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Breaking down changes in NHS cancer waiting times in England

Headshot of Sophia Lowes
by Sophia Lowes | Analysis

17 August 2023

9 comments 9 comments

Doctor looking at a patients notes while the patient sits


You might have seen the headlines this week about changes to cancer waiting time targets in England. But what are cancer waiting times and what do the changes mean for people with cancer?  

Cancer waiting times provide important data on how long it takes for people to be seen by a specialist, receive a diagnosis and get treated for cancer by the NHS.   

They offer clear expectations to people who are urgently referred for suspected cancer, as well as holding the NHS to account on its performance.   

This week, the NHS have announced changes in cancer waiting times standards used in England, following a consultation on their proposed changes last year. The new standards will come into effect later this year. 

What’s changing? 

In England, the NHS are streamlining 10 existing standards into 3 key cancer waiting time standards with associated targets:  

The 28-day Faster Diagnosis Standard (FDS) 

The standard: People should have cancer ruled out or receive a diagnosis within 28 days 

NHS target: 75% of people should meet this standard 

Who does it apply to? 

People who have been urgently referred: 

  • by a GP for suspected cancer  
  • following an abnormal cancer screening result 
  • by a GP for breast symptoms (where cancer is not suspected)  

62-day referral to treatment standard 

The standard: People with cancer should begin treatment within two months (62 days) of an urgent referral 

NHS target: 85% of people should meet this standard 

Who does it apply to? 

People with cancer who have been urgently referred: 

  • by a GP for suspected cancer 
  • following an abnormal cancer screening result 
  • By a consultant who suspects cancer following other investigations (also known as ‘upgrades’) 

31-day decision to treat to treatment standard 

The standard: People with cancer should begin their treatment within a month (31 days) of deciding to treat their cancer 

NHS target: 96% of people should meet this standard 

Who does it apply to? 

  • Anyone who has been diagnosed with cancer, including people who have cancer which has returned. 

Why do the old targets need to be replaced? 

NHS England are retiring one cancer waiting times target, 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, and replacing it with the FDS.  

We support this move, because the 2WW 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.  

Seeing a specialist is only the first step, and before the introduction of the FDS, important information on when people had cancer diagnosed or ruled out wasn’t captured, meaning that we didn’t have a clear idea how long getting a diagnosis actually took. In particular, the FDS benefits those people who don’t have cancer but may have experienced delays in being told definitively that it has been ruled out.  

The reported changes to waiting time targets for England will be helpful for people affected by cancer. The shift to the Faster Diagnosis Standard - moving from ten cancer waiting time targets to three, should set clearer expectations for patients about when they should receive a diagnosis or have their cancer ruled out.

- Naser Turabi, Director of Evidence and Implementation at Cancer Research UK

NHS England are also combining some other targets together to reduce the overall number of standards, including making more patients eligible for the headline 62-day standard by combining three previously separate targets. 

The data and the detail 

While we support the streamlining of cancer waiting times targets, we also want to ensure that this translates into benefits for people affected by cancer. For these new standards to be used meaningfully, they need to be accompanied by high quality data and clear guidance. 

With the introduction of any new way of collecting data, it takes time and effort to iron out data quality issues. To ensure that these targets meaningfully measure progress, there needs to be accurate and comprehensive data and we will be watching closely to make sure this is achieved. For example, for the FDS it is important that all eligible people are captured in the collection and reporting of the data, including all urgent suspected cancer referrals, screening referrals and people with breast symptoms.  

Also, the changes announced will see three individual 62-day standards combined into one. This means that more people are set to be included in the headline 62-day standard. 

However, the guidance is currently unclear about exactly which people consultants should be ‘upgrading’ for suspected cancer after other investigations. There are also some routes which may be harder to track patients through, and it’s not clear whether some people are being missed. 

We want to see NHS England clarify their guidance for local health systems on which people the standards apply to, provide training for staff prior to their introduction and monitor their implementation carefully, in order to ensure the new standards are being used consistently across the country. More needs to be done to develop ways of tracking patients too. This will mean these new targets can be used in the most effective way.  

While streamlining targets is beneficial for focusing efforts, it’s important that we don’t lose any of the richness of insight we currently have. The 2WW target is being replaced at a time when performance against it is among the worst on record – and the target hasn’t been met since May 2020.  

To stop reporting on the 2WW altogether, at a time when services are deteriorating, could see us lose granularity on a part of cancer services which are currently struggling. We would like to see NHS England commit to continuing to collect and report on this part of the pathway in some way going forward. We also need NHS England to maintain the availability of important (anonymised) data breakdowns across all the targets, so we don’t lose the ability to see the performance of the NHS for different patient groups.  

A more ambitious trajectory   

Rapid diagnosis and treatment of cancer can make a difference to the chances of survival. This is why committing to ambitious targets for the time it takes for cancer to be diagnosed is so important.  

The FDS is a step in the right direction, and we’re pleased that NHSE are also looking to make this target more ambitious in the future, increasing the FDS target from 75% to 80% in 2026. In the longer term NHS England should set the FDS target even higher, to ensure even more people will receive a timely diagnosis.   

But targets for cancer are only as good as our ability to meet them.  

Changing the targets will not address the systemic challenges that face cancer treatment and care. Political leadership is required if we’re to make sure these targets are met and then built upon.

- Naser Turabi, Director of Evidence and Implementation at Cancer Research UK

And despite the tireless work of staff right across the NHS, current performance against waiting time targets is among the worst on record  

Cancer waiting time standards are meant to reflect the minimum we expect for cancer patients, and right now in England every cancer target is being missed, and has been missed for years.  

The 62-day target hasn’t been met since 2015, over seven years ago, and currently only 59% of patients are meeting the standard*, well below the target of 85%. The NHS announced today that they are aiming for 70% of patients to begin treatment within two months of their urgent referral by March 2024. It’s positive that the NHS is turning their attention to improving performance against this important standard, but that the aim for this year is significantly below the formal target of 85% is both a reflection of how challenging the current situation is and the need to go further and faster to tackle long cancer waits. 

The challenges facing cancer services are significant and complex, but they are also fixable. 

It is now for the Government to step up and provide the right political leadership on cancer.

That means delivering funding and action to accelerate research, increasing NHS capacity through growing the cancer workforce and investing in key equipment, and developing a more ambitious, strategic approach to cancer backed up with long-term funding.   

 


 

* 59.2% of patients began treatment within 62 days of an urgent suspected cancer referral in June 2023.  

NHS England. Cancer Waiting Times 

    Comments

  • K Singh
    2 January 2024

    There is a significant shortage of staff to support this initiative, and this has been the case for several years. In order to address this issue, we need to provide incentives for individuals to enter relevant radiology and pathology training programs. The shortage of radiologists is a global challenge, and we find ourselves in competition with other first-world nations for the same talent.

    To tackle this problem, I propose that we offer free training to individuals interested in pursuing careers in these fields. This could take the form of a program where the training costs are waived if the individual commits to a certain number of years of service afterward. Alternatively, they could be reimbursed for their training costs upon retirement. Currently, we are spending excessively on agency costs, and investing in training would be a more sustainable and cost-effective solution in the long run.

  • M Clark
    13 September 2023

    Really interested to find out how the transition to 28 days will take place in terms of referrals. Saw GP today with the expectation of being referred as a 2ww, yet I was advised it was 28 days despite the change not coming into play until 1st October. Disconcerting to think that those already over timeframes as they are implemented may get waylaid to ensure the newer referrals get seen to top up the targets as can happen with non cancer RTT pathways. Until earlier this year I worked with patient pathways since they were brought in so look for the loop holes and on the face of it there seems a lot of scope for making them work for the KPI’s not the patients.

  • David Marper
    31 August 2023

    After a bowel screening test in May, I had colonoscopy on 31st May and cancer was diagnosed. It is now nearly September and no treatment offered so far, 3 months from diagnosis. Had 3 telephone appointments cancelled by admin apparently. I have an appointment on the 6th September to be told the results of 3 MDT meetings. Several people did bowel tests after they found out of my diagnosis, 2 had cancer diagnosed, 1 in Portsmouth, 1 in Leeds, and both have had surgery and in recovery now. I am in limbo waiting. So much for urgent treatment

  • Eric Ogilvie
    23 August 2023

    I agree with the comments left by people who have either have or diagnosed with cancer or have close relatives who do. Targets are just that, something that others would like to achieve. The NHS desperately needs more staff to reach targets and do more. This would also need aging equipment constantly needing upgrading. Furthermore, we have heard all this before.

  • Colin Mansbridge
    20 August 2023

    My recent experience has been quite favourable. I had a consultation with my GP on July 4th regarding a wart on my cheek which had gone wild. I had a letter the next day from
    the dermatology department at the Royal South Hants Hospital which stated that I had
    2WW suspected squamous cell carcinoma. I had treatment to remove the wart on 5th
    August. I will have to wait a few weeks to get the result of the biopsy.

  • Marilyn Linda Roebuck
    20 August 2023

    Let us hope this will work better. I was pleased to hear that Consultants in Oncology had taken part in these talks with the Health Secretary.

    We certainly lag behind other countries in our cancer care but we do not pay anywhere near what the people in other countries pay for their service. In France, for example, the people pay 6 percent of their salaries just for health care in addition to all their other taxes and NI equivalents. In Germany it is even higher.

    I find these emails very informative and look forward to reading about the progress being made in the future.

  • Jan Backhouse
    18 August 2023

    I agree in part with this previous comment.
    But investment in medical staffing levels, diagnostic equipment, space treat patients in this huge growth in Cancer diagnosis, will never be achieved until the health system becomes a cross party subject. Every Political party is is only interested in the here and now to gain votes!
    I have been involved in the voluntary sector for 20 years and the cancer growth figures plus the aging baby boom population figures have been available since then and probably longer, but consecutive governments have ignored the need for serious long term planning. Monies designated for the NHS have not been ring fenced for medical staffing and equipment but simply ploughed into middle management by many health authorities to number punch, and sadly my experience is that the figures aren’t even accurate.
    People are resorting to spending their hard earned cash to get tests done Privately, which in turn puts pressure on the private sector, so that their “wait” times are becoming equally distressing.
    This situation, unfortunately is reflected in every department of the NHS. Urgent or emergency appointments are downgraded all the time, in most areas, not just cancer, which is distressing and must be adding to the Mental Health problems the nation is currently “trying” to manage. Again an area that has been hugely under funded and recognised for many years. It has taken a Pandemic to wake us up to this.
    Cradle to Grave no longer applies, in fact for those who are reluctant to speak out reach their grave a lot earlier than they should in some cases.

  • G White
    18 August 2023

    With so many medical professionals taking part in strike action etc is it possible to maintain or achieve any targets or standards ,I am very doubtful of so called targets at the best of times and even more so now.

  • Janette Rawlinson
    17 August 2023

    whilst this may sound good and for many cancers it is – lung cancer in particular is unlikely to meet this 28 day faster diagnosis standard due to pathology samples/biopsies required for treatment taking so long and often usually done after several types of imaging – chest x-ray, CT , PET. This target could well be met for less lethal cancers and it appear that the NHS is doing its job by meeting its target whilst leaving those that have much worse outcomes and in greater numbers continuing to lag other types. the targets are set relatively low at 75 and 85% meaning lots of people could have fairly steady types of skin cancer, prostrate, breast and other types in large numbers meaning the target is achieved whilst others like lung, brain, ovarian and pancreatic failing to reach this target in even small numbers creating this wide chasm between different types of cancers and different parts of the country where Trusts don’t always have access to rapid testing/diagnostic centres.
    So much more is needed in terms of levelling up to bring all parts of the UK up to the same standard. on so many cancer aspects – we don’t need more ways to count/record/monitor/performance manage – we have decades of such data showing that the UK lags other countries. What we need is investment in the short, medium and long term in resources, equipment, scanners, radiotherapy machines, pathology lab capacity and more qualified people to staff them…. targets on their own never achieved anything, People, leadership and a common purpose to improve things for UK patients should be at the heart of any NHS cancer strategy – oh, I forgot that’s been scrapped too by this government! With 1 in 2 of us likely to develop cancer in our lifetimes and several politicians having lost their lives to cancer and government pledges to improve it, these recent decisions on top of the pandemic impact on cancer outcomes and waiting times seem to be pledging the opposite!

    Comments

  • K Singh
    2 January 2024

    There is a significant shortage of staff to support this initiative, and this has been the case for several years. In order to address this issue, we need to provide incentives for individuals to enter relevant radiology and pathology training programs. The shortage of radiologists is a global challenge, and we find ourselves in competition with other first-world nations for the same talent.

    To tackle this problem, I propose that we offer free training to individuals interested in pursuing careers in these fields. This could take the form of a program where the training costs are waived if the individual commits to a certain number of years of service afterward. Alternatively, they could be reimbursed for their training costs upon retirement. Currently, we are spending excessively on agency costs, and investing in training would be a more sustainable and cost-effective solution in the long run.

  • M Clark
    13 September 2023

    Really interested to find out how the transition to 28 days will take place in terms of referrals. Saw GP today with the expectation of being referred as a 2ww, yet I was advised it was 28 days despite the change not coming into play until 1st October. Disconcerting to think that those already over timeframes as they are implemented may get waylaid to ensure the newer referrals get seen to top up the targets as can happen with non cancer RTT pathways. Until earlier this year I worked with patient pathways since they were brought in so look for the loop holes and on the face of it there seems a lot of scope for making them work for the KPI’s not the patients.

  • David Marper
    31 August 2023

    After a bowel screening test in May, I had colonoscopy on 31st May and cancer was diagnosed. It is now nearly September and no treatment offered so far, 3 months from diagnosis. Had 3 telephone appointments cancelled by admin apparently. I have an appointment on the 6th September to be told the results of 3 MDT meetings. Several people did bowel tests after they found out of my diagnosis, 2 had cancer diagnosed, 1 in Portsmouth, 1 in Leeds, and both have had surgery and in recovery now. I am in limbo waiting. So much for urgent treatment

  • Eric Ogilvie
    23 August 2023

    I agree with the comments left by people who have either have or diagnosed with cancer or have close relatives who do. Targets are just that, something that others would like to achieve. The NHS desperately needs more staff to reach targets and do more. This would also need aging equipment constantly needing upgrading. Furthermore, we have heard all this before.

  • Colin Mansbridge
    20 August 2023

    My recent experience has been quite favourable. I had a consultation with my GP on July 4th regarding a wart on my cheek which had gone wild. I had a letter the next day from
    the dermatology department at the Royal South Hants Hospital which stated that I had
    2WW suspected squamous cell carcinoma. I had treatment to remove the wart on 5th
    August. I will have to wait a few weeks to get the result of the biopsy.

  • Marilyn Linda Roebuck
    20 August 2023

    Let us hope this will work better. I was pleased to hear that Consultants in Oncology had taken part in these talks with the Health Secretary.

    We certainly lag behind other countries in our cancer care but we do not pay anywhere near what the people in other countries pay for their service. In France, for example, the people pay 6 percent of their salaries just for health care in addition to all their other taxes and NI equivalents. In Germany it is even higher.

    I find these emails very informative and look forward to reading about the progress being made in the future.

  • Jan Backhouse
    18 August 2023

    I agree in part with this previous comment.
    But investment in medical staffing levels, diagnostic equipment, space treat patients in this huge growth in Cancer diagnosis, will never be achieved until the health system becomes a cross party subject. Every Political party is is only interested in the here and now to gain votes!
    I have been involved in the voluntary sector for 20 years and the cancer growth figures plus the aging baby boom population figures have been available since then and probably longer, but consecutive governments have ignored the need for serious long term planning. Monies designated for the NHS have not been ring fenced for medical staffing and equipment but simply ploughed into middle management by many health authorities to number punch, and sadly my experience is that the figures aren’t even accurate.
    People are resorting to spending their hard earned cash to get tests done Privately, which in turn puts pressure on the private sector, so that their “wait” times are becoming equally distressing.
    This situation, unfortunately is reflected in every department of the NHS. Urgent or emergency appointments are downgraded all the time, in most areas, not just cancer, which is distressing and must be adding to the Mental Health problems the nation is currently “trying” to manage. Again an area that has been hugely under funded and recognised for many years. It has taken a Pandemic to wake us up to this.
    Cradle to Grave no longer applies, in fact for those who are reluctant to speak out reach their grave a lot earlier than they should in some cases.

  • G White
    18 August 2023

    With so many medical professionals taking part in strike action etc is it possible to maintain or achieve any targets or standards ,I am very doubtful of so called targets at the best of times and even more so now.

  • Janette Rawlinson
    17 August 2023

    whilst this may sound good and for many cancers it is – lung cancer in particular is unlikely to meet this 28 day faster diagnosis standard due to pathology samples/biopsies required for treatment taking so long and often usually done after several types of imaging – chest x-ray, CT , PET. This target could well be met for less lethal cancers and it appear that the NHS is doing its job by meeting its target whilst leaving those that have much worse outcomes and in greater numbers continuing to lag other types. the targets are set relatively low at 75 and 85% meaning lots of people could have fairly steady types of skin cancer, prostrate, breast and other types in large numbers meaning the target is achieved whilst others like lung, brain, ovarian and pancreatic failing to reach this target in even small numbers creating this wide chasm between different types of cancers and different parts of the country where Trusts don’t always have access to rapid testing/diagnostic centres.
    So much more is needed in terms of levelling up to bring all parts of the UK up to the same standard. on so many cancer aspects – we don’t need more ways to count/record/monitor/performance manage – we have decades of such data showing that the UK lags other countries. What we need is investment in the short, medium and long term in resources, equipment, scanners, radiotherapy machines, pathology lab capacity and more qualified people to staff them…. targets on their own never achieved anything, People, leadership and a common purpose to improve things for UK patients should be at the heart of any NHS cancer strategy – oh, I forgot that’s been scrapped too by this government! With 1 in 2 of us likely to develop cancer in our lifetimes and several politicians having lost their lives to cancer and government pledges to improve it, these recent decisions on top of the pandemic impact on cancer outcomes and waiting times seem to be pledging the opposite!