Breaking down changes in NHS cancer waiting times in England

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.  

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.  

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