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Why a focus on waiting time targets may neglect the poorest cancer patients

by Naser Turabi | Opinion

22 July 2024

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Naser Turabi, our director of evidence and implementation, explains why ensuring equitable access to cancer treatment is so crucial. 

The Labour party’s pledge to cut waiting times had been put at the heart of its plans for the NHS. 

For patients with cancer, this is not just welcome but essential. The NHS constitution gives them the right to start treatment within 62 days of referral. But the last time the NHS met the 85 per cent target was in 2015. If the target had been met, more than 182,000 people would have started their cancer treatment within 62 days. 

It is true that the cancer backlog peaked during the covid-19 pandemic and has since been falling. 

But, despite best efforts, the numbers remain high and thousands of people every month are still waiting longer than they should to begin treatment. Some patients who breach the 62-day target are going on to wait a very long time. 

A new analysis from Cancer Research UK reveals a worrying and sustained growth in the number of “long waiters” – people who wait more than 104 days for their cancer treatment. 

The problem is so severe that the likelihood of a cancer patient becoming a long-term waiter has almost tripled since 2017-18.  This isn’t just a pandemic problem: the number of patients waiting this long has grown steadily since mid-2021 and in the past year has been hovering between 10-12 per cent. 

Impact 

Delays like these can have a huge impact. Evidence on how this affects mortality is still emerging, but one study estimated that a four-week delay to surgery for some cancers led to a 6-8 per cent increased risk of dying. Delays can be psychologically harmful, and patients can become sicker whilst waiting, potentially reducing the treatment options available to them. 

These figures may understate the effect of delays for patients with more aggressive cancers, and the impact will vary by stage at diagnosis. 

Inequalities 

To make matters worse, these delays are not felt equally across the population. 

Cancer Research UK’s analysis has shown that patients living in areas in the most deprived quintile in England were a third more likely to wait more than 104 days compared with those living in the least deprived quintile.

Our analysis has also shown that patients in their 60s, and those who have comorbidities, are also more likely to experience these very long waits for cancer treatment. In terms of what’s causing these delays, our study showed that the proportion of waits attributed to health service delays has gone up considerably, where a lack of capacity in either staff or equipment is a major factor.

Don’t hit the target but miss outcomes 

In the recent planning guidance, NHS England has turned the spotlight back onto hitting the 62-day cancer standard (albeit at an interim target of 70 per cent) after a period in which cancer services were told to prioritise backlog clearance. The signals from the new Labour government are that this renewed focus on performance standards is here to stay. 

Cancer Research UK is a strong advocate of a non-negotiable ambition on waiting times; all cancer waiting time targets need to be consistently met within the next five years. 

But whilst we give our strong support to a focus on hitting the targets, our analysis shows that it is possible to hit the main target but still not eradicate unacceptable and inequitable long waits for cancer care. 

The current size of the long waiting cohort – more than 1 in 10 people needing cancer treatment but below 15 per cent of all cases – means it is, in theory, possible for a system too narrowly focused on the headline number to sideline the needs of this group and still “achieve” waiting times. 

This must not be allowed to happen. 

What needs to happen 

It’s no secret that the NHS doesn’t have much budget for major uplifts in staffing and equipment. 

But making sure that the pursuit of 85 per cent doesn’t crowd out support for long waiters doesn’t have to cost vast sums, and tackling this could provide solutions for reducing waiting lists across the NHS. 

Long waiting is characterised by inequality, and system leaders should be laser-focused on this: working with alliances or across systems to develop data-driven insights, understanding the specific needs of their populations when it comes to cancer care, tackling local barriers and addressing these proactively. Research shows that navigating a cancer pathway is hard for everyone, but it is especially hard for those facing a range of disadvantages already. 

And as the focus on performance intensifies, leaders at all levels must keep the needs of long waiters in mind. Local and other assurance processes should scrutinise progress. And at the national level, the government and the NHS leadership must send a clear message: that improving waiting times must mean improving them for all. 

These figures aren’t just numbers – no cancer patient should have to wait this much longer than the target time to begin treatment, and we cannot shy away from long waiters in the pursuit of hitting targets. 

This article was originally published in HSJ 

Two women seated in a hospital waiting room

Read more about the Cancer Research UK report on long waiters

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