Together we will beat cancer

What it takes for the NHS to diagnose cancer… and why it’s struggling

Everyone’s journey through cancer is different.

But most people will need tests on the way to a diagnosis. To cope with growing demand, we need an NHS that’s adequately staffed to perform these tests.

Right now, that’s not the case.

Here we draw together the personal journeys of 6 people as they were diagnosed with cancer, plus reflections from the staff on the ground who make diagnosing cancer possible, but work in services that are struggling to cope.

Different journeys

Ask a group of cancer patients the story of their diagnosis and you’ll likely hear a different tale for each.

"It was frustrating. The process didn’t seem tied up enough"


“I was lucky I hadn’t left it any longer”


“Early diagnosis resulted in my cancer experience being a positive one”


“Getting to the diagnosis was tricky and lengthy”


But no matter what the experience, each patient will meet some familiar NHS faces along the way.

“The staff at the hospital treated me with great kindness and understanding”


“[The staff] were stretched but took care to make sure patients were looked after”


The people who diagnose health conditions, including cancer, are the lifeblood of the NHS. But when it comes to those who carry out and interpret diagnostic tests, there aren’t enough of these staff in post.

Many hospitals providing tests that can diagnose cancer can’t fill the vacancies they have for these important jobs: at least 1 in 10 posts are empty. And we know that demand is going to increase in the future.

The NHS will need more of these staff.

That’s why we’ve been telling the Government that to diagnose cancers earlier it can’t keep leaving the NHS short staffed.

Read on for why this matters.

First appointment

Knowing what’s normal for you, seeing your GP, cancer screening invitations and more.

“I know my body and it did not feel right”


“My wife persuaded me to see my GP after I told her about seeing blood in my stools”


“On my 60th birthday I received a bowel cancer screening kit”


“The GP said he would send me for a blood test”


There are many routes that can lead to a cancer diagnosis, but the majority of people who are diagnosed will at some point see their GP.

GPs use guidelines to help decide who should be sent for tests. And there are many ways that GPs can refer patients.

One way is via a routine referral, which comes with a right to start treatment within 18 weeks of a diagnosis.

This is used for people who see a GP due to unexplained symptoms that don’t initially arouse suspicion of cancer, but which need investigating.

A quarter of cancer cases in England are diagnosed following this kind of referral.

“For the first ultrasounds I was referred on a non-urgent basis”


“Each of the referrals took about 8 weeks to get an appointment”


But there’s also an option that’s specifically designed to diagnose cancer quickly: the urgent referral, or ‘two-week wait’.

This is used when a patient has symptoms that could be caused by cancer and aren’t immediately life-threatening, but need urgent investigation.

Patients should be seen by a specialist within 2 weeks, and around a third of cancer cases in England are diagnosed following this kind of referral.

Seeing a specialist

Patients referred via their GP will be seen by a specialist for tests. This contributes to the demand on diagnostic services.

“My colonoscopy was an urgent referral […] and I received an appointment within 2 weeks”


“The first test I had was a scan, then I had a hysteroscopy”


Between April and June 2017, 93.7% of patients in England were seen by a specialist within 2 weeks of an urgent referral from their GP for suspected cancer, meeting NHS England’s target of 93%.

But there were around 485,000 urgent GP referrals for suspected cancer in total over this same period, more than double the number of referrals made in the same period 8 years ago when this target was first set.

This means that demand for tests – such as endoscopy – is increasing.

There’s been year on year increases in our [endoscopy] activity

Ed Seward, endoscopist
Struggling with tests

The demand for tests that can diagnose cancer is growing.

Only a minority of patients referred for tests go on to be diagnosed with cancer. But as the population ages, and efforts to diagnose cancer at an earlier stage increase, it’s likely more people will be sent for cancer tests, or invited for tests following screening.

Some of the tests that diagnose cancer:

Endoscopy (colonoscopy, gastroscopy and more)

Imaging (x-ray, MRI, CT scans)

Pathology (looking for faulty molecules, genes and cancer cells in tissue samples)

“The experience of the tests was straight forward”


“The [colonoscopy] doctor was running about 3 hours behind”


Our research shows that by 2020, more than 750,000 extra people will need endoscopies every year – that’s more than the population of Leeds. And that’s just one type of test.

“We’ve got a 5-10% vacancy rate for nurses in endoscopy and there’s no one out there to fill places” – Ed Seward, endoscopist


Health Education England – who are responsible for educating and training the healthcare workforce – have committed to training 200 non-medical endoscopists by 2018 to address some of the delays.

Radiologists are becoming a scarce commodity

Nisha Sharma, radiologist

“Colleagues across the country tell me they are struggling to recruit to both medical and scientist posts, and with the number of people retiring outstripping those entering the specialty, the situation is likely to get worse” – Suzy Lishman, pathologist

“Everybody is being as creative as they can be to get around these problems. The workforce is adapting to make full use of all skills – it’s not just that there’s a shortage of radiographers who scan patients, there’s a shortage of radiologists who interpret those scans too. So some radiographers are developing their interpreting skills to try and support efficient diagnosis for patients” – Sue Johnson, Society and College of Radiographers

We want to make sure there are enough staff for endoscopy, imaging and pathology – the tests needed to diagnose cancer.

Waiting for results

One in two people will be diagnosed with cancer at some point in their lifetime.

England’s cancer strategy set an ambition for 62% of cancer patients to be diagnosed early (stage 1 and 2) by 2020. Right now, around 54% of patients are diagnosed at an early stage.

This means around 40,000 more cancer patients will need to be diagnosed early each year to meet the strategy’s ambition.

Without action, this target will be missed.

“It had taken 10 months to get from my first visit to the GP to being diagnosed”


“Early detection means life”


Around 230,000 patients in England are waiting more than a month for their imaging test results, according to a survey carried out by the Royal College of Radiologists last year.

“We need to ensure that there are enough training places available to meet the changes in demand, and encourage medical students to consider radiology as a career” – Nisha Sharma, radiologist

“We’ve been informing Health Education England that diagnostic workforce plans have been inadequate for a long time. But we’re really feeling the results of this lack of investment in the workforce now” – Sue Johnson, Society and College of Radiographers

And a key cancer waiting time target has been missed for the last 3 years in England in a large part because diagnostic services are under pressure. Scotland, Wales and Northern Ireland have experienced similar failures too.

Read more: Cancer waiting times – what’s causing the delays?

“It is important that there is investment in training new pathology professionals and that steps are taken to attract people to these important roles” – Suzy Lishman, pathologist

“Extra funding, more training places and more support for staff are all key. After all, it is not just about cancer: patients with a whole range of stomach and bowel conditions and diseases will be diagnosed earlier if we get this right” – Harriet Watson, endoscopy nurse

Take action

 Update 15/12/17: thanks to our campaigning, Health Education England has published a plan to tackle staff shortages up to 2021.

But we need your help to keep those plans on track.

Sign up as an e-campaigner to help us make sure the NHS gets the staff it needs to diagnose more cancers earlier.