NHS England to replace cancer targets

After piloting a new measure which aims to see 75 per cent of patients given the all-clear or a diagnosis within 28 days of referral, NHS England has recommended .The new “faster diagnosis target” would replace the current ’two-week wait’ target, which is for 93 per cent to have seen a specialist within two weeks, but not necessarily had a diagnosis.

This proposal, and other changes to the way cancer waiting time targets are organised, will be consulted on until 6 April.

The nine current cancer targets were created in 2000. The current headline measure along with the two-week wait — a two-month wait from urgent GP referral to first treatment — has not been hit since December 2015.

The document containing the proposals said the current two-week standard saw some patients given an appointment at which no test was taken, purely to hit the target. For some suspected cancers, ”many trusts… offer outpatient appointments to ensure they hit the target”, without improving diagnosis.

The document said: “In some trusts, two-week-wait performance can be over 99 per cent on the lower gastrointestinal pathway, with fewer than 20 per cent of the same patients ultimately receiving a diagnosis within 28 days.”

The two-week referral target has not been met since February 2019, and the NHS has this month missed by a large margin a deadline set last year to return its cancer treatment backlog to pre-pandemic levels, as services struggle to keep up with demand.

The move to scrap the two-week wait was welcomed – with significant caveats — by Cancer Research UK, which said the 75 per cent bar on the new target was not exacting enough. NHSE’s document does not propose percentage performance targets for the new measures, but the FDS has so far been set at 75 per cent.

CRUK chief executive Michelle Mitchell said: “The new Faster Diagnosis Standard is a more meaningful target than the current two-week wait that will hopefully improve early diagnosis. If all trusts met the 75 per cent target, it would be an improvement to where we are now. However, in the long-term to improve cancer survival, we’d like to see a 95 per cent target originally proposed in the 2015 cancer strategy in Sajid Javid’s upcoming 10-year plan for cancer.

“We recognise the target was set lower because of a shortage of cancer specialists, critical to diagnosing cancer across the NHS. The government must provide the extra investment they have promised to grow the NHS workforce. Every moment of delay risks more people waiting for diagnosis and treatment.”

The health secretary this week confirmed there would be no extra money to fund a forthcoming long-term workforce plan will have to come from existing budgets.

At present there are nine separate cancer waiting time standards. Seven of these cover parts of the treatment pathway, including, for example, separate measures for surgery, radiotherapy and chemotherapy treatments.

NHS England’s proposals would consolidate all nine targets into three. 

These would be:

• As described above, the faster diagnosis standard replacing the “two week wait”. This would be a “maximum 28-day wait to communication of definitive cancer/not cancer diagnosis for patients referred urgently (including those with breast symptoms) and from NHS cancer screening”
• Maximum two-month (62- day) wait to first treatment from urgent GP referral (including for breast symptoms) and NHS cancer screening
• Maximum one-month (31- day) wait from decision to treat to any cancer treatment for all cancer patients

NHS England national cancer director Dame Cally Palmer said: “As we see advances in diagnosis and treatments for cancer, it is only right that these standards are modernised.” NHSE’s document said testing of the new measures had been successful.

This could obscure variation in performance by including high volume treatments like radiotherapy alongside surgery.

The most recent national data showed a performance on the 31-day wait from a decision to treat to first treatment with anti-cancer drugs was 98.9 per cent, while the same measure where the treatment was surgery was 83 per cent – a record low and 8.7 percentage lower than the same period in 2019.