained. In November 2023, 72% of patients waited less than four weeks to receive a cancer diagnosis.
Waiting for a diagnosis can be a very stressful experience for patients and their loved ones, making reduced wait times helpful in alleviating patients from needless worry if cancer is not detected. Alternatively, it can result in early detection and shorter time to begin treatment.
Wait time for cancer treatment following decision to treat
The review of access standards concluded that 96% of patients should wait for less than a period of one month (31 days) from a decision to treat to any first cancer treatment. This standard is applicable from October 2023 onwards. Between April 2022 and November 2023, the proportion of patients waiting less than one month to receive any first cancer treatment decreased slightly from 93% to 90% – short of the standard by 6 percentage points, as of November 2023.
Wait time for cancer treatment following referral/screening
The review of access standards concluded that 85% of patients should wait for less than a period of two months (62 days) from a GP urgent referral, NHS cancer screening, or consultant upgrade to any first cancer treatment. This standard is applicable from October 2023 onwards. Between April 2022 and December 2022, the proportion of patients waiting less than one month to receive any first cancer treatment decreased slightly from 69% to 66%. In January 2023, there was a sharp drop to 59%, after which it has fluctuated slightly. In November 2023, 65% of patients waited for less than 2 months for cancer treatment following referral/screening – short of the standard by 20 percentage points.
Wait times for cancer pathways (old standards)
For the first part of a patient's journey, an old target 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%. From 2015 to 2018, average yearly performance dropped slightly to about 94%, after which it has declined year on year. The two-week standard has not been met since Q4 2017/18 (January to March 2018). In Q4 2022/23 (January to March 2023), 84% of patients had their first consultant appointment within two weeks.
For the second part of a patient's journey, on old target states that 96% of patients should start any type of treatment for a new primary cancer within one month (31 days) from the decision to treat. Up until Q3 2019/20 (October to December 2019), the target was met. Since then, performance has fallen to 91% in Q4 2022/23.
Based on an old target, the entire process of a patient’s journey from an urgent GP referral to starting their first treatment for cancer should take place within two months (62 days) for 85% of the patient population. The proportion of patients waiting less than two months to start cancer treatment following an urgent GP referral has decreased significantly over time, from 87% in Q4 2008/09 to 59% in Q4 2022/23 – the worst performance since records began. The target has not been met since Q3 2013/14.
About this data
These indicators use data from NHS England 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.
During the review of NHS access standards, performance of the field test sites continued to be included in the national time series, so data is unaffected by the field testing. Data on the new Faster Diagnosis Standard has been included in the cancer waiting times publication since April 2021. Recommendations for the clinically-led review of NHS cancer standards published in August 2023 can be found here.