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It’s official, NHS England wants to scrap the two-week target for cancer referral and replace it with something else.
The something else is the “faster diagnosis standard” – that 75 per cent of people should receive a diagnosis within four weeks of referral.
It goes without saying in today’s underfunded NHS that the latest results of this measure are the worst since records started.
The irony is that the (hopefully) nadir of this performance measure is the same number as the target for the new “tougher” standard.
At first glance it seems like NHS England just wants to allow twice as long to hit a lower target (four weeks rather than two weeks, 75 per cent against 93 per cent), but an appointment is not the same as a diagnosis.
The consultation document mentions some shocking examples of patients having an appointment that does not feature anything diagnostic, purely to hit the two-week target.
It mentions one (unnamed) gastrointestinal service which saw 99 per cent of patients within a fortnight but less than 20 per cent of those patients received a diagnosis within a month.
There is not enough diagnostic capacity in the NHS (It’s why we’re in the lower half of the table on rich countries’ cancer performance).
Breaking life-changing news to people is also a horrible job. Some trusts have to mandate that time is set aside to do it.
But a gamed target doesn’t mean a target that isn’t worthwhile. It just means it should be measured better.
How long did it take patients seen within two weeks to get their diagnosis? How long did it take patients seen after that to get their diagnosis? Could this data be scrutinised more closely on an ongoing basis, rather than changing the target?
Everyone wants as early a diagnosis as possible, presumably most appointments offered under the two-week pathway do get one quicker.
An obvious perverse incentive of the new system is that services will have twice as long to see someone.
Another is prioritising giving diagnoses to people about to breach the four-week standard ahead of people who are already past that point.
It can be terrible news to break, having it done en-masse to hit a target risks making the process even more impersonal.
Cancer Research UK said that the new target would be more “meaningful”, and it is, but we don’t know if it’s easier or harder. NHS England might, but as usual they are not saying.
CRUK said the target should be the 95 per cent originally proposed in the 2015 cancer strategy but conceded “if all trusts met the 75 per cent target it would be an improvement on where we are now”.
Thanks to the shadow-running of the proposed new target since last April, we have an idea of how big the “if” is. Performance went from 72.9 per cent that first month to 70.5 per cent in December and 63.8 per cent in January. And this is only part of the cancer waits problem.
The consultation on scrapping two-week waits closes early next month.
Not even the worst performer
The NHS missed the two-week target for all of 2019-20 and most of 2018-19, so it wasn’t actually doing as badly as the other main measure, the 62-day wait from GP referral to first treatment hasn’t been hit since December 2015.
The other part of the proposed changes are to this target and the 31-day follow-up targets.
There are seven of these in total: one for first treatment within a month of decision to treat, three that cover different kinds of subsequent treatment and three breaking down referral-to-treatment by the kind of treatment (surgery, drugs, radiotherapy).
The proposal is to replace these with just two targets, 62-days by all routes and the 31-days from decision to treatment.
So less granular targets on how people are treated, and less granular targets on how they get to treatment.
It’s hard to not to be cynical about NHS England’s desire that cancer wait statistics be more “easily understood” by the public. NHS England has now told us it will continue to measure and publish performance against all the existing (ie, soon-to-be scrapped) measures, which will be important to watch.
In that spirit, there are some really important areas where it could add to transparency: It could publish data on follow-ups if it wanted to do that.
It could publish the waiting lists broken down by priority (the P1s, 2s and 3s) if it wanted to do that.
If it wanted to do that – and it doesn’t – it could publish a regional breakdown of where the cancer long wait backlogs are concentrated, and how long they have waited.
Amended on 11 March 11.50am to reflect new information provided by NHS England.