The must-read stories and debate in health policy and leadership.

From December, NHS England will start its new method for measuring patient waiting times for cancer diagnosis and treatment.

The regulator has changed the way that 62 day breaches are shared between multiple providers involved in the patient’s care.

If the trust that diagnoses a patient will not be treating him or her, it must now refer them to the second provider within 38 days. The “treating provider” then has 24 days to start treatment, so the 62 day referral to treatment target can be met overall.

NHS England told HSJ that the new process is intended to increase transparency and clearly show where delays in the system are occurring.

However, the new system has raised concerns among some providers.

Sources have told HSJ that 24 days may be unachievable for the treating provider and the new system may also mask very poor performers. We have also been told it could create a perverse incentive for treating trusts to send patients back to diagnosing providers, so that their part of the waiting target is broken, and therefore the target breach is split.

The concerns illustrate just how hard it can be to show where and when patients are being let down by providers during diagnosis and treatment.

Cancer charities also said the change would not improve care overall because the system does not address underfunding, which they believe is at the root cause of 62 day breaches.

Staff shortages prompt toughest of questions

A small NHS hospital considered suspending all its elective procedures – including cancer patients and those deemed clinically urgent – under emergency proposals to address significant nursing shortages.

Queen Elizabeth King’s Lynn Hospital Foundation Trust, placed in special measures earlier this month, discussed the proposal on Tuesday.

The trust ultimately opted to avoid this most unpalatable option which would have seen the closure of 24 elective beds and around 25 operations a week cancelled for the next six months.

It instead drew up plans which could still see routine procedures postponed but has ensured cancer and urgent operations are protected. Read here for further details.

In an indication of how serious the proposal to cancel cancer operations was, the paper outlining the option revealed the trust had held “initial discussions” with neighbouring tertiary centres about transferring urgent and cancer patients.

QEKL has long struggled due to its isolated geographical location and modest catchment population. But it is not the only small rural hospital in the NHS and its current predicament may not prove unique this winter