There are currently four main ways of measuring the NHS’s performance when it comes to how well it is treating cancer.
All of them are concerned with speed – acting fast to ensure that people are diagnosed as early as possible, and then starting treatment soon after that.
The government is set to announce it will be removing one of the four, and changing its priorities to focus mostly on one other.
What are the targets?
The priority for future targets is how quickly the NHS can confirm or rule out suspected cancers. That should take no longer than 28 days after first being referred by a GP.
Once cancer is confirmed, treatment should start within a further month. Not all of these cases will have come from a GP referral.
As a summary measure, it should be no more than two months for someone to start cancer treatment after being referred.
What’s changing?
The one that they’re getting rid of occurs halfway through the diagnostics stage and surrounds consultant appointments.
In its current state, all suspected cancer patients are required to see a specialist cancer consultant within two weeks of receiving their GP referral. Often they will then carry out or prescribe further tests.
Cancer specialists and charities involved with the consultation process have isolated this as the place where there are patient bottlenecks.
Cancer consultants can’t see enough people to match the current demand, causing knock-on delays to everything else, including patients’ cancer diagnoses and future treatment.
Patients can still be referred to a consultant, if it’s a particularly complicated case or is deemed necessary for any other reason, but there’s no requirement for it anymore.
How is the NHS performing with its targets at the moment?
Not well.
The one it is now focusing on – about getting a diagnosis within four weeks – has only been in place since April 2021, so it’s hard to get a historical comparison.
But it hasn’t met its own target even once since it was introduced. That meant 68,822 people waited more than a month to have their suspected cancer confirmed or ruled out in June. The number is almost two million since the target was introduced.
It is doing worst on the one it is getting rid of. In June almost one in five people – more than 50,000 – waited more than two weeks to get a consultant appointment after being referred, almost three times more than the operational standard of 7%.
The data shows how the demand for consultant appointments has almost tripled since 2010, while the capacity of the NHS to treat everyone in time has fallen behind – at first steadily and then rapidly since the pandemic.
It’s a similar story for the number of treatments starting within a month of a cancer diagnosis.
The number of treatments needed has been rising but the capacity to start that treatment within the right timeframe has fallen behind.
In June that meant that 2,551 people, 8.7% of those who were confirmed to have cancer, waited longer than a month to start treatment, more than double the operational standard of 4%.
It’s slightly different on the overall pathway from a GP referral to treatment starting, and not in a good way.
Demand has increased – it’s almost doubled since 2010 – but the number of people treated within two months has actually been going backwards since the pandemic. It’s currently at the level last seen in late 2015.
Two in five people – 6,592 – who started treatment in June had been waiting longer than two months since their GP referral. That’s almost three times higher than the 15% target.
Demand for cancer care increasing faster than capacity
Health Secretary Steve Barclay told Sky News that capacity has been increasing already and that the reforms he’s pushing through are focused on outcomes rather than procedure:
“We’re making progress on cancer in terms of the number of people being checked. There were three million checks this year, 636,000 more than before the pandemic.
“We’re checking more people, we’re diagnosing earlier, we’re treating more people, but we want to ensure that the targets we have are focused on outcomes rather than the process of whether someone’s had the check.”
“We’ve already established that the NHS are checking and treating more people, and the earlier diagnosis comes from a combination of innovative screening methods and improved technology.”
Cancer referrals at record high – but NHS can’t keep up with tests
Professor Karol Sikora, the former chief of the cancer programme at the World Health Organisation who was part of a committee that introduced the two-week wait consultant target, told Sky News it was only meant to be a stop-gap while the NHS improved other diagnostics options.
“It was meant to be solved within five years, but there hasn’t been the expansion in diagnostics facilities and there still isn’t.
“If we’re being cynical, on 4 August the data published by NHS England was appalling on all 10 targets [this number includes breakdowns of the other targets], and then 10 days later the targets get scrapped.
“It’s been replaced by three targets which are good, but the targets are not being able to be met by most trusts at the moment. That’s the problem. We need to get more capacity, more cancer centres, and most importantly, better – more trained – people working in cancer. That’s the challenge, there’s no short-term fix available.”
Mike Osborn, president of the Royal College of Pathologists, echoed that sentiment, telling Sky News:
“Targets in themselves are useful because they allow you to benchmark things but they’re not the answer to the problem, the answer to the problem is properly resourcing, properly supporting the services that are required.”
The number of cancer staff has been increasing in number since 2010, by almost two thirds, but as we’ve seen above, demand for some services has tripled over that time.
Chris Thomas, from the commission on health and prosperity at the Institute for Public Policy and Research, expressed a similar sentiment to Professor Sikora and Mr Osborn, about needing more resources as well as the streamlined plan.
He told Sky News: “I think targets are ultimately a means to an end – the target doesn’t matter unless it’s an instrument that helps us to deliver on better outcomes for patients.
“The new targets will focus on early diagnosis and I would agree that early diagnosis is an incredibly important part of good cancer outcomes. It’s one of the big explanations for why the UK lags behind other countries.
“I think they [the targets] remain essentially undeliverable unless we get a number of other things right – prevention, workforce and a shift to care in the community.”
What do delays mean for health outcomes and deaths?
It’s hard to say exactly, but survival rates have been improving overall in recent years. Almost three-quarters of people diagnosed with cancer in 2020 survived at least one year, up from less than a third of those diagnosed in 2005.
If the percentage chance of death had been the same, an extra 18,471 people would have died. Recent improvements have been particularly impressive for lung cancer.
Data on outcomes from cancer is complicated and internationally comparable figures haven’t been released since 2014, however.
A 2020 study published in the British Medical Journal, however, estimated there was roughly a 10% increased chance of death for every four weeks that cancer treatment is delayed.
Just as with overall survival rates, the deterioration of a cancer patient over time can be better or worse for different types of cancer, and depends on many other factors including the patient’s existing health.
An NHS England spokesperson told Sky News: “By making sure more patients are diagnosed and treated as early as possible following a referral, and replacing the outdated two-week wait target with the faster diagnosis standard already being used across the country, hundreds of patients waiting to have cancer ruled out or diagnosed could receive this news faster.”
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