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Five steps to getting cancer diagnostics back on track

Alice Hilborn, a policy advisor at Cancer Research UK
by Alice Hilborn | Analysis

13 May 2024

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This photo shows a mammographer with a patient, wearing a hospital gown, before a mammogram.
©Patrick Harrison 2024

Tests, checks and scans are essential to almost every person that interacts with the NHS. They’re vital tools in figuring out what is wrong with a patient and the best way to treat them.  

This is particularly true for cancer. Getting the right tests to patients in the right place, at the right time is crucial – as for some cancers, just a few weeks can make the difference between whether or not a cancer has progressed, and therefore the treatment options available.  

But too many people are waiting too long to be diagnosed with cancer.  

Cancer waiting times are the targets that the Government and the NHS set for how long people should wait to have their cancer diagnosed and to start treatment. There are similar targets for how long anyone should wait for a diagnostic test. They are not the ‘gold standard’, but rather represent the minimum that people who might have cancer should expect.  

Given this, it’s really worrying that, despite some progress, the last time all cancer waiting times targets were met in England was in 2015. In February alone, around 2,100 people in England had to wait more than 104 days after an urgent cancer referral to start their treatment, despite the target being 62 days.   

Behind these missed targets are patients – as well as their friends, family and loved ones – who are facing unacceptably long and anxious waits to find out if they have cancer and when they can begin treatment. 

With a UK General Election on the horizon, we have set out our recommendations to deliver change in A Full Diagnostic. Below we summarise what’s holding us back, and highlight five things a post-election UK Government could do to get diagnostics back on track.  

1 – Reform of the UK Government’s approach to investment in health 

The UK’s spending on the buildings and equipment needed to provide healthcare, known as ‘capital spending’, has long lagged behind our near neighbours. This has a direct impact on patients as it limits the amount of money that can be spent on diagnostic equipment.  

For example, the UK is near the bottom of the rankings compared to similar countries when we look at the number of CT and MRI scanners. The same is true for more advanced PET-CT scanners. Our digital infrastructure is also in desperate need of improvement to drive productivity and allow us to get the most from data.  

We’ve seen positive steps made by the UK Government on capital investment in England recently through the Community Diagnostic Centre (CDC) programme and commitments in the Spring Budget on IT and AI tools. But for this ambition to be realised, it needs to be matched by long-term, strategic investment.  

For too long capital investment hasn’t delivered for the NHS in England. If we want to offer patients more advanced tests and more quickly, not only do we need to invest more – we also need to see reforms to the approach to NHS capital investment so we’re making the most of every pound. 

2 – Improve workforce planning for diagnostic services 

The NHS would be nothing without its staff. And diagnostic services are supported by a dedicated and highly skilled workforce, but there simply aren’t enough staff to meet growing patient need.  

The NHS England Long Term Workforce Plan took a long-needed strategic approach to workforce planning, but it doesn’t go far enough to consider the many specialist roles essential to cancer diagnosis and care.  Cancer Research UK workforce modelling suggests that we will need to train or recruit enough people to fill 16,000 full-time posts to meet the targets set out by Health Education England back in 2017. That includes key diagnostic professions like radiographers and pathologists.  

It’s not just having enough staff, they also need the right skills to meet changing patient needs. However, numerous barriers exist in upskilling staff such as a lack of funding for professional development and not enough time to do training.  

To ensure we have the right staff with the right skills we need to have a specific cancer workforce plan. This plan should consider the specialities essential to the diagnosis of cancer such as endoscopy, pathology and radiology.  

3 – Setting up screening programmes for success  

Screening can help spot cancers at an early stage, when treatment is more likely to be successful and the chances of survival are much better. But currently, the potential of screening is being held back by a lack of diagnostic capacity.  

For example, England has committed to rolling out a targeted lung cancer screening programme, but it won’t reach full coverage until 2030. This slow roll out is in part due to a lack of sufficient staff, equipment and digital infrastructure to support it. Our provisional estimates indicate that at least 1,500 lung cancer deaths could be avoided in England each year with a 50% uptake of the national lung screening programme , so it’s important that the programme is fully rolled out as quickly as possible.  

To ensure that screening can have the biggest possible impact on the earlier diagnosis of cancer, we must invest in current programmes as well as prepare the system for the innovations of the future.  

4 – Prepare the health system for the adoption of innovation 

The rate of innovation in diagnostics is staggering, and we could soon be seeing genomics and AI tools changing the way we understand disease and how patients are diagnosed. But without getting the basics right and creating a clear pathway for the adoption of these innovations into the health system, we won’t be able to take full advantage.  

Innovation can also help unlock capacity, making services more efficient and improving staff productivity. For example, even in the short term, AI tools could see computers taking on simple routine tasks and assisting clinicians with decision-making, helping to free up clinician time to focus on patients.  

Currently, the pathway from bench to bedside for many innovative technologies is slow and convoluted. For example, currently, there is ad hoc trialling, evaluation and implementation of AI technologies without national coordination or guidance on things like cost-effectiveness criteria. If the UK Government can optimise the innovation process, it could make the country a world-leader in pioneering new tools and technologies that detect cancer more effectively.   

5 – Take a strategic approach to diagnostics

 In his 2020 Review of Diagnostic Services, Professor Sir Mike Richards reported that diagnostic services were already at a ‘tipping point’ where they were no longer able to keep up with demand. Since then, there has been significant progress, but challenges remain, and new innovations means that diagnostics is fundamentally changing.  

With such a range of challenges and opportunities, now is the time to deliver real change in diagnostics in England. Given the ambition of this task, we need a clear roadmap that brings together actions on workforce, capital, and service models.  

Key to this will be an immediate refresh of the 2020 Richards Diagnostics Review. This should investigate current barriers to improvement, as well as the many possibilities on the horizon that could make diagnostics more efficient, more effective and more accessible. 

By taking a strategic and long-term approach, underpinned by targeted investment to support innovation and address the biggest challenges, we can turn diagnostic services in the UK from world-lagging to world-leading.  

Getting back on track 

We know what needs to be done to get diagnostics back on its feet. We need to implement proven measures we know work, while investing more in research in areas where we need new solutions. By doing this, we can create a diagnostics service fit to meet the demands of today and prepared to adopt the innovations of the future. 

This week we’ve published A Full Diagnostic outlining the current state of play on diagnostics in England and how we can address issues to deliver a world-class cancer service. This report builds on our manifesto for cancer research and care, Longer, better lives. Through our policy work we aim to make driving earlier diagnoses a priority for the post-election UK Government. 

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