In February 2026, the Government published the National Cancer Plan, the first dedicated cancer strategy for England in a decade. With a new Government now responsible for the Plan’s implementation, it is vital that the Plan remains a priority and that its ambitions are delivered at pace. In this series, we offer our perspective on a few key features within the Plan and what actions are needed to translate its commitments into genuine improvements for people affected by cancer. 

In this third article in our series on the National Cancer Plan for England, Matt Sample, Senior Health Policy Manager, explores the dual challenge of meeting cancer waiting time targets and driving longer term action to improve survival.  

“When you’re waiting for a cancer diagnosis or to begin treatment, every single day can feel like forever.” 

That’s what people affected by cancer told us when we asked why the NHS’s Cancer Waiting Time targets (CWTs) matter to them.   

It’s also why the pledge in the recent National Cancer Plan to meet these targets by March 2029 was a landmark moment. They’ve been missed for far too long.  

But the Plan is about much more than cancer waiting times. Its centrepiece ambition is to see 3 in 4 patients survive their cancer for five years or more by 2035. Improving operational performance is an important part of the picture, but delivering the Plan’s ambitions will require action across the breadth of the cancer pathway. 

This leaves government and the NHS with two key challenges ahead: first, setting a credible path to actually meeting the commitment on cancer waiting times. Second, doing this alongside the wider actions needed to improve cancer survival.  

Does the NHS have the right resources and approach to take on this ‘dual challenge’? And if not, what more does it need? 

A difficult starting point, a difficult road ahead 

The headline CWT target – that 85% of patients should start treatment within 62 days of being referred with an urgent suspicion of cancer – hasn’t been met nationally for over a decade.  

This has a real human impact. In the first half of this year, around 51,500 people in England waited longer than 62 days to start their treatment after an urgent referral.   

Naturally, NHS staff have worked incredibly hard to improve things. But progress has been slow, and waiting times against the 62-day target in England have hardly shifted, from 68% in July 2024 to 70% in June 2026.  

At the same time, demand for cancer services has been growing, and that’s only going to continue. The number of people diagnosed each year in the UK has now passed 400,000 and is expected to pass half a million by 2040, driven largely by a growing and aging population who will increasingly be living with multiple health conditions and require more complex care. 

On top of this, advances in research and innovation are expanding treatment options and creating new opportunities to improve outcomes for patients, but they are also increasing the complexity of service delivery. 

These trends mean the job of improving operational performance is only getting harder.  

And this is our worry: the Government must deliver the National Cancer Plan’s central ambition to drive up survival through action right across the breadth of the cancer pathway at the same time as improving cancer waits.  

This creates two key challenges.  

The first challenge: meeting waiting time targets by 2029 

More people requiring cancer care, coupled with stretching goals on improving operational performance, mean capacity across the cancer pathway will need to expand.  

The Plan places considerable emphasis on improving productivity, through improved pathway management, technology and innovation. The Government is right to pursue this and make better use of existing resources, but it’s risky to place too much expectation here.  

The long standing barriers to improving NHS productivity are well understood, and there is not a linear relationship between productivity improvements and falling waiting times. The Health Foundation has compellingly argued that recent improvements in waits for hospital care have already exhausted the ‘quick fixes’ to improve productivity, and longer-term improvement will need sustained investment alongside productivity gains. 

It’s also welcome that the Plan recognises and gives extra weight to the work Cancer Alliances do to provide intelligence-led intensive support to challenged Trusts. The support Cancer Alliances provide will be invaluable to improving performance. But again, this support is not a substitute for a properly resourced system. 

On new capacity, the Plan points to investment for more Community Diagnostic Centres, funding for new radiotherapy machines, new aseptic medicines production and digital diagnostics.  

Undoubtedly this is all welcome. However, wider NHS pressures mean there will be significant competing demands on that additional resource, particularly in areas like diagnostics where capacity is shared. Government has to grapple with the challenge of either ensuring new capacity reaches cancer pathways or investing further to expand capacity. 

The second challenge: faster care and better outcomes 

Compared with other important markers of progress, like survival or stage of diagnosis, waiting times are easier to measure, are highly visible to patients and the public, and offer a quicker indication of whether performance is improving. So it’s understandable that they often take centre stage in conversations about how well the NHS is doing on cancer.  

But beyond waiting time improvement, getting to a place where 75% of patients survive their cancer for five years or more by 2035 will require reducing late-stage cancer diagnoses, tackling treatment variation and addressing inequalities, to name but a few areas.  

This means that action on waiting times needs to be accompanied by an equal focus on other areas. Timeliness is a critical part of high-quality cancer care, but so are access, equity, and experience. Government needs to prioritise action across the piece to make good on the promise of faster care and better outcomes.  

The dual challenge 

To illustrate the dual challenge, let’s take the example of tackling variation in access to best-practice treatment.  

Research has shown that, in the UK, people with cancer receive chemotherapy and radiotherapy less often than in comparable countries. Although the underlying reasons aren’t fully understood, this probably indicates that some people are missing out on treatments that they might receive if they were treated in other countries. This suggests the NHS needs to not only improve treatment waits, but do this alongside planning for the extra activity needed to close the treatment gap.  

There aren’t quick or easy solutions to reduce demand in cancer pathways either. For example, the steep rise in urgent suspected cancer (USC) referrals is putting huge demand on NHS services, particularly in diagnostics. However, with a few limited exceptions, there aren’t currently good approaches to reducing USC referrals without the (clearly unacceptable) risk of missing more cancers.  

Undoubtedly this makes the challenge all the greater.  

But the NHS must not make the mistake of either failing to hit these targets or hitting them but missing opportunities to improve cancer care and survival. There needs to be a reality check: achieving the commitments in the cancer plan means taking the dual challenge head on. 

Taking on the dual challenge 

Part of the answer can come through the NHS’s oversight regime. This year’s NHS Oversight Framework brought welcome changes, with a positive balance across CWTs and outcomes measures or proxies like stage of diagnosis. Government must continue to back stretched local NHS leaders with the time, space and resources to make progress on earlier diagnosis, treatment quality and addressing variation, while also bringing down waiting times. 

However, the question of whether the National Cancer Plan is backed with sufficient resources to address the dual challenge remains. 

It’s for Government to provide assurance that it does, but it has yet to do so.  

That’s because the National Cancer Plan wasn’t accompanied by a delivery framework that explains how the Government is going to guarantee implementation of the cancer plan as a whole. Such a framework would set out the approach to planning for the capacity needed to deliver the full range of commitments, whilst responding to rising demand, across the lifetime of the plan.  

That gap needs to be addressed urgently. With the next spending review expected in a little less than a year, any delay risks missing the opportunity to secure what is needed to make good on the promise government has made to people affected by cancer – to cut waits and improve outcomes.