Breaking down the new standards for cancer care proposed by NHS England

An empty hospital hallway

Cancer waiting times provide data on the waiting times of people being seen by a specialist and treated for cancer by the NHS.

These figures have been important in offering clear expectations of how long people being urgently referred for suspected cancer should wait to see a specialist for the first time and for all cancer patients to begin treatment.

This week, NHS England published a report which has proposed shifts in cancer waiting times standards.

In April last year, the NHS in England began reporting on a new measure called the Faster Diagnosis Standard (FDS). This was recommended in the 2015 cancer strategy as a way of measuring a part of the pathway that was previously not captured and had often been taking a long time; having tests, receiving the results and ultimately a diagnosis.

And since October 2021, Trusts have been measured on this Faster Diagnosis Standard which requires that patients on certain cancer-related referrals are receiving a diagnosis, or having cancer ruled out, in 28 days.

As currently proposed, the NHS has set a target for 75% of patients getting a cancer diagnosis, or having cancer ruled out, within 28 days of being urgently referred by their GP for suspected cancer, being referred because of breast symptoms, or having been picked up through cancer screening.

For a few months, the FDS has been running alongside the cancer waiting times targets that have been around for a while.

NHS England are now proposing that one of the cancer waiting times targets, the 2 Week Wait (2WW), which aims for people with suspected cancer to see a specialist within 14 days of being urgently referred by their GP or a cancer screening programme, is replaced by the FDS.

The publication of the report kick-starts a 4-week consultation period which provides the opportunity for patients, clinicians, charities and the public to share their views on the proposed standards over the next month.

We believe that the proposed changes are a big step in the right direction as they focus on tangible outcomes for cancer patients rather than processes. They could play an important role in driving improvements and capacity in diagnostic services.

There are currently 9 separate performance standards for cancer. The standards aim to streamline the current existing targets into 3 key targets:

  • The 28-day FDS – People who have been urgently referred for suspected cancer, have breast symptoms, or have been picked up through cancer screening, have cancer ruled out or receive a diagnosis within 28 days.
  • A 62-day referral to treatment standard – Patients who receive a cancer diagnosis after an urgent suspected cancer referral, referral for breast cancer symptoms, or via cancer screening should start treatment within 62 days of that initial referral.
  • A 31-day decision to treat to treatment standard – Patients, regardless of how they came to be diagnosed with cancer, should receive their first treatment within a month of a deciding to treat their cancer.

do the old targets need to be replaced?

Right now, a key target is for people with suspected cancer to see a specialist within 14 days of being urgently referred by their GP or a screening programme, often referred to as the 2WW target. However, this doesn’t set expectations for how long someone will wait to have any tests they need, for the test results to come back, and for them to be told whether or not they have cancer.

Being referred for suspected cancer can be an anxious time and the 2WW target around seeing a specialist helped to ensure that many people got seen by a specialist quickly.

However, seeing a specialist is only the first step, and many people with cancer need to have tests, and receive test results, and sometimes even further tests and test results in order to get a diagnosis.

Before the introduction of the FDS, this important information wasn’t captured, meaning that no one had a clear idea how long it all took, and the targets were not providing an incentive to make this part of the cancer pathway go quicker.

“The new Faster Diagnosis Standard is a more meaningful target than the current 2-week wait that will hopefully improve early diagnosis,” says Michelle Mitchell, our chief executive.

Latest Cancer Waiting Times

Many of the targets set by NHS England have not been met for some time. Figures released yesterday show that for January 2022 (amid winter challenges and a surge in the Omicron variant), the 2-week wait was met for just 75% of patients, despite the current target being set at 93%. The FDS, which is already being used by NHS England, also missed its 75% target, with 64% of patients being diagnosed or having cancer ruled out within 28 days of an urgent suspected cancer referral.

“Despite the tireless work of NHS staff, performance against targets has again hit a record low. More people than ever before are facing unacceptably long waits for vital cancer tests and treatment,” says Mitchell.

“If all trusts met the 75% target, it would be an improvement to where we are now.”

A more ambitious trajectory

Cancer that’s diagnosed at an early stage, when it isn’t too large and hasn’t spread, is more likely to be treated successfully.

This is why committing to ambitious targets for the time it takes for cancer to be diagnosed is so important.

While the FDS is a step in the right direction, in the longer term we hope that NHS England will set the FDS on a more ambitious trajectory, raising the target to the 95% target initially proposed in the 2015 Cancer Strategy for England, to ensure even more patients will receive a timely diagnosis.

Even to achieve the proposed standard of 75% for FDS, many patients will need to be seen by a specialist much sooner than 14 days, but without investment to grow the workforce and clarity about how the chronic workforce shortages are going to be addressed, this is going to be very difficult for Government and the NHS to deliver.

If these targets are to meaningfully contribute to the vision to improve cancer outcomes in Health Secretary Sajid Javid’s upcoming 10-year plan for cancer, it is now up to the Government to provide the extra investment they have promised to expand the NHS workforce.

“We recognise the target was set lower because of a shortage of specialists critical to diagnosing cancer across the NHS. The Government must provide the extra investment they have promised to grow the NHS workforce,” says Mitchell.

“Every moment of delay risks more people waiting for diagnosis and treatment.”

Although there are some challenges in the NHS right now, if you notice any changes to your health that are not normal for you or aren’t going away, tell you doctor.

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